Acute abdomen Flashcards
What is the acute abdomen
sudden onset abdominal pain (<24 hours) due to an underlying cause which can be life threatening
symptoms associated with acute abdomen
pain - may radiate N+V haematemesis jaundice heartburn weight loss / anorexia diarrhoea PR bleeding PV bleeding and LMP - pregnancy dysuria, haematuria
causes of RUQ pain
liver - hepatitis, cirrhosis, abscess subphrenic abscess gallbladder - colic, cholecystitis, ascending cholangitis, perforation duodenal ulcer duodenitis renal - calculi, pyelonephritis ovarian/testicular lower lobe pneumonia
causes of epigastric pain
oesophagitis gastritis GORD peptic ulcer disease / perforation pancreatitis cholecystitis peritonitis MI lower lobe pneumonia DKA ruptured AAA malignancy
causes of LUQ pain
gastritis gastric ulcer pancreatitis / malignancy spleen - rupture, abscess, infection renal - calculi, pyelonephritis ovarian/testicular subdiaphragmatic abscess left lower lobe pneumonia
Causes of umbilical pain
early appendicitis diverticulitis peritonitis bowel obstruction mesenteric ischaemia gastroenteritis DKA ruptured AAA
causes of RIF pain
late appendicitis diverticulitis IBD - Crohns ovarian, ectopic pregnancy... testicular torsion UTI Meckels diverticulitis psoas abscess perforation (caecum) inguinal hernia mesenteric adenitis - previous viral like symptoms
causes of LIF pain
diverticulitis (sigmoid) IBD inguinal hernia volvulus ovarian/testicular UTI
what is guarding
when you palpate, the abdominal muscles become tense
what is rebound tenderness
initial palpation does not cause pain but removal of your hand does
what is board like rigidity
the abdomen is solid when you go to palpate
list investigations you would carry out in an acute abdomen
FBC U+E LFT CRP Ca lactate (ischaemic tissue) Amylase + lipase (ALL ABDO PAIN) troponins Urinary dipstick Urinary pregnancy test stool culture ABG ECG Erect CXR AXR (obstruction, colitis) - lot of radiation USS abdo - kidney, GB, liver, appendix TVUSS - ovarian CTAP MRI
types of abdominal pain
visceral - dull, aching, poorly localised
parietal - sharp, stabbing, well localised (pain, guarding and rebound)
referred - felt at a site away from pathological organ due to shared nerves
example of referred pain
GB or liver or subphrenic abscess
diaphragm C3,4,5
Classification of abdominal pain
intra abdo - GI, GU, gynae, vascular
extra abdo - CVS, hernia, zoster, DKA, neurogenic, psych
NSAP - everything is normal but pain is felt
