Acute abdomen Flashcards Preview

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Flashcards in Acute abdomen Deck (10):
1

Definition 

Any patient who becomes acutely ill and in whom symptoms and signs are chiefly related to the abdomen.

2

History 

  1. Site of pain
  2. Type of pain
  3. Duration of pain
  4. Associated symptoms
  5. Previous episodes/previous investigations

3

Clinical examination 

  1. abdominal examination 
  2. guarding 
  3. rebound tenderness 
  4. palpable tender mass e.g gallbladder, diverticular mass 
  5. rectal examination 

4

Types of pain 

  • Localised pain is generally somatic, ie that it originates from the site of disease process.
  • Generalised pain is usually visceral, ie diffuse, midline and difficult to localize.
  • Colicky pain is usually due to obstruction of the gut, biliary system, urogenital system or uterus.
  • Viscus obstruction causes waves of pain, whereas obstruction by stones etc causes sharp pain which is not eaisly relieved.
  • Constant pain tends to be more associated with inflammation and will be supported by other features.
  • Peritonism – Board-like abdomen, rigidity, guarding, no bowel sounds. Can be localised or general – General = PERFORATION until otherwise proven

5

Investigations of acute abdomen 

  1. Blood tests – full blood count, U+Es, LFTs, amylase
  2. Erect chest X-ray
  3. Ultrasound
  4. CT scan
  5. Arterial blood gases
  6. Erect chest X-ray in perforated ulcer showing free gas under diaphragm
  7. Blood cultures
  8. Pregnancy test

6

Treatment of acute abdomen 

Treatment - Depends on cause diagnosed.

  • IV access x 2
  • Treat shock
    • IV fluid resus – aggressive if shocked, control in elderly
    • IV antibiotics – broad spectrum
    • Catheterise
    • Involve anaesthetics early if theatre needed
  • Give adequate analgesia
    • Renal pathology – diclofenac (voltarol) 100mg PR
    • Intra-abdominal pathology – 5-10mg morphine IV
  • Sepsis 6
  • Theatre If needed
  • Admit or discharge

7

Upper abdominal pain causes 

Upper abdominal pain

  1. Gastritis/peptic ulcer
  2. Acute cholecystitis
  3. Acute pancreatitis
  4. Perforated duodenal/gastric ulcer
  5. Referred pain from thorax – MI, pneumonia

8

Lower abdominal pain 

Lower abdominal pain

  1. Acute appendicitis
  2. Diverticulitis
  3. Ovarian cyst/ruptured cyst/torsion
  4. Ectopic pregnancy
  5. Ureteric stones
  6. Urinary retention

9

Generalised abdominal pain

  1. Perforated viscus
  2. Mesenteric ischaemia
  3. Diabetes – ketoacidosis
  4. Bowel obstruction – may be more localised
  5. Gastroenteritis

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