The Acute Abdomen

Question 1

What is the differential diagnosis for the acute abdomen?

Answer 1

1) Acute appendicitis
2) Acute cholecystitis
3) Peptic ulcer perforation
4) Non-specific pain

Question 2

How is the acute abdomen patient assessed?

Answer 2

1) History
2) Examination
3) Investigation

Question 3

How is the acute abdomen patient investigated?

Answer 3

1) Bloods:

• FBC
• U+E’s
• LFT

2) Radiology:

• Plain X-ray
• USS
• Abdo CT
• CRP

3) Surical options:

• Laparoscopy (investigative)
• Laparotomy (large incision)

Question 4

What are the signs and symptoms of acute abdomen patients?

Answer 4

Symptoms:

• Pain (visceral, somatic, referred)
• Vomiting
• Distension
• Constipation

Signs:

• Shock
• Prostration (lying flat out on ground)
• Abdominal tenderness
• Guarding
• No bowel sounds

Question 5

How is visceral pain characterised?

Answer 5

1) Poorly localised
2) Patient uses palm of hand to show where pain is
3) Systemic upset

Question 6

How is somatic and referred pain characterised?

Answer 6

• Well localised
• Patient uses pointed finger to show where pain is