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
peptic ulcer perforation
What factors should you consider when assessing the pathophysiology of the acute abdomen?
What do the mesothelial cells of the peritoneum produce and what is its function?
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
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
---Foregut = epigastrium
---Midgut = umbilical
---Hindgut = hypogastric
Describe somatic pain
-Comes from the parietal peritoneum (which is innervated by somatic nerves)
-Sharp in nature
-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.
-Contamination is too rapid
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?
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
-ENSURE ADEQUATE PAIN RELIEF
What investigations can you carry out to help with acute abdomen diagnosis?
Ward tests: Urine
Lab Tests: FBC, U+E, LFT
Radiology: Ultrasound, CT