The acute abdomen Flashcards
What is an acute abdomen
Abdominal pain which has been around for less than 10 days
Causing severe morbidity or threat to life
Who does it present to?
GP A&E General surgeons Gynae General Medicine
What are some of the common causes of acute abdomen
Non-specific abdominal Pain (1/3rd of patients) Acute appendicitis Intestinal obstruction Urological causes Gallstone disease Diverticular disease of the colon Trauma Malignancy Perforated ulcer Pancreatitis IBS Bacterial and viral infections Gynae things
What are the ages for women of child-bearing age?
10-55
What are some of the less common causes of acute abdomen
Ruptured or symptomatic AAA
IBD
Medical causes
Ischemic gut
What is Munchhausen’s syndrome
Attention - making something up
What are drug seekers?
Typically women who want morphine who are manipulating
3 types of abdominal pain
Visceral
Parietal
Extra-abdominal
5 associated symptoms of abdominal pain
Nausea/ Vomiting Burping Heartburn / indigestion Change in bowel habit PR blood / mucus
In what condition will the pain totally disappear?
Renal colic
What are the 9 regions of the abdomen
Right and Left Hypochondrian Epigastric Right and Left Lumbar Umbilical Right and Left iliac fossa Suprapubic
What questions do you ask about vomit?
Colour Green or foodstuff Projectile Blood Coffee
What is golden yellow vomit
Digested bile
What colour is digested bile
Green
What is localised peritonism
Localised pain and guarding
What is peritonitis
Refers to pain in all 4 quadrants
What does generalised peritonitis
Board like
Usually perforated duodenal ulcer
Describe the bowel sounds in ileus
Absent
What is the common analgesia given?
IV morphine with anti-emetic
IV paracetamol
What is Cullen’s sign
Periumbilical bruising often with Pancreatitis
What are initial investigations for abdomen?
Bloods: FBC,LFT,UE, CRP, Ca, Lactate, Coag AMYLASE!!!!! ABGs Plain radiology AXR and erect if possible CXR Or straight to CT
Why is amylase so important to do?
Pancreatitis
What do we look for with an erect chest
Free air under diaphragm First line and very useful if abnormal Lateral decubitis if too ill to stand Excludes pneumonia Useful as a preoperative investigation
What is the gold standard scanning for acute abdomen
CT scanning - less mortality and decreased hospital stay is done early
Who is US very useful for?
Children and women with pelvic pain or RUQ or RIF pain
What are the 3 most important things to look for
Exclude pancreatitis
AAA
What patients go straight to surgery
ruptured AAA
ischaemic guts
Faecal peritonitis
Who does not go to theatre?
Nobody with pancreatitis
Nobody with DKA
What are 5 types of colonic emergencies
Obstruction Volvulus Acute diverticulitis Toxic colitis Perforations (stercoral, iatrogenic, anastomotic)
How is a volvulus managed
Decompress using rigid sigmoidoscope
What is typhilitis
A condition common in patients on chemotherapy
What is a Hartmann’s procedure
surgical resection of the rectosigmoid colon with closure of the rectal stump and formation of an end colostomy. It was used to treat colon cancer or diverticulitis.
