the acute abdomen

Question 1

what does sudden onset of pain suggest

Answer 1

• perforation
• rupture
• torsion
• acute pancreatitis
• infarction

Question 2

what does back pain suggest

Answer 2

• pancreatitis
• rupture of aortic aneurysm
• renal tract disease

Question 3

what does constant abdominal pain suggest

Answer 3

usually due to inflammation - supported by fever, tachycardia and or raised white cell count

Question 4

what does colicky abdominal pain suggest

Answer 4

blocked ‘tube’

Question 5

what does persistent vomiting with abdominal pain suggest

Answer 5

obstructive lesion of the gut

Question 6

what’s acute appendicitis

Answer 6

Appendicitis is inflammation of the appendix, a small pouch connected to your large intestine.

Question 7

what are clinical features of a patient with acute appendicitis

Answer 7

• abdominal pain starting vaguely in centre of abdomen, becoming localised to the right iliac fossa in the first few hours
• nausea
• vomiting
• anorexia
• occasional diarrhoea
• tenderness in right iliac fossa
• raised EBC, ESR and CRP

Question 8

how do you manage acute appendicitis

Answer 8

• laparoscopic surgery

Question 9

what is acute peritonitis

Answer 9

Peritonitis is an inflammation of the peritoneum, the tissue that lines the inner wall of the abdomen and covers and supports most of your abdominal organs. Peritonitis is usually caused by infection from bacteria or fungi.

Question 10

what are clinical features of peritonitis

Answer 10

• acute, severe abdominal pain
• followed by general collapse and shock
• generalised toxaemia (pre-eclampsia)

Question 11

what are investigations for peritonitis

Answer 11

• erect chest X ray - to detect free air under the diaphragm
• serum amylase - to diagnose acute pancreatitis
• imaging with ultrasound

Question 12

how do you manage peritonitis

Answer 12

• treated surgically after adequate resuscitation and the re-establishment of good urinary output
• insertion of a nasogastric tube, IV fluids and antibiotics