The Acute Abdomen Flashcards
Define the acute abdomen
A combination of symptoms and signs, including abdominal pain, which results in a patient being referred for an urgent general surgical opinion
What things should be considered with the acute abdomen?
Peritonitis
Intestinal obstruction
Abdominal pain
How many layers does the peritoneum have?
2
Describe 4 routes of infection for peritonitis
- Perforation of GI/biliary tract
- Female genital tract
- Penetration of abdominal wall
- Haematogenous spread
When does generalised peritonitis occur?
When:
Contamination too rapid
Contamination persists
Abscess ruptures
What are the 3 main characters of abdominal pain?
- visceral
- somatic
- referred
Which receptors pick up visceral pain?
Pain receptors in smooth muscle; poorly localised
How do nerve impulses travel in visceral pain?
Afferent impulses run with sympathetic fibres accompanying segmental vessels (CP, SMA, IMA)
Which receptors pick up somatic and referred pain?
Receptors in parietal peritoneum or abdominal wall; accurate localisation but can be referred
How do nerve impulses travel with somatic and referred pain?
Afferent signals pass with segmental nerves
Worst case scenario what can peritonitis and intestinal obstruction lead to?
Fluid loss and sepsis
Then circulatory collapse
Then death
Name 4 categories of tests done for the acute abdomen
Ward tests: urine
Lab tests: FBC, U+E, LFT
Radiology: plain, US, axial (CT)
Laparoscopy v laparotomy
What are the aspects of resuscitation of the acute abdomen?
Restore circulating fluid volume Ensure tissue perfusion Enhance tissue oxygenation Treat sepsis Decompress gut Ensure adequate pain relief
What are the aspects of treatment for acute abdomen?
Pain relief
Antibiotics
Definitive interventions i.e. surgery
What are the cardinal features of intestinal obstruction? (5)
- pain
- vomiting
- distension
- constipation
- borborgymi
(but depends whether proximal or distal site etc)
