The Acute Abdomen Flashcards
Name three possible different causes for acute abdominal pain
- Peritonitis
- Intestinal obstruction
- Abdominal pain
Name four possible routes of infection in peritonitis
- Perforation of GI / biliary tract
- Female genital tract
- Penetration of abdominal wall
- Haematogenous spread
Name three causes of peritonitis
- Obstruction of lumen
- Wall of gut (tumour)
- Pressing from outside (hernia)
Describe the bacteriology of peritonitis
O2 decreases at site of infection and anaerobes form, therefore after ~4days antibiotics will have to be tailored
What is the difference between localised and generalised peritonitis and when does it occur?
Generalised peritonitis represents failure of localisation and occurs when:
• Contamination too rapid
• Contamination persists
• Abscess ruptures
What are the cardinal features of intestinal obstruction?
- Pain
- Vomiting
- Distension
- Constipation
- Borborygmi (rumbling or gurgling noise made by movement of fluid and gas in intestines)
What does obstruction of duodenum due to fibrosis or tumour present as usually?
No pain or distention, but will vomit and be dead by time of constipation (food doesn’t go further than stomach)
What does obstruction of large bowel usually present as?
Contraction pain on gas or faecal matter which is incompressible (causes pain like uterus contraction during childbirth) causing nausea and vomiting
What do you need to determine about abdominal pain?
- Character of pain: visceral, somatic and referred
- Site of pain
- Severity
- Systemic upset
Describe visceral pain
- Pain receptors in smooth muscle
* Afferent impulses run with sympathetic fibres accompanying segmental vessels (CP, SMA, IMA)
Describe somatic and referred pain
- Receptors in parietal peritoneum or abdominal wall
- Afferent signals pass with segmental nerves
- Accurate localisation but can be referred
How can peritonitis or intestinal obstruction lead to death?
- Loss of fluid as they do not take it in and if they do they vomit it out
- Growth of bacteria sepsis
- Inflammatory cascade
- All about context – i.e. age of patient, worse outcome with age
What investigations are used for acute abdominal pain?
- Ward tests: urine
- Lab tests: FBC, U+E, LFT
- Radiology: plain, US, axial (CT)
- Laparoscopy vs. laparotomy
Name ways of resuscitation for acute abdominal pain
- Restore circulating fluid volume
- Ensure tissue perforation
- Enhance tissue oxygenation
- Treat sepsis
- Decompress gut
- Ensure adequate pain relief
What is the treatment for acute abdominal pain?
- Pain relief
- Antibiotics
- Definitive intervention – i.e. surgery
