The acute abdomen Flashcards
what requires laparotomy
rupture of an organ, peritonitis
what are the signs in ruptured organ
shock, abdominal swelling
what can cause peritonitis
perforation of peptic/duodenal ulcer, diverticulum, appendix, bowel, gallbladder
signs of peritonitis
prostration (extreme exhaustion), shock, lying still, positive cough test, tenderness, rigidity, guarding, no bowel sounds, erect CXR may show gas under the diaphragm
what should you check if all the signs of peritonitis
serum amylase as all of the signs are present in pancreatitis but this doesn’t require laparotomy
tests in acute abdomen
FBC, U&E, amylase, LFT, ABG, urinalysis, erect CXR, AXR, laparoscopy, CT, USS- shows perf and free fluid
plan
treat shock, crossmatch/G&S, blood culture, antibiotics, relieve pain, IVI, plain abdo film, CXR, ECG, NBM
what is important before anaesthetising the patient
treat shock- resus properly as anaesthesia can make shock worse
causes abdo pain RUQ
acute cholecystitis, duodenal ulcer, hepatitis, congestive hepatomegaly, pyelonephritis, appendicitis, pneumonia
causes abdo pain LUQ
ruptured spleen, gastric ulcer, AA, perf colon, pyelonephritis, pneum
causes abdo pain epigastrium
pancreatitis, MI, peptic ulcer, acute cholecystitis, perf oesophagus
causes abdo pain RLQ
appendicitis, salpingitis, tubo-ovarian abscess, ruptured ectopic, renal/ureteric stone, strangulated hernia, mesenteric adenitis, meckels diverticulum, crohns, perf caecum, psoas abscess
causes abdo pain umbilicus
intestinal obstruction, acute pancreatitis, early appendicitis, mesenteric thrombosis, AA, diverticulitis
causes pain LLQ
sigmoid diverticulitis, salpingitis, tubo-ovarian abscess, ruptured ectopic, strangulated hernia, perf colon, crohns,, UC, renal/ureteric stone
what is the chief cause of the medical acute abdomen
IBS so ask about pain assoc with loose stools relieved by defacation, bloating, urgency
