The acute abdomen

Question 1

what requires laparotomy

Answer 1

rupture of an organ, peritonitis

Question 2

what are the signs in ruptured organ

Answer 2

shock, abdominal swelling

Question 3

what can cause peritonitis

Answer 3

perforation of peptic/duodenal ulcer, diverticulum, appendix, bowel, gallbladder

Question 4

signs of peritonitis

Answer 4

prostration (extreme exhaustion), shock, lying still, positive cough test, tenderness, rigidity, guarding, no bowel sounds, erect CXR may show gas under the diaphragm

Question 5

what should you check if all the signs of peritonitis

Answer 5

serum amylase as all of the signs are present in pancreatitis but this doesn’t require laparotomy

Question 6

tests in acute abdomen

Answer 6

FBC, U&E, amylase, LFT, ABG, urinalysis, erect CXR, AXR, laparoscopy, CT, USS- shows perf and free fluid

Question 7

plan

Answer 7

treat shock, crossmatch/G&S, blood culture, antibiotics, relieve pain, IVI, plain abdo film, CXR, ECG, NBM

Question 8

what is important before anaesthetising the patient

Answer 8

treat shock- resus properly as anaesthesia can make shock worse

Question 9

causes abdo pain RUQ

Answer 9

acute cholecystitis, duodenal ulcer, hepatitis, congestive hepatomegaly, pyelonephritis, appendicitis, pneumonia

Question 10

causes abdo pain LUQ

Answer 10

ruptured spleen, gastric ulcer, AA, perf colon, pyelonephritis, pneum

Question 11

causes abdo pain epigastrium

Answer 11

pancreatitis, MI, peptic ulcer, acute cholecystitis, perf oesophagus

Question 12

causes abdo pain RLQ

Answer 12

appendicitis, salpingitis, tubo-ovarian abscess, ruptured ectopic, renal/ureteric stone, strangulated hernia, mesenteric adenitis, meckels diverticulum, crohns, perf caecum, psoas abscess

Question 13

causes abdo pain umbilicus

Answer 13

intestinal obstruction, acute pancreatitis, early appendicitis, mesenteric thrombosis, AA, diverticulitis

Question 14

causes pain LLQ

Answer 14

sigmoid diverticulitis, salpingitis, tubo-ovarian abscess, ruptured ectopic, strangulated hernia, perf colon, crohns,, UC, renal/ureteric stone

Question 15

what is the chief cause of the medical acute abdomen

Answer 15

IBS so ask about pain assoc with loose stools relieved by defacation, bloating, urgency

Question 16

what is the main cause of shock in the surgical patient

Answer 16

hypovolaemia

Question 17

what is class 1 shock

Answer 17

30ml/h

Question 18

what is class 2 shock

Answer 18

15-30% blood loss, >100bpm, RR 20-30, urine output 20-30

Question 19

what is class 3 shock

Answer 19

30-40% blood loss, >120 bpm, RR 30-40, urine output 5-15ml

Question 20

what is class 4 shock

Answer 20

> 40% blood loss, >140 bpm, RR >35, negligible urine output