Podcast
Questions and Answers
Which symptom is typically associated with colicky pain?
Which symptom is typically associated with colicky pain?
What is the typical radiation pattern for pain starting from the appendix?
What is the typical radiation pattern for pain starting from the appendix?
Which factor is NOT included in the SOCRATES mnemonic for pain assessment?
Which factor is NOT included in the SOCRATES mnemonic for pain assessment?
Which scenario would indicate a strong suspicion of an abdominal aortic aneurysm (AAA) in a male over 50?
Which scenario would indicate a strong suspicion of an abdominal aortic aneurysm (AAA) in a male over 50?
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What type of pain is typically constant and associated with inflammation?
What type of pain is typically constant and associated with inflammation?
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What is defined as an acute abdomen?
What is defined as an acute abdomen?
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Which of the following is NOT a common cause of an acute abdomen?
Which of the following is NOT a common cause of an acute abdomen?
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Which symptom is associated with a sudden onset of pain in an acute abdomen?
Which symptom is associated with a sudden onset of pain in an acute abdomen?
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What type of pain is typically related to an obstructive process in an acute abdomen?
What type of pain is typically related to an obstructive process in an acute abdomen?
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In the context of acute abdomen, what does the term 'peritonitis' refer to?
In the context of acute abdomen, what does the term 'peritonitis' refer to?
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Which of the following is important for managing patients with an acute abdomen?
Which of the following is important for managing patients with an acute abdomen?
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Which condition is associated with ischaemia in the context of an acute abdomen?
Which condition is associated with ischaemia in the context of an acute abdomen?
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What initial step is essential in taking a medical history for a patient with suspected acute abdomen?
What initial step is essential in taking a medical history for a patient with suspected acute abdomen?
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What is the prognosis for pancreatitis if the prognostic score is greater than 3?
What is the prognosis for pancreatitis if the prognostic score is greater than 3?
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Which symptom is common in both peptic ulcer disease and pancreatitis?
Which symptom is common in both peptic ulcer disease and pancreatitis?
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What is the typical pain progression in appendicitis?
What is the typical pain progression in appendicitis?
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What potential complication can arise from pancreatitis?
What potential complication can arise from pancreatitis?
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Which sign indicates a perforated duodenal ulcer during examination?
Which sign indicates a perforated duodenal ulcer during examination?
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How is the pain from a peptic ulcer typically described?
How is the pain from a peptic ulcer typically described?
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What does the presence of gallbladder inflammation for 6 days to 6 weeks imply about surgical risks?
What does the presence of gallbladder inflammation for 6 days to 6 weeks imply about surgical risks?
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What is a potential local complication of pancreatitis?
What is a potential local complication of pancreatitis?
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What is the first step to assess when managing a patient in distress?
What is the first step to assess when managing a patient in distress?
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Which of the following symptoms is commonly associated with acute cholecystitis?
Which of the following symptoms is commonly associated with acute cholecystitis?
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In the physical examination process, which technique is NOT typically used for assessing the abdomen?
In the physical examination process, which technique is NOT typically used for assessing the abdomen?
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What laboratory test is particularly important for assessing infection in a patient?
What laboratory test is particularly important for assessing infection in a patient?
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During the systems review, which of the following factors should NOT be documented in the social history?
During the systems review, which of the following factors should NOT be documented in the social history?
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What preventive measure is recommended for all patients to avoid thromboembolic events?
What preventive measure is recommended for all patients to avoid thromboembolic events?
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Which imaging study can be most helpful in diagnosing gallbladder issues?
Which imaging study can be most helpful in diagnosing gallbladder issues?
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When would you typically consider administering oxygen to a patient?
When would you typically consider administering oxygen to a patient?
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What is a possible complication of acute appendicitis that can occur after 6 days?
What is a possible complication of acute appendicitis that can occur after 6 days?
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Which symptom is commonly associated with bowel obstruction depending on its level?
