The acute abdomen Flashcards
Definition
Rapid onset
Severe
Potentially life threatening
Requires urgent surgical intervention
Atypical acute abdomen population groups
Elderly
Pregnant (particularly third trimester)
Immunocompromised
Older people and acute abdomen- reasons for atypical presentations (4)
Pathophysiologic
Immunologic
Pharmacological
Neurological
Severe abdominal pain with rigidity of entire abdominal wall and prostration
Perforated peptic ulcer
Perforation of other intra-abdominal organ
Dissecting aneurysm
Severe pancreatitis
Tenderness and rigidity in right hypochondrium
Acute cholecystitis Cholangitis Subphrenic abscess Plerusy RLL Pneumonia Acute pyelonephritis, nephrolithiasis Perforated peptic ulcer
Tenderness and rigidity in left hypochondrium
Pancreatitis Subphrenic abscess Diverticulitis Splenic rupture Acute pyelonephritis, nephrolithiasis Leaking aneurysm of splenic artery Acute gastric distension
Tenderness and rigidity in right lower quadrant
UC/Chrons Appendicitis Mekels diverticulitis Ovarian cyst rupture, torsion Ectopic PID Hernia
Tenderness and rigidity in left lower quadrant
Diverticulitis Colitis Colon cancer Pelvic peritonitis Cyst, torsion, ectopic, PID Hernia Sigmoid volvulus
Periumbilical pain without abdominal signs
Acute mesenteric ischemia/infarction/adenitis Appendicitis SBO Pancreatitis DKA, dissecting aneurysm
Signs of peritonism
Guarding
Rigidity
Rebound tenderness
Abnormal bowel sounds
Red flags
Red flags Adhesions Incarcerated/strangulated hernia Cholecystitis Gastric ulcer Appendicitis Ectopic pregnancy Pelvic inflammatory disease Acute pancreatitis Acute diverticulitis Gastrointestinal malignancy Volvulus Intussusception Duodenal ulcer Ovarian torsion Abdominal aortic dissection Ruptured aortic aneurysm Acute mesenteric ischaemia and infarction Meckel's diverticulitis Oesophageal perforation (Boerhaave’s syndrome) Ischaemic colitis Ruptured splenic artery aneurysm Budd-Chiari syndrome Splenic infarct Diabetic ketoacidosis
Urgent considerations
Surgical consult Abnormal vitals->fluids and blood 2 large IV cannula Group and hold Fluid resuscitation 0 negative blood Oxygen If perforation/appendictis->broad spectrum antibiotics Pregnancy test
BP goal for ruptured AAA
Systolic 80-90mmHg
Abdominal pain out of proportion to physical examination
Consider mesenteric ischemia->older, smoking, peripheral vascular disease, AF
History
SOCRATES
Sudden->perforation, appendictis
Long term->ulcer, worse= perforation
Sudden pain after vomiting->esophageal perforation
Similar pain->cholecystitis, pancreatitis, diverticulitis
Associated/GI->cholecystitis, ulcer, appendicitis, mesenteri ischemia, PID, diverticulitis, hepatitis
Anorexia
Last meal/oral intake Medical/surgical-> ->+obstruction/adhesions ->Immunocompromised ->ChemoT, radiation ->IBD
LMP, contraception, pregnancy status
Medication to alleviate
Cardiac
Alcohol, drugs
