*The Acute Abdomen* Flashcards
What is meant by “acute abdomen”?
A combination of symptoms and signs, including abdominal pain, which results in a patient being referred for an urgent general surgical opinion
List some potential causes of acute abdomen (there are lots!)
Non-specific pain Acute appendicitis Acute cholecystitis/colic Peptic ulcer perforation Urinary retention Acute pancreatitis Small bowel obstruction Trauma Urinary stones Large bowel obstruction Acute diverticulitis Malignancy Medical disorders Vascular conditions Gynaecological conditions Peritonitis
What are the possible routes of infection that can cause peritonitis?
Perforation of GI/ biliary tract
Female genital tract, Penetration of abdominal wall, Haematogenous spread
Which bacteria are found in the GI tract as part of the normal gut flora?
bacteriodes
coliforms
lactobacilli
streptococci
Describe the distrubution of aerobes and anaerobes in the GI tract
Numbers of bacteria increase dramatically as you go down the tract, especially anaerobes. Top of the GI tract is sterile.
Over time, number of anaerobes overtakes aerobes because numbers of aerobes decreases because they have used up a lot of the oxygen (less competition for the anaerobes so their numbers grow)
Describe the difference between local and generalised peritonitis
Local vs generalised peritonitis; peritoneum initially holds infection in one localised area by the two layers sticking together, but as infection multiplies the pressure increases and the local area can burst, causing diffuse peritonitis. Penetrating wounds can also cause generalised peritonitis
What are the most common causes of bowel obstruction
Originating from wall; cancer, sometimes inflammatory diseases
Originating outside the gut tube; tumours, hernias
What are the cardinal features of bowel obstruction?
pain vomiting distension constipation borborygmi
Describe colicky pain
Colicky pain is intermittent because it occurs when the smooth muscle of the gut tries to conduct (peristalsis) but can’t e.g. because of an obstruction
- Also associated with restlessness
- Visceral upset can cause systemic upset hence the nausea (“looking green”)
- Similar to labour – ask women if their pain is similar to when they were in labour
What are the five stages of management of the acute abdomen (bearing in mind that these are often conducted simultaneously)
Assess Resuscitate Investigate Observe Treat
Give two clinical syndromes that usually require laparotomy
Rupture of an organ, e.g. spleen, aorta, ectopic pregnancy
Peritonitis, e.g. perforation of peptic/duodenal ulcer, diverticulum, appendix, bowel or gallbladder
What tests should be done in a patient presenting with acute abdomen?
FBC, U&E, amylase, CRP, ABG Urinalysis Erect CXR AXR USS
What can cause acute pain in the right upper quadrant?
Cholecystitis
Biliary colic
Hepatitis/hepatic abscess
Perforated duodenal ulcer
What can cause acute pain in the left upper quadrant?
Gastritis
Splenic abscess/rupture
What can cause acute epigastric pain?
Acute pancreatitis
Herpes zoster virus
MI (referred pain)
