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1

Acute abdo

Recent or sudd onset of unexp signs and symps incl abdo pain
Intra and extra perit processes
NOT ALWAYS req surg
Potential sev infec, fluid or blood loss
Visceral or somatic or referred pain

2

Visceral pain

Stim of sm Rs
Eg isch, distension, tension. Often colicky.
Autonimic conduction- vagus
Poorly localised midline pain
Assoc malaise, NV, sweating

3

Embryology

Epig pain- stom to D2, liver, panc, spleen
Periumb- D2 to proximal 2/3 transv colon
Suprapubic- distal transv to anal verge

4

Somatic pain

Pain Rs in parietal perit
Segmental somatic N conduc
Accurately localised
Overrides visceral

5

Referred pain

Comm central neural paths in SC that are comm to somatic Ns and visceral organs.
Eg bil tract to R inferior scap.
Diaph irrit to ipsi shoulder tip.

6

Common causes

Non specif
Acute appendicitis
Acute cholecystitis and bil colic
Peptic ulcer/CA/divertic perforat and bleed
bowel obstruc
Isch eg strang hernia, volvulus, TE
Gynae dis
Ureteric obstruc, urin reten
Acute pancreatitis
Rupt aneur

7

Ix

ABCDE
Fluids
Bm, urinalysis, preg test
FBC, UE, amylase, LFT, ABG, CRP, clotting, GS
O2
Hx
Exam
CXR, AXR
US
Contrast studies
CT
ECG
Exploratory laparotomy/ laparoscopy
Stool- faecal occult blood

8

px

Pain- char, locat, onset, prog, prev episodes, aggrav and relieving
Appetite
NV
Distens
Bowel habit
Wl
PV disch
Urin freq, urgency, pain, blood

9

pain chars

Sudden onset- perforat, rupture, AAA, MI, mestenteric occlus
Rapidly accelerating- bil or ureteric colic, SI obstruc
Grad onset- IBD, obstruc, other mech

10

diffs

MI
Pneumonia
Pleurisy
Herpes zoster
Diabetic ketosis

11

Malig feats

Intermitt pain over 48hr
Alt bowel habit
Distension
Mass
Wl

12

Obstruc feats

Colicky sev pain
No aggrav facs
Vom and constip
Prev surg
Distension
High pitch bowel sound

13

perforated viscus feats

Sudd onset
Constant sev
Aggrav by move or cough
Diffuse tenderness
Silent rigid abdo
Check amylase

14

AAA

Sudd onset central pain
Collapse
Hypot

15

exam

ABCDE
Appearance- pain, pallor, jaund etc
Vital signs
Inspec- distens, scars, bulging, bruising, igne
Palpation- start away from pain, guarding, rigidity, mass, hernia
Percuss
Ausc- peritonitis no bowel sounds
DRE, genitals eg testic torsion
Sys rev- CVS, resp, vasc

16

gen mx

NBM
Fluids
Regul obs
Catheter, NG
Thromboprophylxais
Analgesia- parenteral opioid
Antiemetic
AB
Surg

17

abdo sign masking

Steroids
Imm suppressants
Anti inflamm
Alc intox
Alt conc

18

Acute append

Px- NV, central to RIF pain
Exam- fever, tend, gurading, RIF mass, pelvic perit.

19

Perf ulcer with acute perit

Px- Vom. Acute onset sev pain. Hx dyspepsia,ulcer dis, NSAID, CA
Exam- shallow breathing, guarding, rigid, distens, silent bowel.

20

Acute pancreatitis

Px- anorexia, NV, const sev epig pain, alc hx, cholelith hx.
Exam- fever, cullens, grey turner, epig tend, guarding, reduc sounds.

21

rupt AAA

Px- sudd sev tearing loin or abdo pain, hypot, hx vasc dis or HTN.
Exam- shock, hypot, pulsatile tender mass, asymm fem pulses.

22

acute mesenteric isch

Px- anorexia, NV, bloody diarr, const abdp pain, hx vasc dis and HTN.
Exam- AF, HF, asymm periph pulses, no sounds, tend, guarding.

23

obstruc

Px- colicky central pain, NV, constip
Exam- scars, hernia, mass, distens, visib peristalsis, incr sounds.

24

rupt ectopic preg

Px- delayed period, hypot, IF pain unilat, shoulder tip pain, prune juice discharge.
Exam- suprapubic tend, periumb bruising, VE pain, swelling fornix.

25

Signs

Murphys acute cholecystitis- RUQ pain when press on inhalation.
Rovsings acute append- LIF palp cause RIF pain.
Iliopsoas append or abcess- pain when flex thigh ag resis.
Grey turner and cullen haemorrhagic pancreatitis, aortic rupt, rupt ectopic- cullens bleed into falciform lig bruied umb, grey turner loin.

26

GI ix

CXR, AXR
Barium meal, folow through, enema
CT colonograph
US
CT
MRCP
UGI endosc
Colonoscopy
Capsule endosc
ERCP
Laparoscopy
Biopsy

27

cirrhosis ix

High bili
Low alb
High PT
Ascites
Enceph

28

ascitic fluid

Blood stained- malig
Turbid- infec or high prot
Chlous and milky so high fat- lymphatic obstruc
Ix- prot, alb, cell count, cult, gluc, amylase, cytology for malig cells.
Exudate- inflamm, malig
Transudate- cirrhosis, portal HTN