The Acute Abdomen Flashcards
What is The Acute Abdomen?
An emergency surgical condition caused by damage to one or more of the abdominal organs due to injury or disease’
What are the key types of pain the acute abdomen can present with?
Inflammatory
Obstructive
Referred visceral pain (typically midline)
Describe inflammatory pain
Constant pain w/ a raised temp, pulse and leucocytosis
What is Peritonitis?
Inflammation of peritoneum giving localised pain
Describe the pain present in Peritonitis
Localised pain (due to somatic innervation)
Exacerbated by movement, coughing, inspiration
Associated w/ guarding and rigidity
Describe the pain present in Obstruction
Colicky pain, agitates patients
Can become constant w/ superimposed inflammation
Describe referred pain from the foregut
Foregut (oesophagus - D2) pain is referred to the upper abdomen
Describe referred pain from the midgut
Midgut (D2 - transverse colon) pain is referred to the middle abdomen
Describe referred pain from the hindgut
Hindgut (transverse colon - rectum) is referred to the lower abdomen
What types of condition can cause a presentation of the acute abdomen?
Abdominal viscera conditions Vascular conditions Medical conditions Gynae conditions Other conditions
What abdominal viscera conditions should be included in the acute abdomen ddx?
Acute appendicitis Meckel's diverticulitis Intestinal obstruction Perforated viscus (acute severe pain + shock) Acute pancreatitis Acute cholecystitis/cholangitis Renal calculi Acute scrotum IBD
What vascular conditions should be included in the acute abdomen ddx?
AAA
Mesenteric thrombosis/embolus
What medical conditions should be included in the acute abdomen ddx?
GORD
Referred pain from pneumonia/MI/UTI/Pyelonephritis
What gynae conditions should be included in the acute abdomen ddx?
Ruptured ectopic pregnancy
Tortured/ruptured ovarian cysts
Salpingitis
What other conditions should be included in the acute abdomen ddx?
Non-specific mesenteric adenitis
What investigations are appropriate for a patient presenting with an acute abdomen?
FBC, U&Es, LFTs, CRP, Amylase, ABG Pregnancy test Urinalysis Erect CXR/AXR USS/CT
What is the appropriate initial management of an acute abdomen?
ABCDE resuscitation
Urgent laparotomy in certain conditions
Which abdominal conditions require urgent laparotomy?
Organ rupture (spleen/aorta/ectopic)
Peritonitis (perforated ulcer, diverticulum, appendix, gallbladder)
Pancreatitis can mimic these
What tests should always be done to check for pancreatitis?
Amylase
Lipase
