The Acute Abdomen Flashcards
What is the acute abdomen?
Abdominal condition of abrupt onset associated with severe abdominal pain (resulting from inflammation, obstruction, infarction, perforation or router of intra-abdominal organs)
A combination of symptoms and signs, including abdominal pain, which results in a patient being referred for an urgent general surgical opinion.
Give some of the aetiologies of the acute abdomen
Non-Specific pain
Acute appendicitis
Acute cholecystitis
peptic ulcer perforation
What factors should you consider when assessing the pathophysiology of the acute abdomen?
Consider:
- Peritonitis
- Intestinal Obstruction
- Abdominal Pain
What do the mesothelial cells of the peritoneum produce and what is its function?
Produce anticoagulant.
This allows the surface of the intestines to smoothly glide over eachother.
If this is lost then the intestines start to stick
What are the routes of infection of peritonitis?
Perforation of GI/ Biliary tract
Female genital tract
Penetration of abdominal wall
Haematogenous spread
What is cholecystitis?
Inflammation of the gall bladder
What is haematogenous spread?
Spread from the blood
How does the bacteriology of the upper GI tract compare to the lower GI tract and what does this mean in terms of perforation?
Oesophagus and stomach are quite sterile environments.
Duodenum onwards have many different bacteria.
A perforation of the GI tract will spill contacts that are relatively sterile and so you just clean up and fix hole.
Midgut and hindgut perforation will be a much larger risk of infection
How do the different factors of perforation affect the type of treatment yo deliver?
Diffuse peritonitis more likely to have aerobes.
Abscess more likely to have anaerobes.
New perforation more likely to have aerobes.
Older perforation more likely to have anaerobes.
What is localised peritonitis?
Inflammation is in one area. Occurs with all acute inflammatory conditions of the GI tract
Infection causes mesothelial cells to stop producing anticoagulant and so peritoneum sticks to infected organ and contamination is localised.
Describe Visceral pain
- Comes from abdominal/ pelvic viscera
- Transmitted by visceral afferent nerve fibres in response to stretching or excessive contraction
- Dull in nature and vague
- Poorly localised
- –Foregut = epigastrium
- –Midgut = umbilical
- –Hindgut = hypogastric
Describe somatic pain
- Comes from the parietal peritoneum (which is innervated by somatic nerves)
- Sharp in nature
- Well localised
- Made worse by movement, better by lying still
Describe Referred Pain and give an example in the abdomen
-Pain felt some distance away from its origin
Gallbladder inflammation can irritate diaphragm which is innervated by C3, 4, 5.
Dermatomes of these spinal cord segments supplies the shoulder, hence referred shoulder pain
What is general peritonitis?
Occurs as a result of rupture of an abdominal viscus
Represents a failure of localisation.
Occurs when:
- Contamination is too rapid
- Contamination persists
- Abscess ruptures
What role do adjuvant substances play in peritonitis?
eg. stool, shrapnel
Bring infection and need to be removed.
Shrapnel cavities the abdomen. The spaces are great for bacteria to establish and grow.
On top of this its hard for the body to launch an attack in these spaces.
Vasculature may also be effected
