*The Acute Abdomen Flashcards
What causes RUQ acute abdo problems? (6)
Biliary colic cholecystitis cholangitis Pneumonia Musculoskeletal liver abscess/ hepatitis
What is the acute abdomen?
a condition of severe abdominal pain, usually requiring emergency surgery, caused by acute disease of or injury to the internal organs.
What will most patients with RUQ pain have?
Gallstones
what symptoms/ signs can gallstones cause?
RUQ/ epigastric pain
Temperature
Jaundice
(depends on what type of problem the gallstones are causing)
Intermittent RUQ pain (which may radiate to the shoulder blade) with no temperature or jaundice?
Biliary colic
Constant RUQ pain (which may radiate to the shoulder blade) with a temperature but no jaundice?
Cholecystitis
Constant RUQ pain (usually), jaundice but no temperature?
Choledocholithiasis (presence of at least one gallstone in the common bile duct)
Constant RUQ pain with a temperature and jaundice?
Cholangitis
Constant epigastric pain which can radiate to the back and may or may not cause a temperature or jaundice?
Pancreatitis
What causes epigastric acute abdo problems? (5)
pancreatitis Perf DU AAA Gastritis/ reflux Oesophagitis
What in the history is usually found in a patient with pancreatitis?
Alcohol or gallstones sometimes
How is pancreatitis diagnosed?
Amylase more than 300
What tests are done on a patient with probable pancreatitis/
Amylase (more than 300 for diagnosis)
Scoring
USS (to look for gallstones)
CT (if you’re unsure if a patient has pancreatitis)
What in the history can indicate a perforated DU?
Alcohol intake
NSAID use
Why do you need to take an erect x-ray for a patient with a suspected DU?
To look for air under the diaphragm
What presentation should make you suspect an AAA?
Severe epigastric pain radiating to the back with collapse
How is gastritis/ GORD/ oesophagitis diagnosed?
Upper GI endoscopy
What causes an acute abdomen in the LUQ? (3)
Splenic injury/ rupture/ infarct
Pneumonia
Musculoskeletal
What test should be done on a trauma patient to rule out abdominal injury?
CT
What history is usually present with spleen problems?
Splenomegaly or injury
What causes an acute abdomen in the flank areas?
Pyelonephritis
renal colic
musculoskeletal
Where does renal pain often radiate?
To the back
What can renal colic pain mimic?
A ruptured AAA
What wil urinalysis show in a patient with renal colic?
Blood in the urine
Leucocytes (if they have an infection)
What causes an acute abdomen in umbilicus?
Obstruction
Early appendicitis
AAA
Meckels
Elderly male, severe pain radiating to back, collapse, CV history?
AAA until proven otherwise - need an urgent CT
Presentation of obstruction?
Generalised abdo pain
Distended abdomen
vomiting
constipation
Causes of obstruction?
Hernia
Tumour
Previous surgery
What causes a suprapubic acute abdomen? (4)
UTI
Ovarian
Appendicitis
Diverticulitis
LIF acute abdomen causes? (5)
Diverticulitis Ectopic pregnancy Torsion of ovarian cyst Hernia (femoral/ inguinal) Gastroenteritis
What is complicated diverticulitis?
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)
What things should make you suspicious of an ectopic pregnancy?
What should you do?
Child bearing age Sudden onset LIF/ RIF pain Sepsis + shock BHCG do a pregnancy test
Sudden onset suprapubic pain that is severe and mid-cycle?
Ovarian torsion
What should you always examine the groin for in all acute abdomen problems?
Hernias
What causes RIF acute abdomen problems?
Appendicitis Ectopic pregnancy Torsion of ovarian cyst Hernia: femoral/ inguinal Diverticulitis Chrons Meckels Perf caecal cancer
