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
- 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
- Retroperitoneal
Medical Causes
- Referred Pain
- degenerative disease of thoracic spine
- herpes zoster
- lobar pneumonia
- pleurisy
- MI
- Haematological
- Infective & Inflammatory
- tabes dorsalis
- Henoch-Schönlein purpura
- Endocrine and metabolic
- uraemia
- hypercalcaemia
- diabetic ketoacidosis
- Addison's disease
- acute intermittent porphyria
Treatment
- Relieve Pain
- IV Fluid and NG suction
- Broad-spectrum antibiotics if sepsis or peritonitis
- 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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