Flashcards in The acute abdomen Deck (32):
1
What is an acute abdomen
Abdominal pain which has been around for less than 10 days
Causing severe morbidity or threat to life
2
Who does it present to?
GP
A&E
General surgeons
Gynae
General Medicine
3
What are some of the common causes of acute abdomen
Non-specific abdominal Pain (1/3rd of patients)
Acute appendicitis
Intestinal obstruction
Urological causes
Gallstone disease
Diverticular disease of the colon
Trauma
Malignancy
Perforated ulcer
Pancreatitis
IBS
Bacterial and viral infections
Gynae things
4
What are the ages for women of child-bearing age?
10-55
5
What are some of the less common causes of acute abdomen
Ruptured or symptomatic AAA
IBD
Medical causes
Ischemic gut
6
What is Munchhausen's syndrome
Attention - making something up
7
What are drug seekers?
Typically women who want morphine who are manipulating
8
3 types of abdominal pain
Visceral
Parietal
Extra-abdominal
9
5 associated symptoms of abdominal pain
Nausea/ Vomiting
Burping
Heartburn / indigestion
Change in bowel habit
PR blood / mucus
10
In what condition will the pain totally disappear?
Renal colic
11
What are the 9 regions of the abdomen
Right and Left Hypochondrian
Epigastric
Right and Left Lumbar
Umbilical
Right and Left iliac fossa
Suprapubic
12
What questions do you ask about vomit?
Colour
Green or foodstuff
Projectile
Blood
Coffee
13
What is golden yellow vomit
Digested bile
14
What colour is digested bile
Green
15
What is localised peritonism
Localised pain and guarding
16
What is peritonitis
Refers to pain in all 4 quadrants
17
What does generalised peritonitis
Board like
Usually perforated duodenal ulcer
18
Describe the bowel sounds in ileus
Absent
19
What is the common analgesia given?
IV morphine with anti-emetic
IV paracetamol
20
What is Cullen's sign
Periumbilical bruising often with Pancreatitis
21
What are initial investigations for abdomen?
Bloods: FBC,LFT,UE, CRP, Ca, Lactate, Coag
AMYLASE!!!!!
ABGs
Plain radiology
AXR and erect if possible CXR
Or straight to CT
22
Why is amylase so important to do?
Pancreatitis
23
What do we look for with an erect chest
Free air under diaphragm
First line and very useful if abnormal
Lateral decubitis if too ill to stand
Excludes pneumonia
Useful as a preoperative investigation
24
What is the gold standard scanning for acute abdomen
CT scanning - less mortality and decreased hospital stay is done early
25
Who is US very useful for?
Children and women with pelvic pain or RUQ or RIF pain
26
What are the 3 most important things to look for
Exclude pancreatitis
AAA
27
What patients go straight to surgery
ruptured AAA
ischaemic guts
Faecal peritonitis
28
Who does not go to theatre?
Nobody with pancreatitis
Nobody with DKA
29
What are 5 types of colonic emergencies
Obstruction
Volvulus
Acute diverticulitis
Toxic colitis
Perforations (stercoral, iatrogenic, anastomotic)
30
How is a volvulus managed
Decompress using rigid sigmoidoscope
31
What is typhilitis
A condition common in patients on chemotherapy
32