Acute abdomen

Question 1

Definition of acute abdomen

Answer 1

Abdominal pain plus one or more peritoneal signs (rigidity, tenderness +/- rebound, involuntary guarding).

Question 2

What is the most common cause of free air under the diaphragm?

Answer 2

Perforated peptic ulcer (90%)

Question 3

What’s the deal with contrast for abdominal CT?

Answer 3

Both oral and IV are optimal. Exception: nephrolithiasis should do non-contrast

Question 4

What are surgical causes of abdominal pain in the RUQ?

Answer 4

Perforated duodenal ulcer, cholecystitis, hepatic abscess, retrocecal appendicitis, appendicitis in pregnant woman

Question 5

What are surgical causes of abdominal pain in the RLQ?

Answer 5

Appendicitis, cecal diverticulitis, Meckel’s diverticulitis

Question 6

What are surgical causes of abdominal pain in the LLQ?

Answer 6

Sigmoid diverticulitis, volvulus (sigmoid most common type)

Question 7

What are surgical causes of abdominal pain in the LUQ?

Answer 7

Splenic rupture, splenic abscess

Question 8

What are surgical causes of abdominal pain the is diffuse?

Answer 8

Bowel obstruction, leaking aneurysm, mesenteric ischemia

Question 9

What are surgical causes of abdominal pain in the periumbilical area?

Answer 9

Early appendicitis, referred pain from small bowel

Question 10

What are surgical causes of abdominal pain in the suprapubic area?

Answer 10

Ectopic pregnancy, ovarian torsion, tubo-ovarian abscess, psoas abscess, incarcerated groin hernia

Question 11

What are NONsurgical causes of abdominal pain in the RUQ?

Answer 11

RLL PNA, biliary colic, cholangitis, hepatitis, Fitz-Hugh-Curtis

Question 12

What are NONsurgical causes of abdominal pain in the midepigastric region?

Answer 12

PUD (nonperf), MI, esophagitis, PE, pancreatitis, Herpes zoster, rectus sheath hematoma

Question 13

What are NONsurgical causes of abdominal pain in the RLQ or LLQ?

Answer 13

Ureteral calculi, regional enteritis, IBD, PID, endometriosis, prostatitis, Mittelschmerz, UTI, ruptured ovarian cyst

Question 14

What are NONsurgical causes of abdominal pain in the LUQ?

Answer 14

LLL PNA, gastritis, splenomegaly, splenic infarct

Question 15

What are NONsurgical causes of abdominal pain diffusely?

Answer 15

Abd wall hematoma, black widow spider envenomation, lead poisoning, DKA, gastroparesis, sickle cell crisis, adrenal crisis, opiate withdrawal, nerve root compression