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Flashcards in Acute abdomen Deck (11):
1

acute abdomen

rapid onset of severe Sx
may indicate life threatening intra abdo pathology
pain usually, but not always a feature
pain free more likely in the elderly, children and 3rd trimester

2

major causes

acute cholecystitis
acute appendix or meckel's diverticulum
acute pancreatitis
ectopics
diverticulitis
peptic ulcer disease
PID
obstruction
gastroenteritis
intestinal ischaemia/infarct
GI haemorrhage
renal colic
acute urinary retention
AAA
torsion

also non-surgical disease, eg:
MI, pericarditis, pneumonia, sickle cell crisis, hepatitis, IBD, opiate withdrawal, typhoid, acute intermittent porphyria

3

RUQ pain

acute cholecystitis
duodenal ulcer
hepatitis
congestive hepatomegaly
pyelonephritis
appendicitis
pneumonia

4

epigastrium pain

MI
peptic ulcer
acute cholecystitis
perforated oesophagus

5

LUQ pain

ruptured spleen
gastric ulcer
aortic aneurysm
perforated colon
pyelonephritis
pneumonia

6

RLQ pain

appendicitis
salpingitis
tubo-ovarian abscess
ruptured ectopic
renal/ureteric stone
incarcerated hernia
mesenteric diverticulitis
meckel's
crohn's
perforated caecum
psoas abscess

7

LLQ pain

higher:
obstruction
acute pancreatitis
early appendicitis
mesenteric thrombosis
aortic aneurysm
diverticulitis

lower:
sigmoid diverticulitis
salpingitis
tubo-ovarian abscess
ruptured ectopic
incarcerated hernia
perforation
crohn's
UC
renal/ureteric stone

8

Hx

cover the following:
demographics, Hx of recent trauma
pain - SOCRATES
associated Sx - vomiting, melaena, stool/urine colour, new lumps, eating and drinking, bowels, fainting, dizziness or palpitations, fevers/rigors, rash, pruritus, urinary Sx, recent weight loss
PMH & surgical Hx
obs & gynae - contraception, LMP, STIs, PID, gynae/tubal surgery, ectopics, PV bleeding, DH & allergies

9

hospital care for acute abdo

NBM
O2 as appropriate
IV fluids
? NG tube if severe vomiting
analgesia - via opiates
antiemetics
ABx - if septic, peritonitis, severe UTI suspected (IV cephalosporin + metronidazole)
surgical/gynae review

10

red flags for serious pathology

hypotension
confusion/impaired consciousness
signs of shock
systemically unwell/septic
signs of dehydration
rigid abdomen
lying very still or writhing
absent/altered bowel sounds
associated testicular pathology
marked involuntary guarding or rebound tenderness
tenderness to percussion
Hx of haematemesis/melaena or evidence of latter on PR
suspicion of medical cause for pain

11

top 5 medical causes of acute abdomen in the elderly

inferior MI
lower-lobe pneumonia/PE causing pleurisy
DKA or HONK
pyelonephritis
IBD