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Flashcards in The acute abdomen Deck (17):
1

Definition

Rapid onset
Severe
Potentially life threatening
Requires urgent surgical intervention

2

Atypical acute abdomen population groups

Elderly
Pregnant (particularly third trimester)
Immunocompromised

3

Older people and acute abdomen- reasons for atypical presentations (4)

Pathophysiologic
Immunologic
Pharmacological
Neurological

4

Severe abdominal pain with rigidity of entire abdominal wall and prostration

Perforated peptic ulcer
Perforation of other intra-abdominal organ
Dissecting aneurysm
Severe pancreatitis

5

Tenderness and rigidity in right hypochondrium

Acute cholecystitis
Cholangitis
Subphrenic abscess
Plerusy
RLL Pneumonia
Acute pyelonephritis, nephrolithiasis
Perforated peptic ulcer

6

Tenderness and rigidity in left hypochondrium

Pancreatitis
Subphrenic abscess
Diverticulitis
Splenic rupture
Acute pyelonephritis, nephrolithiasis
Leaking aneurysm of splenic artery
Acute gastric distension

7

Tenderness and rigidity in right lower quadrant

UC/Chrons
Appendicitis
Mekels diverticulitis
Ovarian cyst rupture, torsion
Ectopic
PID
Hernia

8

Tenderness and rigidity in left lower quadrant

Diverticulitis
Colitis
Colon cancer
Pelvic peritonitis
Cyst, torsion, ectopic, PID
Hernia
Sigmoid volvulus

9

Periumbilical pain without abdominal signs

Acute mesenteric ischemia/infarction/adenitis
Appendicitis
SBO
Pancreatitis
DKA, dissecting aneurysm

10

Signs of peritonism

Guarding
Rigidity
Rebound tenderness
Abnormal bowel sounds

11

Red flags

Red flags
Adhesions
Incarcerated/strangulated hernia
Cholecystitis
Gastric ulcer
Appendicitis
Ectopic pregnancy
Pelvic inflammatory disease
Acute pancreatitis
Acute diverticulitis
Gastrointestinal malignancy
Volvulus
Intussusception
Duodenal ulcer
Ovarian torsion
Abdominal aortic dissection
Ruptured aortic aneurysm
Acute mesenteric ischaemia and infarction
Meckel's diverticulitis
Oesophageal perforation (Boerhaave’s syndrome)
Ischaemic colitis
Ruptured splenic artery aneurysm
Budd-Chiari syndrome
Splenic infarct
Diabetic ketoacidosis

12

Urgent considerations

Surgical consult
Abnormal vitals->fluids and blood
2 large IV cannula
Group and hold
Fluid resuscitation
0 negative blood
Oxygen
If perforation/appendictis->broad spectrum antibiotics
Pregnancy test

13

BP goal for ruptured AAA

Systolic 80-90mmHg

14

Abdominal pain out of proportion to physical examination

Consider mesenteric ischemia->older, smoking, peripheral vascular disease, AF

15

History

SOCRATES
Sudden->perforation, appendictis
Long term->ulcer, worse= perforation
Sudden pain after vomiting->esophageal perforation
Similar pain->cholecystitis, pancreatitis, diverticulitis
Associated/GI->cholecystitis, ulcer, appendicitis, mesenteri ischemia, PID, diverticulitis, hepatitis
Anorexia

Last meal/oral intake
Medical/surgical->
->+obstruction/adhesions
->Immunocompromised
->ChemoT, radiation
->IBD

LMP, contraception, pregnancy status
Medication to alleviate
Cardiac
Alcohol, drugs

16

Right scapula pain

Gall bladder
Liver
Irritation of right hemidiaphragm->pneumonia

17

Left scapula pain

Cardiac
Gastric
Pancreas
Spleen
Irritation left hemidiaphragm