The acute abdomen

Question 1

What is it?

Answer 1

Sudden abdominal pain which lead to urgent surgical admission

Question 2

Causes

Answer 2

• Acute appendecitis
• Acute cholangitis
• Peptic-ulcer perforation
• Non-specific pain

Question 3

What investigation to carry out?

Answer 3

• Urine
• U&E
• FBC
• Radiology
• If needed open up: laparotomy/laparoscopy

Question 4

How to manage/treat?

Answer 4

Resusciation: may be required to re-stabilise/manage patient before they undergo treatment

Treat:

• active observation
• Definite surgery

Question 5

What does resuscitation involve?

Answer 5

• Reperfuse: 02 and bloods
• Decompress the gut
• Treat sepsis
• Pain relief
• Antibiotics/surgery

Question 6

Different types of abdominal pain depending on source

Answer 6

Visceral: Pain derived from visceral peritoneum (internal organs). Associated with a systemic illness.
Somatic: Pain derived from parietal peritoneum. Pain is often separate from systemic illness

Question 7

Why is somatic pain more localised than visceral pain?

Answer 7

Somatic: receptors in parietal peritoneum.

Afferent signals sent along thoraco-abdominal/subcostal nerves)

Question 8

How does somatic pain arise from visceral pain?

Answer 8

A source of Visceral pain (from a systemic illness) irritates the parietal wall and leads to more localised pain.

Question 9

Peritonitis

Answer 9

Inflammation of the peritoneum.

Question 10

Routes of infection of peritonitis

Answer 10

• Female GI tract
• Ulceration/penetration into abdominal wall
• Ulceration/penetration into common bile duct
• Haematogenous spread i.e. through blood

Question 11

What happens to the bacterial fauna in peritonitis

Answer 11

• The number of anaerobes increases

- The number of aerobes decreases

Question 12

What are the causes of small bowel obstruction

Answer 12

• Something pressing on the abdominal wall
• Something inside the abdominal wall
• Something inside the bowel

Question 13

What are the main symptoms of small bowel obstruction?

Answer 13

• Pain
• Vomiting
• Constipation
• Borborygmi: rumpling/gurgling in the stomach
• Distension of the abdominal wall

Question 14

Treatment of small bowel obstruction

Answer 14

• Fluid/analgesia
• blood test/imaging
• surgery

Question 15

How will proximal bowel obstruction be different to distal?

Answer 15

Proximal will present with vomiting and dehydration before other symptoms can present.