the acute abdomen

Question 1

LLQ pain DDx?

Answer 1

Sigmoid diverticulitis

Question 2

Diffuse abdominal pain differential?

Answer 2

Mesenteric ishcaemia 
Peritonitis 
Acute pancreatitis 
Early appendicitis 
Intestinal obstruction 
Gastroentertitis.

Question 3

RLQ DDx?

Answer 3

Appendicitis
Meckels diverticulum
Mesenteric amenities.

Question 4

RUQ pain?

Answer 4

Cholecytitis 
Biliary colic 
Congestive hepatomgeal 
Perforated duodenal ulcer 
Hepatitis

Question 5

LUQ pain?

Answer 5

Gastritis 
Splenic disorders (abscess, rupture)

Question 6

Absent bowel sounds?

Answer 6

Ileum.

Question 7

Where is McBurney’s point and what is it a sign of?

Answer 7

1/3 of the way between ASIS and umbilicus

Appendicitis

Question 8

What is Rosvig’s sign?

Answer 8

Pain in RIF when LIF pressed.

Question 9

Investigation of appendicitis/

Answer 9

Raised WCC

Imaging not done unless uncertain Dx, CT abdo if needed.

Question 10

Complications of appendicitis?

Answer 10

Rupture
Appendicular abscess.
Ilioinguinal nerve during appendectomy.

Question 11

Perforation investigation?

Answer 11

Erect CXR, shows air under the diaphragm,

If seen, prepare for emergency laparotomy.

Question 12

Presentation of mesenteric ischaemia?

Answer 12

Almost always involves the small bowel.

Usually cause by thrombotic blockage of SMA.

Presents with acute abdomen and generalised tenderness.

Question 13

Diagnostic test for mesenteric ischamia?

Answer 13

Mesenteric angiography.

Question 14

Someone with a history of AF who then develops acute abdominal pain?

Answer 14

Mesenteric ischamia.

Question 15

Management of mesenteric ischaemia?

Answer 15

Resus and stabilise.

Outcomes are generally poor.

Emergency laparotomy (bowel resection)