The acute abdomen

Question 1

What is an acute abdomen

Answer 1

Abdominal pain which has been around for less than 10 days

Causing severe morbidity or threat to life

Question 2

Who does it present to?

Answer 2

GP
A&E
General surgeons
Gynae
General Medicine

Question 3

What are some of the common causes of acute abdomen

Answer 3

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

Question 4

What are the ages for women of child-bearing age?

Answer 4

10-55

Question 5

What are some of the less common causes of acute abdomen

Answer 5

Ruptured or symptomatic AAA
IBD
Medical causes
Ischemic gut

Question 6

What is Munchhausen’s syndrome

Answer 6

Attention - making something up

Question 7

What are drug seekers?

Answer 7

Typically women who want morphine who are manipulating

Question 8

3 types of abdominal pain

Answer 8

Visceral
Parietal
Extra-abdominal

Question 9

5 associated symptoms of abdominal pain

Answer 9

Nausea/ Vomiting
Burping 
Heartburn / indigestion
Change in bowel habit 
PR blood / mucus

Question 10

In what condition will the pain totally disappear?

Answer 10

Renal colic

Question 11

What are the 9 regions of the abdomen

Answer 11

Right and Left Hypochondrian
Epigastric
Right and Left Lumbar 
Umbilical 
Right and Left iliac fossa
Suprapubic

Question 12

What questions do you ask about vomit?

Answer 12

Colour
Green or foodstuff
Projectile
Blood
Coffee

Question 13

What is golden yellow vomit

Answer 13

Digested bile

Question 14

What colour is digested bile

Answer 14

Green

Question 15

What is localised peritonism

Answer 15

Localised pain and guarding

Question 16

What is peritonitis

Answer 16

Refers to pain in all 4 quadrants

Question 17

What does generalised peritonitis

Answer 17

Board like

Usually perforated duodenal ulcer

Question 18

Describe the bowel sounds in ileus

Answer 18

Absent

Question 19

What is the common analgesia given?

Answer 19

IV morphine with anti-emetic

IV paracetamol

Question 20

What is Cullen’s sign

Answer 20

Periumbilical bruising often with Pancreatitis

Question 21

What are initial investigations for abdomen?

Answer 21

Bloods: FBC,LFT,UE, CRP, Ca, Lactate, Coag
AMYLASE!!!!!
ABGs
Plain radiology
AXR and erect if possible CXR
Or straight to CT

Question 22

Why is amylase so important to do?

Answer 22

Pancreatitis

Question 23

What do we look for with an erect chest

Answer 23

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

Question 24

What is the gold standard scanning for acute abdomen

Answer 24

CT scanning - less mortality and decreased hospital stay is done early

Question 25

Who is US very useful for?

Answer 25

Children and women with pelvic pain or RUQ or RIF pain

Question 26

What are the 3 most important things to look for

Answer 26

Exclude pancreatitis

AAA

Question 27

What patients go straight to surgery

Answer 27

ruptured AAA
ischaemic guts
Faecal peritonitis

Question 28

Who does not go to theatre?

Answer 28

Nobody with pancreatitis

Nobody with DKA

Question 29

What are 5 types of colonic emergencies

Answer 29

Obstruction
Volvulus
Acute diverticulitis
Toxic colitis
Perforations (stercoral, iatrogenic, anastomotic)

Question 30

How is a volvulus managed

Answer 30

Decompress using rigid sigmoidoscope

Question 31

What is typhilitis

Answer 31

A condition common in patients on chemotherapy

Question 32

What is a Hartmann’s procedure

Answer 32

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.