Which symptom is commonly associated with bowel obstruction depending on its level?
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What is a common characteristic of an abdominal aortic aneurysm?
What is a common characteristic of an abdominal aortic aneurysm?
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What are the potential causes of bowel obstruction?
What are the potential causes of bowel obstruction?
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What symptom is not typical of kidney stones?
What symptom is not typical of kidney stones?
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What are the likely complications that can arise from acute appendicitis after an extended period?
What are the likely complications that can arise from acute appendicitis after an extended period?
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Which imaging technique is most effective in identifying an obstruction in the abdomen?
Which imaging technique is most effective in identifying an obstruction in the abdomen?
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Which symptom is a hallmark sign of kidney stones that distinguishes it from other abdominal conditions?
Which symptom is a hallmark sign of kidney stones that distinguishes it from other abdominal conditions?
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What characterizes a ruptured abdominal aortic aneurysm (AAA) in terms of clinical presentation?
What characterizes a ruptured abdominal aortic aneurysm (AAA) in terms of clinical presentation?
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Which of the following is a common cause of bowel obstruction related to adhesions?
Which of the following is a common cause of bowel obstruction related to adhesions?
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What is a crucial factor in deciding the outcome of patients with an acute abdomen?
What is a crucial factor in deciding the outcome of patients with an acute abdomen?
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Which type of pain is most likely associated with a perforation of an organ in the abdomen?
Which type of pain is most likely associated with a perforation of an organ in the abdomen?
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What type of abdominal condition might necessitate surgical intervention despite an initial conservative management approach?
What type of abdominal condition might necessitate surgical intervention despite an initial conservative management approach?
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Which condition is NOT commonly classified under obstructive causes of acute abdomen?
Which condition is NOT commonly classified under obstructive causes of acute abdomen?
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In assessing a patient with an acute abdomen, which feature of pain should prompt suspicion of an obstructive process?
In assessing a patient with an acute abdomen, which feature of pain should prompt suspicion of an obstructive process?
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Which of the following is NOT a salient feature to explore during a medical history for acute abdomen assessment?
Which of the following is NOT a salient feature to explore during a medical history for acute abdomen assessment?
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Which diagnostic approach is essential when formulating a differential diagnosis for acute abdomen?
Which diagnostic approach is essential when formulating a differential diagnosis for acute abdomen?
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What does the term 'peritonitis' imply in the context of acute abdomen?
What does the term 'peritonitis' imply in the context of acute abdomen?
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What does the 'R' in the SOCRATES mnemonic stand for in the context of pain assessment?
What does the 'R' in the SOCRATES mnemonic stand for in the context of pain assessment?
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Which pattern of pain is typically characterized by a sudden onset and is often indicative of a perforation?
Which pattern of pain is typically characterized by a sudden onset and is often indicative of a perforation?
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In which situation would a patient presenting with back pain be most likely suspected of having an abdominal aortic aneurysm?
In which situation would a patient presenting with back pain be most likely suspected of having an abdominal aortic aneurysm?
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What is the typical radiation pattern for pain originating from the gallbladder, as indicated by Collin's sign?
What is the typical radiation pattern for pain originating from the gallbladder, as indicated by Collin's sign?
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What associated symptom is most concerning in a patient experiencing vomiting related to potential abdominal issues?
What associated symptom is most concerning in a patient experiencing vomiting related to potential abdominal issues?
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What is the primary purpose of performing palpation during a physical examination of the abdomen?
What is the primary purpose of performing palpation during a physical examination of the abdomen?
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In the universal management plan for a patient with suspected acute abdomen, which of these options is prioritized first?
In the universal management plan for a patient with suspected acute abdomen, which of these options is prioritized first?
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Which laboratory investigation is particularly significant in evaluating inflammation in a patient with acute abdomen?
Which laboratory investigation is particularly significant in evaluating inflammation in a patient with acute abdomen?
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What symptom is commonly evaluated during the physical examination for acute cholecystitis?
