The acute abdomen Flashcards
What is the acute abdomen
series of signs and symptoms (including abdominal pain) which lead to referral for urgent general opinion
Causes of acute abdomen
-Non-specific pain
acute appendicitis
-acute cholecystitis
-peptic ulcer perforation
Differential diagnosis of acute abdomen
Peritonitis
Intestinal obstruction
Pathology of peritonitis?
- Decreased fibrolytic activity
- Increased fibrous tissue
- Peritoneum becomes adhered to organs and walls
Routes of infection of peritonitis?
- Female genital tract
- Perforation of GI/Bile duct
- Penetration of abdominal wall
- Hematogenous spread i.e. blood
What happens to bacterial flora in peritonitis?
-Number of anaerobes increases
-Number of aerobes decreases (after 5 days)
More severe in abcess than diffuse peritonitis
Differences between generalised and localised,lised peritonitis?
Generalised occurs when the body fails to localise the problem:
- Contamination is too rapid
- Contamination persists
- Abcess ruptures
What happens when abceses rupture in Peritonitis
Loss of fluid
Potential sepsis
Types of intestinal obstruction
- Something inside bowel
- Something adherent to bowel wall
- Something outside bowel wall
Symptoms of bowel obstruction
- Pain
- Vomiting
- Distension
- Constipation
- Borborygmi
What is Borborygmi?
Rubling/gurgling sound related to the movement of fluid
Proximal intestinal obstruction vs distal?
Proximal: vomiting/dehydration will occur before any other symptoms
Treatment
- monitor fluids
- analgesia
- Blood test + imaging
- Surgery/stenting
What is colic?
Pain that starts and stop abruptly .
Occurs due to muscular contractions in a hollow tube to relieve and obstruction a by forcing out the contents
Difference between visceral and somatic pain
Visceral:
- due to internal organs
- Associated with systemic illness
Somatic:
- Pain due to body wall
- Not associated with systemic illness
Where is the main site of visceral abdominal pain?
Generalised- can split into section of gut tube (fore, mid, hind gut)
Why is somatic pain more localised than visceral?
Receptors on the parietal peritoneum or abdominal wall.
How does somatic pain arise from visceral pain?
Source of visceral pain irritates the parietal wall and irritates the receptors
How can peritonitis/intestinal obstruction lead to death?
Fluid loss
Bacteremia
Can lead to circulatory collapse and death
Investigations of acute abdomen?
- Urine
- FBC
- u&eS
- Laparotomy/laparoscopy
Resuscitation
Required prior to further investigation/ treatment
Perfusion: oxygenation and circulation of fluid
Decompression of gut
Treat sepsis
Pain relief
Antibiotics/surgery if required
