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
How is somatic and referred pain generated?
- Receptors in parietal peritoneum or abdominal wall
- Afferent signal pass with segmental nerves
- Accurate localisation but can be referred
What do the effects of peritonitis and intestinal obstruction both lead to?
- Fluid loss and bacteraemia/endotoxaemia
- Circulatory collapse
- Death
What are the pathways for acute abdomen assessment from GP?
- Hospital admission
- Walk-in/ambulatory clinic to hospital admission
What are the general principles of acute abdomen management?
- Assess (+resuscitate)
- Investigate
- Observe
- Treat
What should be considered in the assessment of acute abdomen?
- What is the problem?
- What are the effects?
- What should I do?
- History
- Examination
- Investigation
- Capacity
- Level of care vs palliation
What investigations should be done in the case of acute abdomen?
- Urine analysis
- FBC
- U+Es
- LFTs
- Plain film
- US
- Axial CT
- Laparoscopy vs laparotomy
What resuscitation is involved in the case of acute abdomen?
- Restore circulating fluid volume
- Ensure tissue perfusion
- Enhance tissue oxygenation
- Treat sepsis
- Decompress gut
- Ensure adequate pain relief
What is active observation useful for?
When diagnosis is uncertain and risk of alternative intervention is greater
What is the treatment for acute abdomen?
- Definitive surgery
- Be tough on sepsis and the causes of sepsis