What symptom is commonly evaluated during the physical examination for acute cholecystitis?
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Which intervention is considered an essential part of managing any patient with an acute abdomen?
Which intervention is considered an essential part of managing any patient with an acute abdomen?
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During a systems review, which aspect of social history might commonly be overlooked by patients?
During a systems review, which aspect of social history might commonly be overlooked by patients?
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What is a common imaging technique used to evaluate suspected abdominal fluid collections or masses?
What is a common imaging technique used to evaluate suspected abdominal fluid collections or masses?
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In the assessment of abdominal pain, what does the term 'guarding' refer to?
In the assessment of abdominal pain, what does the term 'guarding' refer to?
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What indicates a severe case of pancreatitis based on the prognostic score?
What indicates a severe case of pancreatitis based on the prognostic score?
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Which symptom is most likely associated with a perforated duodenal ulcer?
Which symptom is most likely associated with a perforated duodenal ulcer?
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What complication may arise from pancreatitis that is characterized by the collection of fluid?
What complication may arise from pancreatitis that is characterized by the collection of fluid?
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In the context of appendicitis, what characterizes the initial pain location?
In the context of appendicitis, what characterizes the initial pain location?
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Which factor is typically a precursor to the development of peptic ulcers?
Which factor is typically a precursor to the development of peptic ulcers?
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What is a primary treatment consideration for a patient with a longstanding gallbladder inflammation?
What is a primary treatment consideration for a patient with a longstanding gallbladder inflammation?
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What is a common risk associated with gallbladder inflammation lasting 4-6 days?
What is a common risk associated with gallbladder inflammation lasting 4-6 days?
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What significant finding might suggest the presence of necrosis in a patient with pancreatitis?
What significant finding might suggest the presence of necrosis in a patient with pancreatitis?
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Study Notes
Defining Acute Abdomen
- A group of intra-abdominal conditions requiring emergency treatment and intervention
- Potentially life-threatening
- Peritonitis is a general term for inflammation of the peritoneum
Common Causes
-
Perforation:
- Perforated Peptic Ulcer, Ruptured AAA, Perforated Bowel, Perforated Bladder
-
Inflammatory:
- Acute Appendicitis, Acute Diverticulitis, Acute Pancreatitis, Acute Cholecystitis
-
Ischaemia / Other:
- Acute Bowel Ischaemia, Mesenteric Ischaemia, Torsion, Gynaecological Emergencies
-
Obstructive:
- Small Bowel Obstruction, Large Bowel Obstruction, Intussusception
Importance of Recognition
- Recognition of an acute abdomen is essential
- Resuscitation and initial medical treatment are crucial for outcome
- Triage plays an important role
Taking a Medical History
-
Understanding pain is essential:
- Onset: Sudden onset - perforation; Gradual/Rapid - inflammation
- Character: Constant pain - likely inflammatory; Colicky pain - likely obstructive
- Location: Circle around the area of pain, size of circle can be helpful
- Referral: Pain often has specific referral patterns
SOCRATES Mnemonic for Pain Assessment
- S = Site
- O = Onset
- C = Character
- R = Radiation
- A = Associated Symptoms
- T = Timing
- E = Exacerbating or Relieving Factors
- S = Severity
Nature and Character of Pain
- Colicky pain: Obstruction of a muscular viscus
- Constant pain: Usually due to inflammation
- Pain exacerbated by movement or coughing indicates parietal peritoneum involvement (Peritonitis)
- Constant pain of sudden onset is typical of a perforation
Radiation of Pain
- Pain can radiate to different areas:
- Right shoulder: Gallbladder (Collin's Sign)
- Around flank to groin: Kidney/Ureter
- Appendix pain starts centrally then goes to RIF
- Back: AAA, PUD, Pancreatitis
- Pain in back or flank in males > 50 should be considered an AAA until proven otherwise
Associated Symptoms & Medical History
- Anorexia, Nausea, Vomiting
- Hematemesis or "Coffee Grounds": Presence of blood in first vomit, if not - Mallory Weiss
- Change in bowel habits, Melaena
- Change in urinary habits: Urine appearance and smell
- Past medical/surgical history, previous abdominal operations
- Menstrual History: Last menstrual period, regularity, OCP, abnormal bleeding/discharge
- Drug History, Allergies, Family History, Social History (occupation, accommodation, smoking, alcohol, drugs, etc.)
