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Acute Abdomen


Definition

  • Difficult to define
  • Indicates any non-traumatic disorder of acute onset,
  • symptoms predominantly abdominal,
  • may require urgent surgery

Distinguish between

  • Severe causes requiring urgent surgery
  • Severe abdominal pain that does not require surgery
  • Conditions which don't require urgent investigation and treatment

History

  • Age
  • Pain
    • Time of onset
    • Character
    • Severity
    • Constancy
    • Location (has it moved)
    • Radiation
    • Aggravating/alleviating factors
  • Vomiting
    • Place in sequence of events
    • Character
    • Frequency
  • Defaecation
  • Fever
  • Past History
    • Previous surgery may cause adhesions, no appendix
    • Recent trauma
    • Menstrual history

Examination

  • General
    • Patient lying comfortably?
    • Lying still but in pain?
    • Writhing in agony?
    • Flushed?
  • Pulse, temperature, respiration
  • Neck
  • Chest
  • Abdomen
  • Rectal examination
  • Vaginal examination

Investigations

  • WCC
  • U&Es
  • LFTs
  • Amylase
  • CXR
  • AXR
  • USS
  • KUB
  • IVU
  • Angiography

Differential Diagnoses

  • Gastrointestinal
    • Gut
      • Acute appendicitis
      • Intestinal obstruction
      • Perforated peptic ulcer
      • Diverticulitis
      • Inflammatory Bowel Disease
      • Acute exacerbation of peptic ulcer
      • Gastroenteritis
      • Mesenteric adenitis
      • Meckel's Diverticulitis
    • Liver & Biliary tract
      • Cholecystitis
      • Cholangitis
      • Hepatitis
      • Biliary Colic
    • Pancreas
      • Acute pancreatitis
    • Spleen
      • Splenic infarct & Spontaneous rupture
  • Urinary Tract
    • Cystitis
    • Acute pyelonephritis
    • Ureteric colic
    • Acute retention
  • Gynaecological
    • Ruptured ectopic pregnancy
    • Torsion of ovarian cyst
    • Ruptured ovarian cyst
    • Salpingitis
    • Severe dysmenorrhea
    • Mittelschmerz
    • Endometriosis
  • Vascular
  • Peritoneum
    • Primary peritonitis
    • Secondary peritonitis
  • Abdominal Wall
    • Rectus sheath haematoma
  • Retroperitoneal
    • Haemorrhage

Medical Causes

  • Referred Pain
    • degenerative disease of thoracic spine
    • herpes zoster
    • lobar pneumonia
    • pleurisy
    • MI
  • Haematological
    • Sickle cell crisis
  • Infective & Inflammatory
    • tabes dorsalis
    • Henoch-Schönlein purpura
  • Endocrine and metabolic
    • uraemia
    • hypercalcaemia
    • diabetic ketoacidosis
    • Addison's disease
    • acute intermittent porphyria

Treatment

  1. Relieve Pain
  2. IV Fluid and NG suction
  3. Broad-spectrum antibiotics if sepsis or peritonitis
  4. Surgery if indicated

Indications for surgery

  • localised peritoneal irritation
  • spreading tenderness
  • tense or progressive distension
  • generalised peritonitis
  • shock with bleeding or sepsis
  • free gas on radiograph
  • mesenteric occlusion on angiography
  • blood, bile, pus or bowel contents on paracentesis
 

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