Acute Abdomen

Question 1

Define term

Answer 1

Acute abdominal condition caused by damage to one or more of the abdominal organs.

Question 2

Cardinal symptoms and pain patterns with most common conditions.

Answer 2

Inflammation causes pain and nausea.
Obstruction causes pain, vomiting, absolute constipation.
Perforation causes pain, bleeding, hypotension and peritonitis.
Organic Pathology- Referred pain, specific signs.

Question 3

Ddx for acute abdomen:

Answer 3

Appendicitis, Biliary Colic, Cholecystitis, Diverticulitis, Ulcer, Cancer, Obstruction, Adhesions, Volvulus, Renal Colic, Pancreatitis, Hepatitis, IBD, AAA, UTI, Ischaemic Colitis, Acute urinary retention, strangulated hernia and Gastroenteritis.

Question 4

Physical findings and pathology

Answer 4

Patient looks ill, shocked, pale, sweaty, weak rapid pulse. This is due to inflammation and leukocytosis.
Guarding and rigidity suggests peritonitis- localised pain worse with movement, coughing and inspiration. Patient lies still with shallow breathing. Inflammation causes constant pain. Obstructive pain causes colicky pain.

High pitched, tinkling bowel suggests fluid obstruction. Distension shows obstruction. Fever may be present.

Question 5

Which appropriate investigations aid diagnosis?

Answer 5

FBC (Hb, WBC), U&Es, Serum Amylase, Pregnancy Test, CRP & ESR, lactate, erect CXR, USS, CT, E/MRCP , laparoscopy

Question 6

Initial management of acute abdomen?

Answer 6

ABCDE: IV fluids, Oxygen, Analgesia. Catheter for fluid balance, NG tube for drain/feeding. History and exam.

Question 7

Indications for urgent resusc and operative intervention?

Answer 7

Ruptured ectopic pregnancy, aneurysm leak and trauma.