- Systems Review: Sweep through all systems as patients may forget
Physical Exam
- Vital Signs (HR, BP, RR, Temp, O2 Sats, Urinary Output)
- ABCDE: Airway, Breathing, Circulation, Disability, Exposure
- Inspection: Incisons, scars, movement
-
Palpation:
- Superficial: Tenderness, guarding (involuntary), rebound, rigidity
- Deep: Masses, Liver, Spleen, AAA
- Percussion: Organs or fluid
- Auscultation: Ileus or enteritis
- Groins + External Genitalia
- Rectal Examination
Workup
- Bedside investigations: History and Examination, ECG, Urine dipstick and Beta HCG, Glucose check
- Laboratory investigations:
- FBC (esp. White cell count), C-reactive protein (CRP), ABG/VBG (lactate) & repeat if abnormal, Kidney function tests & Serum electrolytes, LFTs, Serum amylase/lipase, Coagulation profile
- Imaging:
- Erect CXR, Abdominal X-ray (Erect and Supine Abdomen), Ultrasound abdomen, CT Abdomen & Pelvis, MRI Abdomen & Pelvis, ERCP, Interventional Radiology
Universal Management Plan
- Admit patient
- ABCDE: Airway, Breathing, Circulation, Disability, Exposure
- Oxygen if in doubt - until blood gasses (ABG) available
- IV Fluids: 100ml/hour until losses known, intake/output chart, consider urinary catheter
- Analgesia: Opiates usually necessary, be aware of potential complications
- Anti-emetics: Occasionally
- Antibiotics: Always consider, Co-amoxiclav is common
- NPO +/- NG if vomiting
- Type and screen: If surgery potential
- DVT prophylaxis: Always
Acute Cholecystitis
- Inflammation of gallbladder
- Commonly associated with gallstones
- RUQ pain, nausea, vomiting, tenderness, guarding, fever, + Murphy's Sign
Gallbladder - Inflammation and Surgical Implications
- No inflammation: Surgery relatively easy and safe
- 1-3 days of inflammation: Surgery more difficult but usually safe
- 4-6 days of inflammation: Surgery can be much more difficult and dangerous
- 6 days to 6 weeks of inflammation: Surgery very difficult and dangerous
- 3 months of inflammation: Surgery straightforward and safe again
Pancreatitis
- Causes: Ethanol, Gallstones, and others
- Digestion of the pancreatic acini releases digestive enzymes and cytokines throughout the body
- Constant epigastric pain, band-like, radiating straight to back
- Relieved by bending forward
- Nausea, vomiting, abdominal tenderness
- Requires fluid and oxygen
Complications of Pancreatitis
- Systemic: Organ failure
- Local: Necrosis, abscess, collections of fluid
- Prognosis: Prognostic Score (Ranson Score):
- P: PaO2 < 60 mmHg
- A: Age > 55 years
- N: Neutrophils > 15x10⁹
- C: Calcium < 2mmol/l
- R: Raised Urea > 16mmol/l
- E: Enzyme (LDH) > 600units/l
- A: Albumen < 32mmol/l
- S: Sugar > 10mmol/l -> 3 or more points indicates severe pancreatitis
Peptic Ulcer Disease (PUD)
- Epigastric pain:
- Relieved by eating (DU)
- Precipitated by food (GU)
- Burning, gnawing, aching sensation
- Increased by coffee, stress, spicy food, smoking
- Improved by alkaline food, antacids, milk
Complications of PUD
- GI Bleed
- Perforation: Intense, steady pain, patient lies still, rigid abdomen
Appendicitis
- Appendix becomes inflamed, gangrenous, possibly perforated
- Usually caused by faecolith obstruction
- Pain begins in the periumbilical area and moves to RIF
- Anorexia, nausea, vomiting
- Examination: Tenderness, guarding, rebound in RIF
- Low-grade pyrexia
