The Acute Abdomen Flashcards
What is the definition of the acute abdomen?
A combination of symptoms and signs including abdomen pain, which results in a patient being referred for an urgent general surgical option
What are some causes of acute abdomen?
Non- specific pain, acute appendicitis, acute cholangitis, peptic ulcer perforation, urinary retention, acute pancreatitis and small bowel obstruction
What are some pathophysiology to consider for the acute abdomen?
Peritonitis
Intestinal obstruction
Ischaemia
Non-surgical abdominal pain
Describe the peritoneum
2 layers
Semi permeable membrane
Specialised lymphatics
Fibrinolytic activity
What are the routes of infection for peritonitis?
Perforation of GI/ biliary tract
Female genital tract
Penetration of abdominal wall
Haematogenous spread
Describe the bacteriology of the normal GI tract
All different bacteria types in different parts of abdomen
Can have bacterial transportation if bacteria in wrong place
Describe the bacteriology of peritonitis
Aerobes decrease and anaerobes increase as days increases from diffuse peritonitis to abscess
What is generalised peritonitis?
Represents failure of localisation and occurs when -
Contamination too rapid, contamination persists or abscess ruptures
What are the cardinal features of intestinal obstruction?
Pain, vomiting, distention, constipation and borborygmi - rumbling/ gurgling noises
Depends on site
Describe intestinal ischaemia
Severe abdominal pain not corresponding to abdominal examination findings
Gas exchange and metabolic acidosis
Medical and social background
What are different characters of pain?
Visceral, somatic and referred
Describe visceral pain
Pain receptors in smooth muscle
Afferent impulses run with sympathetic fibres accompanying segmental vessels
Is poorly localised
Describe somatic and referred pain
Receptors in parietal peritoneum or abdominal wall
Afferent signals pass with segmental nerves
Accurate localisation but can be referred
What can peritonitis and intestinal obstruction lead to?
Fluid loss and sepsis
Then circulatory collapse
Which can lead to death
What is the management of acute abdomen?
Assess and resuscitate
Investigate
Observe
Treat
