The Acute Abdomen

Question 1

What is acute abdomen?

Answer 1

A combination of symptoms and signs including abdominal pain, which results in the patient being referred for an urgen general surgical opinion

Question 2

What is the aetiology of acute abdomen?

Answer 2

Non-specific pain

Acute appendicitis

Acute cholecystitis

Peptic ulcer perforation

Urinary retention

Question 3

What should be considered for the pathophysiology of acute abdomen?

Answer 3

Peritonitis

Intestinal obsruction

Abdominal pain

Question 4

What is the surface area of the peritoneum?

Answer 4

About 2m²

Question 5

What activity is done by the peritoneum?

Answer 5

Fibrinolyric (blood clotting)

Question 6

What are the 2 layers of the peritoneum?

Answer 6

Parietal and visceral

Question 7

What is peritonitis?

Answer 7

Infections of the peritoneum

Question 8

What are some routes of infection for peritonitis?

Answer 8

Perforation of GI/biliary tract

Female genital tract

Penetration of the abdominal wall

Haematogenous spread

Question 9

Are anaerobes or aerobes more likely to cause diffuse pritonitis?

Answer 9

Aerobes

Question 10

Are anaerobes or aerobes more likely to cause abscess?

Answer 10

Anaerobes

Question 11

What are the 2 vague kinds of peritonitis?

Answer 11

Localsied or generalised

Question 12

When does generalised peritonitis occur?

Answer 12

Contamination too rapid

Contamination persists

Abscess ruptures

Question 13

What are cardinal features of intestine obstruction?

Answer 13

Pain

Vomiting

Distension

Constipation

Borborygmi

Question 14

What do symptoms of obstruction depend on?

Answer 14

Site (proximal vs distal)

Question 15

What abdominal pain, what must be asked?

Answer 15

Character of pain

Site of pain

Severity of pain

Systemic upset

Question 16

What receptors are responsible for visceral pain?

Answer 16

Pain receptors in smooth muscles

Question 17

Where does afferent impulses of viseral pain run?

Answer 17

With sympathetic fibres accompanying segmental vessels

Question 18

Is visceral pain well or poorly localised?

Answer 18

Poorly localised

Question 19

What receptors are responsible for somatic and reffered pain?

Answer 19

Receptors in parietal peritoneum or abdominal wall

Question 20

What do afferent signals of somatic and referred pain travel with?

Answer 20

With segmental nerves

Question 21

Is the localisation of somatic and refered pain good or bad?

Answer 21

Accurate localisation

Question 22

What are the clinical consequences of peritonitis and intestinal obstruction?

Answer 22

Causes fluid loss and sepsis

Then circulatory collapse

Then death

Question 23

What are the steps for managing acute abdomen?

Answer 23

1) Assess (and resuscitate if required)
2) Investigate
3) Observe
4) Treat

Question 24

What is required for the assessment of acute abdomen?

Answer 24

History

Examination

Investigation

Question 25

What investigations can be done for acute abdomen?

Answer 25

Ward tests (urine) Lab tests (FBC, U&E, LFT) Radiology (plain, US, axial CT) Laparoscopy vs laparotomy

Question 26

What steps are involved in resuscitation for acute abdomen?

Answer 26

Restore circulating fluid volume Ensure tissue perfusion Enhance tissue oxygenation Treat sepsis Decompress gut Ensure adequate pain relief

Question 27

What is the treatment for acute abdomen?

Answer 27

Pain relief Antibiotics Definitive interventions such as surgery