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Flashcards in Acute Abdominal Pain in Adults Deck (19)
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1

What are the possible causes of acute abdominal pain in adults?

  • Inflammation
  • Perforation
  • Obstruction
  • Vascular
  • Urological
  • Trauma
  • Cardio-respiratory disease

2

What are the inflammatory causes of acute abdominal pain?

  • Appendicitis
  • Cholecystitis
  • GORD / peptic ulcer / gastritis
  • Acute pancreatitis
  • Diverticulitis
  • IBD (UC and CD)
  • Urinary infection
  • Gynaecological causes

3

What are the perforative causes of acute abdominal pain?

  • Peptic ulcer disease
  • Diverticular disease
  • Bowel cancer
  • Obstruction / ischaemia
  • Inflammatory bowel disease

4

What are the obstructive causes (in the small intestine) of abdominal pain?

What are the common symptoms?

  • Adhesions
  • Hernia: internal or external
  • Volvulus 
  • Intraluminal (gallstone ileus, FB)
  • Tumours (rare)

 

  • Symptoms
    • Distension
    • Pain
    • Vomitting or nausea 
    • Symptoms depend on the site of the obstruction

 

5

What are the obstructive causes (in the large intestine) of abdominal pain?

What are the common symptoms?

  • Tumour
  • Diverticular disease
  • Volvulus
  • Faecal impaction

6

What are the vascular causes of acute abdominal pain?

  • Aneurysms (abdo pain with radiation to the back)
  • Ischaemic bowel
  • Trauma

7

What are the urological causes of acute abdominal pain?

  • Acute and chronic urinary retention
  • Ureteric colic
  • Urinary infections
  • Testicular problems - some can refer pain to the abdomen

8

What questions should be asked in the history of a patient presenting with acute abdominal pain?

  • Pain
    • How long?
    • Severity?
    • Whereabouts?
    • Character (colicky / continuous) 
    • Radiation
    • Exacerbating / relieving factors
    • Anything like this in the past
    • Associated symptoms: bowels, nausea vomiting, apetite, urinary.
    • Drugs
    • Allergies

9

Describe the examination of the acute abdomen.

  • Observation ?Distension
  • Palpation ?Tenderness and where is it worse
  • ?Rigidity; Any masses?
  • Specific signs? E.g. Murphy's sign
  • Always examine for ?Hernias in the groin
  • Auscultation; percussion; ?PR ?PV
  • Other places: legs, cardio-respiratory, scrotum.

10

What are the basic investigations for a patient with an acute abdomen?

  • Blood tests:
    • FBC
    • U&E
    • CRP
    • Glucose, amylase, LFTs
  • Pregnancy test
  • ?CXR, AXR

11

What are the more specific investigations (after the basics) for a patient with the acute abdomen?

  • USS (if the pain is mainly RUQ, or lower abdominal in females). 
  • CT scan (with or without contrast).
  • ECG
  • Endoscopy

12

Describe the features of this CXR.

  • There is a perforation on the right side of the diaphragm. There is air under the right hemi-diaphragm.

  • There is a gastric bubble under the left hemi-diaphragm. 

13

Which is the most vulnerable part of the large bowel to perforation?

The caecum

14

What is abnormal about this abdominal X-ray?

The aorta is MASSIVE

15

What is the abnormality on this X-ray?

Renal calculi

16

What is ischaemic colitis?

  • Inflammation and injury of the large intestine result from inadequate blood supply. 
  • Occurs with greater frequency in the elderly.
  • Most common form of bowel ischaemia. 

17

What are the main treatments for the acute abdomen?

Break these down into conservative, semi-urgent and urgent.

  • Conservative
    • ​IV fluids
    • Antibiotics
    • Observation
    • Investigation
  • Semi-urgent = surgery. Done for:
    • Appendicitis
    • Cholecystitis
    • Some obstructions
  • Urgent = surgery. Done for:
    • Perforations
    • Haemorrhage
    • Ischaemia (including some hernias)

18

Under which circumstances would interventional radiology be used to treat an acute abdomen?

  • Drainage of some abscesses.
  • Treatment of some aneurysms.
  • Helpful in some trauma cases.

19

Under which circumstances would endoscopy be used to treat the acute abdomen?

  • Management of CBD stones
  • Relief of some obstructions (e.g. sigmoid volvulus)
  • Control of GI bleeding