The Acute Abdomen Flashcards
What is the acute abdomen?
A combination of symptoms and signs including abdominal pain, resulting in the patient being referred for an urgent general surgical opinion
What to consider when acute abdominal pain presents?
Peritonitis
Intestinal obstruction
Ischaemia
Appendicitis
Routes of infection of the peritoneum (peritonitis)?
- Perforation of GI/biliary tract
- Female genital tract
- Penetration of abdominal wall
- Haematogenous spread
How does the bacteriology of the infection change as peritonitis develops to an abscess?
Starts out as mostly aerobes and a few anaeorbes - becomes mostly anaerobic with a few aerobes
What does generalized peritonitis rather than localized indicate?
One of the following:
- Contamination was too rapid
- Contamination persists
- Abscess has ruptured
What condition is likely to cause severe abdominal pain but not correspond with abdominal examination findings?
Intestinal ischaemia
Not always detectable with common abdominal exams
Different characters of abdominal pain and what they indicate?
Visceral - pain receptors in smooth muscle, poorly localized
Somatic & Referred - Receptors in parietal peritoneum or abdominal wall, accurate localization but can be referred
What is referred pain?
Pain perceived at a location other than the origin of its stimulus
Investigations for acute abdominal symptoms?
Ward tests - urine + bHCG
Lab tests - FBC, U+E’s, LFTs & Amylase
Radiology - USS, CT, other?
Laparoscopy/laparotomy
Important steps in resuscitation of acute abdominal patients?
- Restore circulating fluid volume
- Ensure tissue perfusion
- Enhance tissue oxygenation
- Treat sepsis
- Decompress gut
- Ensure adequate pain relief
Treatment of acute abdomen cases?
- Pain relief
- Antibiotics
- Definitive interventions: case dependent, includes types of surgery
