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Flashcards in Acute abdomen Deck (43)
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1

Define Acute abdomen

Recent or sudden onset of unexpected signs or symptoms including abdominal pain

2

What is the significance of acute abdomen?

Potential for life-threatening infection or fluid/blood loss

3

Name 2 causes of abdominal visceral pain

  • Ischaemia
  • Distension
  • Tension - often colicky

4

What areas can be involved in Epigastric pain?

  • Stomach to the 2nd part of duodenum
  • Liver and biliary tree
  • Pancreas and spleen

5

What areas can be involved in Periumbilical pain?

2nd part of duodenum to proximal 2/3 transverse colon

6

What areas can be involved in Suprapubic pain?

Distal 1/3 transverse colon to anal verge

7

Where does biliary tract pain refer to?

Right inferior scapular area

8

Where does diaphragmatic irritation refer to?

Ipsilateral shoulder tip pain

9

Categorise the types of intra-abdominal causes of abdominal pain

  • Generalised peritonitis
  • Localised peritonitis
  • Motility disorders
  • Ischaemia
  • Ruptured AAA

10

Categorise the types of extra-abdominal causes of abdominal pain

  • Thoracic
  • Neurological disease
  • Metabolic
  • Toxins

11

Name two causes of generalised peritonitis ➔ abdominal pain

  • Perforated viscus
  • Primary infectious peritonitis
  • Rupture of cyst

12

Name 2 causes of localised peritonitis ➔ abdominal pain

  • Appendicitis
  • Cholecystitis
  • Pancreatitis
  • Diverticulitis
  • Abscess
  • Salpingitis/ruptured ectopic

13

Name 2 motility disorders causing abdominal pain

  • Obstruction - intestinal, ureteric, biliary
  • Spasm - irritable colon, uterine contraction

14

Name 2 ischaemic causes of abdominal pain

  • Mesenteric angina (chronic)
  • Splenic infarction
  • Torsion - testicle, ovarian cyst, omentum
  • Tumour necrosis - hepatoma, fibroid

15

Name 2 thoracic causes of abdominal pain

  • Lung disease
  • Ischaemic heart disease
  • Oesophageal disease

16

Name 1 neurological cause of abdominal pain

  • Shingles (Herpes zoster)
  • Spinal arthritis
  • Abdominal epilepsy (Seizures ➔ abdominal symptoms)

17

Name 2 metabolic causes of abdominal pain

  • Diabetes mellitus (Gastroparesis: delayed emptying. Commoner in T1DM)
  • Chronic renal failure
  • Porphyria (Porphyrin accumulation)
  • Acute adrenal insufficiency

18

Name 2 toxin causes of abdominal pain

  • Snake and insect bites
  • Lead poisoning
  • Strychnine (pesticide)
  • Peptic ulcer (H. pylori)
  • Inflammatory disease

19

Name 4 differential diagnoses for acute abdominal pain

  • Nonspecific
  • Acute appendicitis
  • Acute cholecystitis and biliary colic
  • Peptic ulcer perforation
  • Small bowel obstruction
  • Gynaecological disease
  • Acute pancreatitis

20

What features are suggestive of abdominal malignancy?

  • Intermittent pain of 48+hr
  • Altered bowel habit
  • Abdominal distension
  • Mass
  • Weight loss

21

What features are suggestive of bowel obstruction?

  • Colicky severe pain
  • No aggravating factors
  • Vomiting and constipation
  • Previous surgery
  • Abdominal distension
  • High pitched tinkling bowel sounds

22

What features are suggesting of a perforated viscus?

  • Sudden onset of pain
  • Constant severe pain
  • Pain aggravated by movement, coughing, sneezing
  • Diffuse tenderness
  • Silent rigid abdomen

N.B. This slightly raises serum amylase

23

Which bedside investigations may be done in acute abdomen, and why?

  • BM (DKA)
  • Urinalysis
  • Pregnancy test*
  • ECG (exclude MI, and necessary for anaesthetic)

24

What laboratory investigations may be done in acute abdomen, and why?

  • FBC (infection, rarely diagnostic)
  • U&Es
  • Serum amylase* (3x normal max ➔ acute pancreatitis)
  • LFTs
  • ABGs
  • CRP

25

What radiological investigations may be done in acute abdomen and, why?

  • AXR - rarely diagnostic
  • Erect CXR*: pneumoperitoneum
  • Upper abdo USS: assess hepatobiliary pathology
  • Pelvic USS: tubo-ovarian disease
  • Contrast studies
  • Endoscopy
  • Abdominal CT: best Ix for generalised peritonitis
  • MRI

CT and MRI are not routine due to significant radiation.

26

Outline the general management of acute abdomen

NBM Fluid balance: IV fluids + Catheter/NG tube Analgesia + antiemetic Observations Avoid ABX until a clear diagnosis is formed Treat underlying cause once management plan established.

27

What radiological finding suggests viscus perforation?

Air under the diaphragm in an erect CXR

28

Name 3 causes of acute abdomen that are surgical emergencies?

  • Generalised peritonitis (except acute pancreatitis)
  • Intestinal obstruction
  • Acute mesenteric ischaemia
  • Viscus perforation
  • Strangulated (irreducible, tender) hernia

29

Name 3 causes of acute abdominal pain in Right hypochondriac region

  • Right lower lobe pneumonia/embolism
  • Cholecystitis
  • Biliary colic
  • Hepatitis

30

Name 3 causes of acute abdominal pain in Epigastric region

  • Pancreatitis
  • Gastritis
  • Peptic ulcer
  • MI