Acute Abdomen Overview

Study Notes

Acute Abdomen Summary

Acute abdomen is a sudden onset of severe abdominal pain needing urgent medical or surgical care.
Types include inflammatory (appendicitis, cholecystitis, pancreatitis), obstructive (bowel obstructions, volvulus), vascular (mesenteric ischemia, ruptured abdominal aortic aneurysm), perforative (perforated peptic ulcer, perforated diverticulitis), and traumatic (blunt or penetrating trauma).
Causes include inflammation (appendicitis, diverticulitis, pancreatitis), infection (peritonitis, pelvic inflammatory disease), obstruction (bowel obstruction, gallstones), ischemia (mesenteric ischemia, strangulated hernia), perforation (perforated ulcer, perforated diverticulum), and trauma (blunt or penetrating injuries).
Signs and symptoms include severe abdominal pain (sudden and intense), nausea and vomiting (often accompanying pain), abdominal distension (swelling of the abdomen), fever (indicating possible infection), and shock (low blood pressure, rapid heart rate, sweating).
Complications can be sepsis (infection spreading through the body), peritonitis (inflammation of the peritoneum), organ failure (from severe infection or shock), and death (if not treated promptly).
Patients typically present with sudden, severe abdominal pain often accompanied by nausea, vomiting, and shock-like symptoms.
History and physical examination are crucial, looking at onset, location, pain character, associated symptoms, past medical history, medications, and recent trauma.
Examination may reveal abdominal tenderness, guarding, rigidity, distension, and abnormal bowel sounds.
Diagnostic investigations involve lab tests (complete blood count, electrolytes, liver function, amylase/lipase, lactate), imaging (abdominal X-ray, ultrasound, CT scan), and potentially electrophysiologic tests (ECG).
Diagnostic interventions might include diagnostic laparoscopy.
Treatment involves admission, triage, referral (to specialists), elevation of the head of the bed, fluid management, oxygen administration, IV antibiotics, possible catheterization or nasogastric tube insertion, and surgery (as needed).
Post-operative complications include infection, bleeding, and adhesions/recurrence
Multidisciplinary team involvement is crucial including surgeons, gastroenterologists, radiologists, anesthesiologists, and nursing staff.
Evaluation includes monitoring vitals (heart rate, blood pressure, temperature), assesses symptom relief and resolution of underlying cause, and watches for adverse effects from treatments.
Patient disposition determines referral, theater preparation if needed, or further management.