Acute Abdomen Flashcards

1
Q

What is Acute Abdomen?

A

A combination of signs/symptoms, notably abdominal pain, resulting in referral for an urgent general surgical opinion.
Basically abdominal pain acutely (today)

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2
Q

What are the most common causes of acute abdomen?

A
  • Non-Specific pain (undiagnosed)
  • Acute Appendicitis
  • Acute Cholecystitis
  • Peptic Ulcer Perforation
  • Lots of other stuff causing some sort of perforation, inflammation or obstruction
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3
Q

How does peritoneum become adhered?

A

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

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4
Q

How does peritonitis become generalised?

A

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)
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5
Q

Name 4 routes of peritonitis infection?

A
  • Perforation of the GI or biliary tract
  • Female Genital Tract
  • Penetrating through abdominal wall
  • Haematogenous spread (through blood)
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6
Q

explain the bacteriology of peritonitis?

A

Over the course of peritonitis the bacterial presence changes

  • Early Diffuse peritonitis is mostly aerobes
  • After ~5 days an abscess of anaerobes forms
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7
Q

What are the types of bowel obstruction?

A
  • Something in the bowel
  • A problem in the bowel wall
  • Something outside the wall
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8
Q

What are the cardinal features of intestinal obstruction?

A
  • Pain (Colic)
  • Vomiting
  • Distension
  • Constipation
  • Borborygmi
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9
Q

Define borborygmi?

A

Rumbling or gurgling noise made by movement of fluid & gas in the intestine

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10
Q

How does an intestinal obstruction present differently if its very proximal?

A

They will vomit everything up and will die of dehydration etc before they get any other symptoms

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11
Q

Define Colic

A

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

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12
Q

Whats the difference between visceral and somatic pain?

A

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)
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13
Q

How do patients describe the location of visceral abdominal pain?

A

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

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14
Q

Why is somatic pain much more localized than viscera;?

A

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)

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15
Q

How does somatic pain arise from visceral pain? (abdomen)

A

A source of generalised visceral pain e.g. appendicitis

Irritates parietal peritoneum or abdominal wall -> More localised somatic pain

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16
Q

Abdominal pain follows a crescendo - trough - crescendo pattern. What factors help us distinguish the source?

A
  • How localised is it?
  • When did it start?
  • What causes a crescendo?
  • Systemically unwell?
17
Q

How do peritonitis/intestinal obstruction kill you?

A
  • Fluid loss
  • Bacteraemia/endotoxaemia

Leads to circulatory collapse -. death

18
Q

How do we investigate someone with acute abdomen?

A

Urine
FBC, U&E, LFT
Ultrasound, CT, MRI
If you need to open them up to see consider laparoscopy or laparotomy

19
Q

What is acute abdominal resuscitation?

A

Often patients presenting with acute abdominal pain will require some resuscitation prior to further investigation or treatment:

  • Restore fluid volume (IV fluids)
  • Ensure O2 supply and tissue perfusion (O2 mask & tranfusion)
  • Treat Sepsis
  • Decompress the gut
  • Pain relief
20
Q

How should you treat a patient with acute abdominal pain?

A
  • Active Observation
  • Definitive surgery (don’t need a repeat)
  • Treat Sepsis & remove the source (antibiotics/surgery)
21
Q

Having read the oxford handbook:

A

An acute abdomen is anyone acutely ill with symptoms/signs related to the abdomen (particularly pain) such as rupture of an organ, peritonitis, appendicitis, colic, IBS etc.
You need to stabilise with Acute Abdomen Resuscitation
Then test if there’s time:
FBC – U&E – Urinalysis – US – CT – Laparoscopy
Treatment depends on the cause:
- Peritonitis may be infection -> Antibiotics (may also have sepsis)
- May require immediate surgery
- Bed Rest and active observation

22
Q

How do we manage Bowel Obstruction?

A
  • Monitor fluid status
  • Analgesia
  • FBC, U&E etc plus imaging CT/CXR
  • Surgery/endoscopic stenting