Acute Abdomen Flashcards
What is Acute Abdomen?
A combination of signs/symptoms, notably abdominal pain, resulting in referral for an urgent general surgical opinion.
Basically abdominal pain acutely (today)
What are the most common causes of acute abdomen?
- Non-Specific pain (undiagnosed)
- Acute Appendicitis
- Acute Cholecystitis
- Peptic Ulcer Perforation
- Lots of other stuff causing some sort of perforation, inflammation or obstruction
How does peritoneum become adhered?
In peritonitis there is a reduction in fibrinolytic activity leading to an overgrowth of fibrous tissue.
The peritoneum becomes adhered to organs and the wall
How does peritonitis become generalised?
Generalised peritonitis occurs when the body fails to localise (contain) the peritonitis. When:
- Contamination is very rapid
- Contamination is persistant
- Abscess ruptures
- Adjuvant material (e.g. food or faecal matter, very different to contain/clear)
Name 4 routes of peritonitis infection?
- Perforation of the GI or biliary tract
- Female Genital Tract
- Penetrating through abdominal wall
- Haematogenous spread (through blood)
explain the bacteriology of peritonitis?
Over the course of peritonitis the bacterial presence changes
- Early Diffuse peritonitis is mostly aerobes
- After ~5 days an abscess of anaerobes forms
What are the types of bowel obstruction?
- Something in the bowel
- A problem in the bowel wall
- Something outside the wall
What are the cardinal features of intestinal obstruction?
- Pain (Colic)
- Vomiting
- Distension
- Constipation
- Borborygmi
Define borborygmi?
Rumbling or gurgling noise made by movement of fluid & gas in the intestine
How does an intestinal obstruction present differently if its very proximal?
They will vomit everything up and will die of dehydration etc before they get any other symptoms
Define Colic
Pain that starts & stops abruptly.
Occurs due to muscular contractions of a hollow tube (e.g. colon, ureter or cystic duct) to relieve an obstruction by forcing out the contents
Whats the difference between visceral and somatic pain?
Visceral:
- Pain due to the internal organs
- Associated with systemic illness (feels unwell, looks ill, nausea etc)
Somatic:
- Pain isolated from systemic illness
- Often in body wall (when abdominal)
How do patients describe the location of visceral abdominal pain?
Fairly generalised but can be split by section of gut tube.
As the sympathetic afferent fibres follow the segmental vessels so are split between fore/mid/hindgut
Why is somatic pain much more localized than viscera;?
Receptors in the parietal peritoneum or abdominal wall
The afferent signals then travel along the thoraco-abdominal and subcostal nerves (anterior rami of T7-T11 + T12)
How does somatic pain arise from visceral pain? (abdomen)
A source of generalised visceral pain e.g. appendicitis
Irritates parietal peritoneum or abdominal wall -> More localised somatic pain
