The Acute Abdomen Flashcards
What is the acute abdomen
An abrupt onset of a combination of symptoms, associated with severe abdominal pain
What is the acute abdomen a result of
Inflammation Obstruction Infarction Perforation Rupture of intra-abdominal organs
What pathophysiology should be considered in the acute abdomen
Peritonitis
Intestinal obstruction
Abdominal pain
What is peritonitis
Inflammation of the peritoneum which can be localised or generalised
How does pain typically begin in peritonitis
As generalised and becomes localised later
Cause of generalised peritonitis
Occurs due to failure of localisation due to:
- contamination that is too rapid
- rupture of abscess and leakage of bodily fluids into the abdomen
Routes of infection to peritoneum
Perforation of GI / Biliary tract
Female genital tract
Penetration of abdominal wall
Haematogenous spread
In peritonitis, what happens to the population of aerobes and anaerobes
Aerobes - decrease
Anaerobes - increase
What tends to be the most common cause of obstruction
Cancer
What questions to ask about obstruction
Is obstruction outside or inside the bowel or on the bowel wall
Presentation of obstruction
Pain Vomiting Distension Constipation Borborygmi
What is the difference in presentation between an obstruction in the duodenum to one in the rectum
Duodenum - obstruction will cause vomiting and distension but will not cause constipation as there is nothing to build up
Rectum - obstruction will cause all the cardinal features, starting with constipation and progressing to bloating and vomiting as food backs up
Where does visceral pain come from and how is it transmitted
Pain comes from smooth muscle of viscera
- is transmitted by visceral afferent nerve fibres in response to stretching or excessive contraction
What is the nature of visceral pain
Dull and vague
How is visceral pain localised
Poorly to:
- foregut epigastrium
- midgut para-umbilical
- hindgut suprapubic
