The Acute Abdomen Flashcards
What is an 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 happens if the fibrinolytic activity of the peritoneum stops?
The surfaces would stick
How many layers does the peritoneum have?
2
Causes of acute abdomen
Non specific pain 30-45% Acute appendicitis 20 - 25% Acute cholecystitis / colic 7-8% Peptic ulcer perforation 4% Urinary retention 4% Acute pancreatitis 3% Small bowel obstruction 3% Trauma 3% Urinary stones 3% Large bowel obstruction 2-4% Acute diverticulitis 2-4% Malignancy 2% Medical disorders 2% Vascular conditions 2% Gynaecological conditions 1%
Routes of infection to give peritonitis
Perforation of GI/Biliary tract
Female genital tract
Penetration of abdominal wall
Haematogenous spread
Types of peritonitis
Localised
Generalised
Pathology of generalised peritonitis
Represents failure of localisation and occurs when
- contamination rapid
- contamination persists
- abscess ruptures
Types of abdominal pain
Visceral
Somatic
Referral
What is visceral pain usually associated with?
Systemic upset
Where are the pain receptors when there is visceral pain?
Smooth muscle
Localisation of visceral pain
Poorly localised
Where are the pain receptors found in somatic and referred pain?
Parietal peritoneum or abdominal wall
Where do afferent impulses run with visceral pain?
Sympathetic fibres accompanying segmental vessels (CP, SMA, IMA)
Where do afferent impulses run with somatic and referred pain?
With segmental nerves
Localisation of somatic pain
Accurate
But can be referred
Resuscitation of acute abdomen
Restore circulating fluid volume Ensure tissue perfusion Enhance tissue oxygenation Treat sepsis Decompress gut Ensure adequate pain relief
When is active observation useful?
When diagnosis is uncertain and risk of alternative intervention is greater
Investigations of the acute abdomen
Urine FBC U and Es LFTs Xray USS CT
Presentation of intestinal obstruction
Pain Vomiting Distention Constipation Borborygmi
What would point you in the direction for looking for kidney stones?
Abdominal pain WITH blood and leucocytes on dipstix
Investigation for kidney stones
Non contrast CT abdo and renal tract
What is rovsings sign point to a diagnosis of?
Appendicitis
What is Rovsings sign?
RIF pain on palpation of the LIF
