The Acute Abdomen Flashcards
Acute Abdomen
Sudden onset severe abdominal pain developing over a short time period
Presentations Requiring Urgent Intervention
Bleeding
Peritonitis caused by perforation
Ischaemic Bowel
Causes of bleeding
- AAA
- ruptured ectopic pregnancy
- perforated gastric ulcer
- trauma
Causes of peritonitis
- Peptic ulcer perforation
- bowel obstruction
- diverticular disease
Signs of perforation
Tachycardia Hypotension
Rigid abdomen with percussion tenderness
Involuntary guarding
Reduced or absent bowel sounds - paralytic ileus
Ischaemic Bowel presentation
Severe pain out of proportion to the clinical signs
Acidaemic with a raised lactate
Diffuse and constant pain
Examination unremarkable
Definitive diagnosis of ischaemic bowel
CT scan with IV contrast
Differentials for RUQ pain
Cholecystitis Pyelonephritis Ureteric colic Hepatitis Pneumonia Pancreatitis
Differentials for LUQ pain
Gastric ulcer
Pyelonephritis
Ureteric colic
Pneumonia
Differentials for RLQ pain
Appendicitis Ureteric colic UTI IBD Inguinal hernia Testicular torsion Ectopic pregnancy
Differentials for LLQ pain
Diverticulitis Ureteric colic UTI IBD Inguinal hernia Testicular torsion Ectopic pregnancy
Differentials for epigastric pain
Peptic ulcer disease
Cholecystitis
Pancreatitis
MI
Differentials for peri- umbilical region pain
Small bowel obstruction
Large bowel obstruction
Appendicitis
AAA
Investigations
Urine dipstick + MCS
Pregnancy
ABG
Routine bloods:
- FBC, U&Es, LFTs, CRP, amylase
- G+S if surgery likely
Blood cultures
Imaging
Imaging
Erect chest plain film radiograph - evidence of free abdominal air
USS KUB
USS gall bladder and liver - gall stones
CT imaging
Emergency - ECG