Complications of Acute Appendicitis
- Perforation
- Appendix Mass: After 6 days
- Appendix Abscess: Spiking temperature
- Adhesions
Bowel Obstruction
- Causes: Adhesions, herniae, impactions, tumours
- Presentation:
- Abdominal pain: Crampy
- Abdominal distension
- Vomiting: Nausea, depends on level of obstruction
- Constipation: Depends on level of obstruction
- Bowel sounds: Increased in mechanical obstruction, decreased in ileus
- Imaging: Plain films (Erect and Supine Abdomen), CT Abdomen to identify lesion
Abdominal Aortic Aneurysm (AAA)
- Localized weakness of the blood vessel wall with dilation
- AAA: Pulsating mass in the abdomen
- Can cause lower back pain
- Rupture is a serious complication with significant mortality
- Repair by open or Endovascular surgery
Kidney Stone
- Mineral deposits form in the kidney and move to the ureter
- Often associated with history of recent UTI
- Severe flank pain radiating to groin and scrotum (loin to groin)
- Nausea, vomiting due to pain
- Haematuria
- Extreme restlessness
Summary
- Recognize an acute abdomen
- Construct a differential diagnosis (Medical and Surgical)
- Plan appropriate investigations
- Management based on ABCDE principles
- This introduction hopes to stimulate further interest in the topic
Acute Abdomen
- A group of intra-abdominal conditions requiring urgent treatment.
- Peritonitis is inflammation of the peritoneum.
- Common causes include perforation, inflammatory conditions, obstruction, and ischemia.
Causes of Acute Abdomen
-
Perforation:
- Perforated peptic ulcer
- Ruptured abdominal aortic aneurysm (AAA)
- Perforated bowel
- Perforated bladder
-
Inflammatory:
- Acute appendicitis
- Acute diverticulitis
- Acute pancreatitis
- Acute cholecystitis
-
Obstructive:
- Small bowel obstruction
- Large bowel obstruction
- Intussusception
-
Ischemia/Other:
- Acute bowel ischemia
- Mesenteric ischemia
- Torsion
- Gynecological emergencies
Essential Understanding of Acute Abdomen
- Recognize an acute abdomen.
- Understand that resuscitation and initial medical treatment are crucial for outcome.
- Triage is essential.
- Many patients require surgery, while conservative management is best for other conditions.
Taking a Medical History
- Understanding of pain is paramount.
-
Onset:
- Sudden pain suggests perforation.
- Gradual/rapid pain suggests inflammation.
-
Character:
- Constant pain often indicates an inflammatory process.
- Colicky pain often indicates an obstructive process.
-
Location:
- Use a circle to identify the area of pain and size.
-
Referral:
- Be aware of specific pain referral patterns.
SOCRATES Mnemonic for Pain
- Site
- Onset
- Character
- Radiation
- Associated symptoms
- Timing
- Exacerbating or Relieving factors
- Severity
Nature and Character of Pain
- Colicky pain suggests obstruction of a muscular viscus.
- Constant pain typically indicates inflammation.
- If pain worsens with movement or coughing, parietal peritoneum is likely involved, leading to peritonitis.
- Constant pain with sudden onset is characteristic of a perforation.
Radiation of Pain
- Right shoulder pain suggests gallbladder issues (Collin’s sign).
- Pain around flank to groin suggests kidney or ureter problems.
- Appendicitis pain starts centrally and moves to the right iliac fossa (RIF).
-
Back pain can indicate AAA, peptic ulcer disease (PUD), or pancreatitis.
