The acute abdomen

Question 1

Define the term ‘acute abdomen’

Answer 1

• An emergency surgical condition caused by damage to one or more of the abdominal organs due to injury or disease

Question 2

Identify the the cardinal symptoms of the acute abdomen and the pain patterns

Answer 2

Inflammatory

• Constant pain
• Raised temperature, pulse and leucocytosis
• Pertionitis gives localised pain (due to somatic innervation), worse on movement, coughing or inspiration
• Often assoicated with guarding (reflex contraction of abdominal muscles on examination of the inflammed area) and rigidity (increased tone at rest)

Obstructive:

• Colicky pain, patients often agitated
• May become constant with superimposed inflammation

Referred visceral pain (generally midline)

• Fore-gut (oesophagus to D2) pain is referred to the upper abdomen
• Mid-gut (D2 to transverse colon) pain is referred to the middle abdomen
• Hind-gut is referred to the lower abdomen

Question 3

What are the differential diagnosis of the acute abdomen?

Answer 3

Abdominal Viscera:

• Acute appendicitis
• Meckel’s diverticulitis
• Intestinal obstruction
• Perforated viscus (acute sever pain and shock)
• Acute pancreatitis
• Acute cholecystitis/cholangitis
• Renal calculi
• The acute scrotum
• Inflammatory bowel disease

Vascular causes:

• AAA
• Mesenteric thrombosis/embolus

Medical causes:

• GORD
• Referred pain from pneumonia/MI/UTI/pyelonephritis

Gynae causes:

• Ruptured ectopic, torted/ruptured ovarian cysts, salpingitis ect.

Question 4

What investigations would be done to further define a cause for an acute abdomen?

Answer 4

• FBC, U&Es, LFTs, CRP, Amylase & ABG
• Pregnancy test
• Urinalysis
• Erect CXR/AXR
• USS/CT

Question 5

What is the management for a pateint with an acute abdomen?

Answer 5

ABCDE: IV Fluids, Oxygen, Analgesia.

Insert catheter for fluid balance, NG tube for drain/feeding (patient should be kept NBM).

History and examination should be undertaken

Certain presentations require urgent laparotomy:

• Rupture of an organ (spleen/aorta/eptopic)
• Peritonitis (perforated ulcer, diverticulum, appendix or gallbladder)
• Pancreatitis can mimic these so check amylase/lipase