The Acute Abdomen

Question 1

Definition

Answer 1

The sudden onset of abdominal pain within the last 24 hours as a single episode.

Question 2

Location of differential diagnoses on the abdomen - 8

Answer 2

Right hypochondriac - hepatitis, liver failure, gallstones (ascending chol, cholecystitis or biliary colic)

Epigastric - GORD, gastritis, PUD, pancreatitis

Left hypogastric - pancreatitis, splenic infarct/rupture

Umbilical - AAA, mesenteric ischaemia, gastroenteritis, small bowel obstruction

Hypogastric - cystitis, PID, STIs, ectopic

Left Iliac Fossa - diverticulitis, ovarian torsion or cyst

Right iliac fossa - appendicitis, ovarian torsion or cyst

Right and Left Lumbar - kidney stones, pyelonephritis

Question 3

Associated Symptoms

Answer 3

vomiting,
haematemesis,
melaena,
stool/urine colour,
lumps, diarrhoea/constipation, fainting,
fever,
rash,
weight loss,
anaemia, jaundice, Cullens/Grey Turners

Question 4

Red Flags (6)

Answer 4

rigid abdomen,
patient very still,
absent bowel sounds,
rebound tenderness,
hypotension,
signs of shock.

Question 5

Differentials

Answer 5

Acute cholecystitis,
appendicitis,
pacreatitis,
ectopic pregnancy,
diverticulitis,
PUD,
PID,
\ gastroenteritis,
GI haemorrhage,
Urinary stones,
intenstinal ischaemia,
torsion,
urinary retention,
AAA

Question 6

Investigations (5)

Answer 6

DRE and pelvic examination

Urine dipstick and send for culture if needed

Pregnancy test

Blood tests FBC, U and Es, LFTS, Amylase, glucose, ABG

CT scan or X-ray

Question 7

Management (5)

Answer 7

Keep patient nil by mouth

Apply O2 when needed

IV fluids set up immediately

Consider NG tube

Medications – analgesia (morphine), antiemetics, antibiotics (if sepsis, peritonitis or UTI)