- Pain in the back or flank in men over 50 should be assessed for AAA until proven otherwise.
Other Presenting Complaints
- Anorexia, nausea, and vomiting can all be associated with an acute abdomen.
- Hematemesis or "coffee grounds" vomit: If there was no blood in the initial vomit, it could be Mallory Weiss syndrome.
- Change in bowel habits, melena, and a change in urinary habits should be investigated.
Rest of the Medical History
-
Past medical and surgical history:
- Any previous medical/surgical history.
- Any previous abdominal operations.
-
Menstrual history:
- Last menstrual period (LMP).
- Regular or irregular cycles.
- Oral contraceptive pill (OCP) use.
- Abnormal bleeding or discharge.
- Drug history, allergies, and family history.
-
Social history:
- Occupation, accommodation, smoking, alcohol use, and drug use.
-
Systems review:
- Complete review of all body systems to avoid missed information.
Physical Examination
- Vital Signs: HR, BP, RR, Temp, O2 Sats, and Urinary output.
- ABCDE (Airway, Breathing, Circulation, Disability, and Exposure).
-
Inspection:
- Scars, incisions, and movement.
-
Palpation (superficial):
- Tenderness, guarding, rebound, rigidity.
- Work toward the area of pain.
-
Palpation (deep):
- Masses, liver, spleen, AAA.
-
Percussion:
- Organs or fluid.
-
Auscultation:
- Ileus or enteritis.
- Groins and external genitalia.
- Rectal examination.
Workup
- Bedside Investigations: History and Examination.
-
Laboratory Investigations:
- Complete Blood Count (CBC), especially the white cell count (WBC).
- C-reactive protein (CRP).
- Arterial Blood Gas (ABG)/Venous Blood Gas (VBG) including lactate, repeat if abnormal.
- Urine dipstick and beta-HCG (human chorionic gonadotropin).
- Glucose.
- Kidney function tests and serum electrolytes.
- Liver function tests (LFTs).
- Serum amylase/lipase.
- Coagulation Profile.
-
Imaging:
- Erect chest x-ray (CXR).
- Abdominal X-ray (erect and supine).
- Ultrasound Abdomen.
- CT Abdomen and Pelvis.
- MRI Abdomen and Pelvis.
- Endoscopic retrograde cholangiopancreatography (ERCP) in some cases.
- Interventional radiology procedures.
Universal Management Plan
- Admit the patient
- ABCDE
- Oxygen: Administer if in doubt until ABG available.
- IV Fluids: Administer 100 ml/hour until losses are known. Use an intake/output chart. Consider a urinary catheter.
- Analgesia: Opiates are often necessary but use caution.
- Anti-emetics: Use as needed.
- Antibiotics: Co-amoxiclav is a commonly used antibiotic.
- NPO (nothing by mouth): Consider a nasogastric tube if the patient is vomiting.
- Type and screen: Perform if surgery is considered necessary.
- DVT prophylaxis: Always use DVT prophylaxis.
- Role of Surgery? Timing?
Acute Cholecystitis
- Inflammation of the gallbladder, often associated with gallstones.
-
Symptoms:
- Right upper quadrant (RUQ) pain, nausea, vomiting, tenderness, guarding, fever, and Murphy’s sign.
Gallbladder Inflammation Stages
- No Inflammation: Surgery is relatively easy and safe.
- 1-3 Days of Inflammation: Surgery is more difficult but usually safe.
- 4-6 Days of Inflammation: Surgery can be more difficult and dangerous.
- 6-6 Weeks of Inflammation: Surgery is very difficult and dangerous.
- 3+ Months of Inflammation: Surgery is easier and safer again.
Pancreatitis
- Causes: Ethanol and gallstones are common causes, but others exist.
- Pathophysiology: Digestion of pancreatic acini and release of digestive enzymes and cytokines throughout the body.
- Symptoms: Constant epigastric pain, band-like and radiating to the back. Relieved by bending forward. Nausea, vomiting, abdominal tenderness.
