The Acute Abdomen Flashcards
What is the acute abdomen?
A combination of symptoms and signs, including abdominal pain, which results in a patient being referred for an urgent general surgical opinion.
What three things need to be considered when a patient presents with acute abdomen symptoms?
Peritonitis Intestinal obstruction Abdominal pain (type)
Where might a peritonitis infection occur from?
GI/biliary tract perforation
Female genital tract infection
Penetration of abdominal wall
Haematogenous spread
When does generalised peritonitis occur?
When contamination is too rapid, contamination persists or an abscess ruptures
What are the typical presentations of intestinal obstruction?
Pain Vomiting Distension Constipation Borborygmi (stomach rumbling)
What are the three types of abdominal pain?
Visceral
Somatic
Referred
Why is it important to determine the type of pain?
Visceral pain gives poor localisation while somatic pain gives accurate localisation but referred pain may occur in the same location.
Give 6 differential diagnoses for acute abdomen
Acute appendicitis Acute cholecystitis/colic Peptic ulcer perforation Urinary retention Acute pancreatitis Small or large bowel obstruction Trauma Urinary stones Acute diverticulitis Malignancy Medical disorders Vascular conditions Gynaecological conditions
What should be covered in the clinical assessment of a patient presenting with acute abdomen symptoms?
What the problem is and what its effects are
History
Examination
Investigation
Consider patients capacity and level of care required
What are the five stages involved in the management of a patient presenting with acute abdomen symptoms?
Assess Resuscitate Investigate Observe Treat
What should be done in the resuscitation of a patient presenting with acute abdomen symptoms?
Restore circulating fluid volume Ensure tissue perfusion Enhance tissue oxygenation Treat sepsis Decompress gut ensure adequate pain relief
What tests should be done in the investigation of a patient presenting with acute abdomen symptoms?
Ward tests - urine
Lab tests - FBC, LFTs, U&Es
Radiology - plain, US and CT
Laparoscopy vs. laparotomy
When is observation of a patient presenting with acute abdomen symptoms useful?
When diagnosis is uncertain and the risk of alternative intervention is greater
What are the treatment options for patients presenting with acute abdomen symptoms?
Definitive surgery once diagnosis is reached
Treatment of sepsis and any underlying causes
