The Acute Abdomen

Question 1

What is the definition of an acute abdomen?

Answer 1

A combination of symptoms and signs, including abdominal pain, which results in a patient being referred for an urgent general surgical opinion

Question 2

What pathophysiology’s should be considered in the acute abdomen?

Answer 2

Peritonitis, intestinal obstruction and abdominal pain

Question 3

What are the routes of infection in peritonitis?

Answer 3

Perforation of GI/biliary tract, female genital tract, penetration of abdominal wall and haematogenous spread

Question 4

When does generalised peritonitis occur?

Answer 4

When contamination is too rapid, contamination persists or an abscess ruptures

Question 5

What are the cardinal features of intestinal obstruction?

Answer 5

Pain, vomiting, distension, constipation and borborygmi (audible bowel sounds)

Question 6

What are the effects of peritonitis and intestinal obstruction?

Answer 6

Fluid loss and sepsis which leads to circulatory collapse and possibly death

Question 7

What is the management of the acute abdomen?

Answer 7

Assess (+resuscitate), Investigate, Observe and Treat

Question 8

What are the investigations used in the acute abdomen?

Answer 8

Ward Tests: Urine
Lab Tests: FBC, U+Es and LFT
Radiology: Plain, US, Axial (CT)
Laparoscopy vs. Laparotomy

Question 9

What are the steps of resuscitating someone with an acute abdomen?

Answer 9

Restoring circulating fluid volume
Ensure tissue perfusion
Enhance tissue oxygenation
Treat sepsis
Decompress gut 
Adequate pain relief

Question 10

What is the treatment of an acute abdomen?

Answer 10

Pain relief, antibiotics and surgery