Central and Generalised Abdominal Pain Flashcards
What is a sign of gastric outlet or upper small bowel obstruction?
If have full stomach/gastric outlet obstruction, ballot/move patient from side to side > hear gastric contents splash
Is abdominal pain always present with presentation of an acute abdomen?
No
What is the management of an acute abdomen?
Fluid resuscitation Nasogastric tube Watch and wait vs operate Nutritional support - Check electrolytes > correct any imbalances
Of what is the benign appearance of the abdomen in the setting of severe pain highly suggestive?
Ischaemic bowel
Does a normal CT exclude a diagnosis of ischaemic bowel?
No
What are the changes in CT that may be visible in ischaemic bowel?
If severe enough, may see
- Thickening of bowel wall
- Free gas
If do CT angiogram, may see embolus
What are the defining features of ischaemic colitis?
Diarrhoea
PR bleeding
Mucosa looks congested but viable
Not complete transmural process
What does free gas under the diaphragm on plain film suggest?
Perforated viscus
What is the clinical picture for “red” peritonitis?
Vasodilated
Warm peripheries
Flushed
What are the possible causes of “red” peritonitis?
Bacterial
What is the clinical picture for “grey” peritonitis?
Shutdown
Clammy
Sweaty
What are the possible causes of “grey” peritonitis?
Chemical
Severe pancreatitis
MI
PE
What is the clinical picture for “white” peritonitis?
Pale
Shutdown
Cold peripheries
What are the possible causes of “white” peritonitis?
Haemorrhagic shock
What is the immediate management of general peritonitis?
Resuscitation
Action now vs later
Safe transfer
Investigations
