*The Acute Abdomen

Question 1

What causes RUQ acute abdo problems? (6)

Answer 1

Biliary colic
cholecystitis
cholangitis
Pneumonia
Musculoskeletal
liver abscess/ hepatitis

Question 2

What is the acute abdomen?

Answer 2

a condition of severe abdominal pain, usually requiring emergency surgery, caused by acute disease of or injury to the internal organs.

Question 3

What will most patients with RUQ pain have?

Answer 3

Gallstones

Question 4

what symptoms/ signs can gallstones cause?

Answer 4

RUQ/ epigastric pain
Temperature
Jaundice
(depends on what type of problem the gallstones are causing)

Question 5

Intermittent RUQ pain (which may radiate to the shoulder blade) with no temperature or jaundice?

Answer 5

Biliary colic

Question 6

Constant RUQ pain (which may radiate to the shoulder blade) with a temperature but no jaundice?

Answer 6

Cholecystitis

Question 7

Constant RUQ pain (usually), jaundice but no temperature?

Answer 7

Choledocholithiasis (presence of at least one gallstone in the common bile duct)

Question 8

Constant RUQ pain with a temperature and jaundice?

Answer 8

Cholangitis

Question 9

Constant epigastric pain which can radiate to the back and may or may not cause a temperature or jaundice?

Answer 9

Pancreatitis

Question 10

What causes epigastric acute abdo problems? (5)

Answer 10

pancreatitis
Perf DU
AAA
Gastritis/ reflux
Oesophagitis

Question 11

What in the history is usually found in a patient with pancreatitis?

Answer 11

Alcohol or gallstones sometimes

Question 12

How is pancreatitis diagnosed?

Answer 12

Amylase more than 300

Question 13

What tests are done on a patient with probable pancreatitis/

Answer 13

Amylase (more than 300 for diagnosis)
Scoring
USS (to look for gallstones)
CT (if you’re unsure if a patient has pancreatitis)

Question 14

What in the history can indicate a perforated DU?

Answer 14

Alcohol intake

NSAID use

Question 15

Why do you need to take an erect x-ray for a patient with a suspected DU?

Answer 15

To look for air under the diaphragm

Question 16

What presentation should make you suspect an AAA?

Answer 16

Severe epigastric pain radiating to the back with collapse

Question 17

How is gastritis/ GORD/ oesophagitis diagnosed?

Answer 17

Upper GI endoscopy

Question 18

What causes an acute abdomen in the LUQ? (3)

Answer 18

Splenic injury/ rupture/ infarct
Pneumonia
Musculoskeletal

Question 19

What test should be done on a trauma patient to rule out abdominal injury?

Answer 19

CT

Question 20

What history is usually present with spleen problems?

Answer 20

Splenomegaly or injury

Question 21

What causes an acute abdomen in the flank areas?

Answer 21

Pyelonephritis
renal colic
musculoskeletal

Question 22

Where does renal pain often radiate?

Answer 22

To the back

Question 23

What can renal colic pain mimic?

Answer 23

A ruptured AAA

Question 24

What wil urinalysis show in a patient with renal colic?

Answer 24

Blood in the urine

Leucocytes (if they have an infection)

Question 25

What causes an acute abdomen in umbilicus?

Answer 25

Obstruction Early appendicitis AAA Meckels

Question 26

Elderly male, severe pain radiating to back, collapse, CV history?

Answer 26

AAA until proven otherwise - need an urgent CT

Question 27

Presentation of obstruction?

Answer 27

Generalised abdo pain Distended abdomen vomiting constipation

Question 28

Causes of obstruction?

Answer 28

Hernia Tumour Previous surgery

Question 29

What causes a suprapubic acute abdomen? (4)

Answer 29

UTI Ovarian Appendicitis Diverticulitis

Question 30

LIF acute abdomen causes? (5)

Answer 30

``` Diverticulitis Ectopic pregnancy Torsion of ovarian cyst Hernia (femoral/ inguinal) Gastroenteritis ```

Question 31

What is complicated diverticulitis?

Answer 31

Complicated diverticulitis refers to the clinical presentation of acute diverticulitis with inflammatory manifestations and complications, such as feculent peritonitis, obstruction, perforation, phlegmon, and/or abscess formation (the most severe complication is perforation - usually need a Hartmans procedure)

Question 32

What things should make you suspicious of an ectopic pregnancy? What should you do?

Answer 32

``` Child bearing age Sudden onset LIF/ RIF pain Sepsis + shock BHCG do a pregnancy test ```

Question 33

Sudden onset suprapubic pain that is severe and mid-cycle?

Answer 33

Ovarian torsion

Question 34

What should you always examine the groin for in all acute abdomen problems?

Answer 34

Hernias

Question 35

What causes RIF acute abdomen problems?

Answer 35

``` Appendicitis Ectopic pregnancy Torsion of ovarian cyst Hernia: femoral/ inguinal Diverticulitis Chrons Meckels Perf caecal cancer ```