The acute abdomen

Question 1

What do we mean by ‘The Acute Abdomen’?

Answer 1

Someone who becomes acutely unwell and in whom symptoms and signs are predominantly related to the abdomen

prompt laparotomy may be required

Question 2

What are the main symptoms that lead to ‘the acute abdomen’

Answer 2

non-specific pain
acute appendicitis
acute cholecystitis /colic

Question 3

Routes of infection that can cause peritonitis? (4)

Answer 3

Perforation of GI/ biliary tract
Female genital tract
Penetration of abdominal wall
Haematogenous spread

Question 4

When peritonitis progresses to form an abscess which type of bacteria are more abundant?

Answer 4

anaerobes

Question 5

What is generalised peritonitis

Answer 5

In more than one quadrant

failure of localisation because:-

• Contamination too rapid
• Contamination persists
• Abscess ruptures

Question 6

What is a laparotomy

Answer 6

major surgical procedure that involves an incision being made in the abdominal wall. This allows the surgeon access to the contents of the abdomen in order to identify and repair any emergency problems that have occurred

Question 7

What is colic?

Answer 7

Usually a sharp, localised GI or urinary pain that can arise abruptly, and tends to come and go in spasmlike waves

Tends to be caused by obstruction in one of these hollow organs/tubes

Unlike peritonitis, colic causes restlessness

Question 8

localised peritonitis

Answer 8

in specific area/organ
eg
diverticulitis - bulges/pockets in lining - large intestine

cholecystitis - gallbladder

salpingitis - fallopian tubes

appendicitis

Question 9

Cardinal features of intestinal obstruction

Answer 9

pain
vomiting
distension
constipation
Borborygmi - rumbling or gurgling noise made by the movement of fluid and gas in the intestines

but these depend on site - distal or proximal

Question 10

Visceral pain: Afferent impulses run with what type of fibres?

Answer 10

sympathetic

Question 11

How is the parietal peritoneum or abdominal wall innervated?

Answer 11

receptors in abdominal wall and parietal peritoneum

afferent signals pass with segmental nerves (from specific spinal level)

Question 12

what are some effects of peritonitis and intestinal obstruction?

Answer 12

can lead to fluid loss
and sepsis

which then causes circulatory collapse and later death

Question 13

Investigations carried out for The Acute Abdomen (4)

Answer 13

Ward tests: urine

Lab tests: FBC, U+E, LFT

Radiology: plain x-ray, US, axial (CT) ?other

Laparoscopy vs. laparotomy

Question 14

Resuscitation: how does it help?

5

Answer 14

Restores circulating fluid volume

Ensures tissue perfusion

Enhances tissue oxygenation

Treats sepsis

Decompresses gut

Question 15

Treatment for the Acute Abdomen (3)

Answer 15

Pain relief
Antibiotics
definitive interventions i.e surgery

Question 16

Which syndromes usually require laparotomy?

Answer 16

Rupture of an organ e.g spleen, aorta, ectopic pregnancy - blunt or penetrating trauma?

Peritonitis e.g from perforation of peptic/duodenal ulcer, diverticulum, appendix, bowel or gallbladder

Question 17

Which syndromes may not require laparotomy?

Answer 17

Local peritonitis

Colic