Week 4.7 - Acute Abdomen

Question 1

What is the acute abdomen?

Answer 1

series of symptoms and signs ending in a patient being referred to urgent surgical opinion

Question 2

What are the 3 most common aetiology of the acute abdomen?

Answer 2

• non specific pain - haven’t been diagnosed.
• acute appendicitis
• acute cholecystitis/colic

Question 3

How does infection get into the peritoneal cavity? what is this called?

Answer 3

peritonitis
- often after surgery penetrating peritoneal wall
- female genital tract
- heamatogenous spread
- breach of GI/biliary tract

Question 4

What determines the type of bacteria in different parts of the GI tract?

Answer 4

features like O2, pH and transit time. we can estimate likeliness of specific bugs based on their general presence in that area

Question 5

What is the role of the greater omentum in inflammation?

Answer 5

finds area and wraps around it causing seal - allows body to tackle it locally. forms abscess which the body may tackle or may need drainage

Question 6

What is diffuse peritonitis?

Answer 6

spread out affecting the entire abdomen - tenderness everywhere

Question 7

How does surgery remove likeliness of infection worsening?

Answer 7

we drain abscess and then wash it out with saline. some bacteria may be left but this becomes diffuse - less bacteria in a bigger space. we have dissolved the bacteria so the body can tackle it now. may need antibiotics to help.

Question 8

How does localised peritonitis become generalised?

Answer 8

• contamination too rapid
• contamination persists
• abscess ruptures

Question 9

How does obstruction cause acute abdomen?

Answer 9

• may be anywhere - intestine, bowel, gallbladder, pancreas
• bile stones, within tube - stricture, gallstone, embolus, outside tube as external compression - tumour,lymph node

Question 10

how do we treat acute peritonitis and intestine obstruction?

Answer 10

give 3 take 3 method
- give IV fluids, treat sepsis with antibiotics, oxygenation
- take lactate, blood culture, urine output

Question 11

How does a delay in treatment affect morbidity?

Answer 11

every 30 mins to 1 hour decreases chance of survival - treat immediately if suspection of acute issue.

Question 12

how do we know where pain is based on location
?

Answer 12

• visceral pain dull and not specific
• parietal pain is sharp and localised.
  pain starts viscerally then becomes parietal once inflammation makes contact with layer. to detect clinician puts pressure on spot of suspected organ and sees if pain on removal

Question 13

How do you investigate acute abdomen?

Answer 13

• urine
• lab tests (bloods, LFT’s, U&E)
• radiology
• laparoscopy or laparotomy if very unstable

Question 14

How do you resuscitate a patient?

Answer 14

• restore circulating volume
• ensure tissue perfusion and oxygenation
• decompress gut tub
• pain relief
• treat sepsis

Question 15

How do you treat acute abdomen?

Answer 15

• pain relief,
• antibiotics,
• surgery