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Flashcards in The Acute Abdomen Deck (25)

What is the acute abdomen?

Abdominal condition of abrupt onset associated with severe abdominal pain (resulting from inflammation, obstruction, infarction, perforation or router of intra-abdominal organs)

A combination of symptoms and signs, including abdominal pain, which results in a patient being referred for an urgent general surgical opinion.


Give some of the aetiologies of the acute abdomen

Non-Specific pain
Acute appendicitis
Acute cholecystitis
peptic ulcer perforation


What factors should you consider when assessing the pathophysiology of the acute abdomen?

-Intestinal Obstruction
-Abdominal Pain


What do the mesothelial cells of the peritoneum produce and what is its function?

Produce anticoagulant.
This allows the surface of the intestines to smoothly glide over eachother.
If this is lost then the intestines start to stick


What are the routes of infection of peritonitis?

Perforation of GI/ Biliary tract
Female genital tract
Penetration of abdominal wall
Haematogenous spread


What is cholecystitis?

Inflammation of the gall bladder


What is haematogenous spread?

Spread from the blood


How does the bacteriology of the upper GI tract compare to the lower GI tract and what does this mean in terms of perforation?

Oesophagus and stomach are quite sterile environments.

Duodenum onwards have many different bacteria.

A perforation of the GI tract will spill contacts that are relatively sterile and so you just clean up and fix hole.

Midgut and hindgut perforation will be a much larger risk of infection


How do the different factors of perforation affect the type of treatment yo deliver?

Diffuse peritonitis more likely to have aerobes.
Abscess more likely to have anaerobes.

New perforation more likely to have aerobes.
Older perforation more likely to have anaerobes.


What is localised peritonitis?

Inflammation is in one area. Occurs with all acute inflammatory conditions of the GI tract

Infection causes mesothelial cells to stop producing anticoagulant and so peritoneum sticks to infected organ and contamination is localised.


Describe Visceral pain

-Comes from abdominal/ pelvic viscera
-Transmitted by visceral afferent nerve fibres in response to stretching or excessive contraction
-Dull in nature and vague
-Poorly localised
---Foregut = epigastrium
---Midgut = umbilical
---Hindgut = hypogastric


Describe somatic pain

-Comes from the parietal peritoneum (which is innervated by somatic nerves)
-Sharp in nature
-Well localised
-Made worse by movement, better by lying still


Describe Referred Pain and give an example in the abdomen

-Pain felt some distance away from its origin

Gallbladder inflammation can irritate diaphragm which is innervated by C3, 4, 5.
Dermatomes of these spinal cord segments supplies the shoulder, hence referred shoulder pain


What is general peritonitis?

Occurs as a result of rupture of an abdominal viscus

Represents a failure of localisation.

Occurs when:
-Contamination is too rapid
-Contamination persists
-Abscess ruptures


What role do adjuvant substances play in peritonitis?

eg. stool, shrapnel

Bring infection and need to be removed.

Shrapnel cavities the abdomen. The spaces are great for bacteria to establish and grow.
On top of this its hard for the body to launch an attack in these spaces.
Vasculature may also be effected


What are some of the causes of obstruction?

Is the problem lumenal?

Is the problem to do with the wall of the tract?
-Tumour, fibrosis

Is the problem from outside?
-structure pressing on tract


What should you consider when assessing the cause of an obstruction?

Older patient: tumour?

Younger patient: atresia, infection/necrosis?

Environment: Something they swallowed?


What are the cardinal signs of intestinal obstruction?


Selection of symptoms depends on site


What are borborygmi?

Audible bowel sounds


What is colic pain?

Pain that waxes and wanes.

Occurs due to muscular tube contracting to relieve an obstruction.
Childbirth is an example


What are the effects of peritonitis that may lead to death?

Bacteraemia and endotoxaemia

This can leads to circulatory collapse


What are the effects of intestinal obstruction that may lead to circulatory collapse?

Fluid loss through vomiting and body trying to flush blockage.
This can leads to circulatory collapse


How do you resuscitate a patient with acute abdomen?

-Restore circulating fluid volume
-Ensure tissue perfusion
-Enhance tissue oxygenation
-Treat sepsis
-Decompress gut


What investigations can you carry out to help with acute abdomen diagnosis?

Ward tests: Urine

Lab Tests: FBC, U+E, LFT

Radiology: Ultrasound, CT


Why can active observation be a good tool?

Useful when the diagnosis is uncertain and risk of alternative intervention is greater