- Management: Requires fluid resuscitation and oxygen.
Pancreatitis Complications
- Systemic: Organ failure.
- Local: Necrosis, abscess, fluid collections.
- Prognosis: The Ranson Prognostic Score helps determine severity.
Ranson Prognostic Score
- PaO2 < 60 mmHg
- Age > 55 years
- Neutrophils > 15x109
- Calcium < 2 mmol/l
- Raised Urea > 16 mmol/l
- Enzyme (LDH) > 600 units/l
- Albumen < 32 mmol/l
- Sugar > 10 mmol/l
- >3 points indicate severe pancreatitis.
Peptic Ulcer Disease (PUD)
-
Symptoms: Epigastric pain, usually:
- Relieved by eating (duodenal ulcer).
- Precipitated by food (gastric ulcer).
- Pain described as burning, gnawing, or aching.
- Increased by coffee, stress, spicy food, smoking, and alcohol.
- Improved by alkaline food, antacids, and milk.
PUD Complications
- Gastrointestinal (GI) bleed.
- Perforation: Intense, steady pain, with the patient lying still and a rigid abdomen.
Bleeding Duodenal Ulcer
- Can present with hematemesis (vomiting blood) or melena (black, tarry stools).
Perforated Duodenal/Gastric Ulcer
- Symptoms: Sudden-onset, intense epigastric pain, with tenderness, guarding, rigidity and abdominal silence on auscultation.
- X-Ray: Erect chest - look for air under the diaphragm (pneumoperitoneum).
Appendicitis
- Pathophysiology: The appendix becomes inflamed, gangrenous, and possibly perforated, often due to a faecolith obstruction.
- Presentation: Pain begins in the periumbilical area and moves to the RIF. Anorexia, nausea, vomiting, tenderness, guarding, rebound tenderness in RIF, and low-grade pyrexia.
Appendicectomy
- Surgical removal of the appendix.
Complications of Acute Appendicitis
- Perforation.
- Appendix mass: After 6 days.
- Appendix abscess: Spiking temperature.
- Adhesions.
Bowel Obstruction
- Causes: Adhesions, herniae, impactions, tumors.
- Presentation: Abdominal pain (crampy), abdominal distention, vomiting (depending on obstruction level), and constipation (depending on obstruction level).
- Bowel Sounds: Increased in mechanical obstruction and decreased in ileus.
- Imaging: Plain films (erect and supine abdomen) and CT abdomen to identify the lesion.
CT Abdomen
- Can be used to diagnose or confirm a variety of acute abdominal conditions.
Clinical Case
- Example: A 38-year-old male presents with severe epigastric pain for the past 5 hours.
- Next Steps: Start with a thorough history and physical examination, followed by appropriate investigations based on the findings.
Abdominal Aortic Aneurysm (AAA)
- Pathophysiology: Localized weakness of the blood vessel wall causing dilation.
- Presentation: Pulsating mass in the abdomen.
- Symptoms: May cause lower back pain.
- Complications: Rupture leading to shock and high mortality.
- Management: Repair by open or endovascular procedures.
Kidney Stone
- Pathophysiology: Mineral deposits form in the kidney, move to the ureter. Often associated with a recent urinary tract infection (UTI).
- Presentation: Severe flank pain radiating to the groin and scrotum (loin to groin pain), nausea, vomiting (due to pain), hematuria, and extreme restlessness.
Summary
-
Recognize an acute abdomen.
-
Construct a differential diagnosis: Be aware of both surgical and medical differential diagnoses.
-
Plan appropriate investigations.
-
Management: Follow ABCDE principles.
-
This introduction to the acute abdomen is intended to stimulate further learning.
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Description
This quiz explores the vital concept of acute abdomen, its definitions, common causes, and the importance of recognition in emergency settings. Understand how timely medical history and symptom assessment can influence treatment outcomes. Perfect for medical students or professionals looking to enhance their emergency care knowledge.
