The Acute Abdomen Flashcards
Acute abdomen
A combination of symptoms and signs including abdominal pain which results in a patient being referred for an urgent surgical opinion
What could cause acute abdomen?
- 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
What pathophysiology should be considered?
- Peritonitis
- Intestinal obstruction
- Abdominal pain
What are the features of the peritoneum?
- 2 layers
- Surface are 2m^2
- Semi-permeable membrane
- Specialised lymphatics
- Fibrinolytic activity
What are the routes of infection fro peritonitis?
- Perforation of GI/ biliary tract
- Female genital tract
- Penetration of abdominal wall
- Haematogenous spread
How does the bacteriology of peritonitis change over 5 days?
- From diffuse peritonitis to abscess
- Aerobes from 80% to 20%
- Anaerobes from 20% to 80%
What are the 2 categories of peritonitis?
- Localised
- Generalised
What does generalised peritonitis represent?
Failure of localisation
When does generalised peritonitis occur?
- Contamination too rapid
- Contamination persists
- Abscess ruptures
What is the aetiology of obstruction?
- Adult vs paediatric practice
- Environment
What are the cardinal features of intestinal obstruction?
- Pain
- Vomiting
- Distension
- Constipation
- Borborygmi
What are the cardinal features of intestinal obstruction dependent on?
Site (proximal vs distal)
How can abdominal pain be described?
- Character
- Site
- Severity
- Systemic upset
How can the character of abdominal pain be described?
- Visceral
- Somatic
- Referred
How is visceral pain generated?
- Pain receptors in smooth muscle
- Afferent impulses run with sympathetic fibres accompanying segmental vessels
- Poorly localised
