Podcast
Questions and Answers
What is the primary purpose of conducting a systems review during a patient evaluation?
What is the primary purpose of conducting a systems review during a patient evaluation?
- To ensure no symptoms are overlooked (correct)
- To assess history of family diseases
- To confirm allergies to medications
- To summarize social history
Which of the following would NOT typically be assessed during the vital signs check?
Which of the following would NOT typically be assessed during the vital signs check?
- Family history (correct)
- Blood pressure
- Respiratory rate
- Heart rate
In the context of abdominal examination, what does 'guarding' signify?
In the context of abdominal examination, what does 'guarding' signify?
- Pain relief after surgery
- Absence of tenderness
- Involuntary muscle tension due to pain (correct)
- Presence of fluid in the abdomen
What is the most common condition associated with acute cholecystitis?
What is the most common condition associated with acute cholecystitis?
Which of the following laboratory investigations can indicate inflammation?
Which of the following laboratory investigations can indicate inflammation?
What is a common initial management step for a patient suspected of having pancreatitis?
What is a common initial management step for a patient suspected of having pancreatitis?
Which symptom is least likely to be associated with pancreatitis?
Which symptom is least likely to be associated with pancreatitis?
What is crucial to monitor if a patient is NPO (nil per os)?
What is crucial to monitor if a patient is NPO (nil per os)?
Which procedure is least likely to be performed for acute abdomen workup?
Which procedure is least likely to be performed for acute abdomen workup?
What is the recommended approach for pain management in a surgical setting?
What is the recommended approach for pain management in a surgical setting?
What does a sudden onset of pain typically indicate?
What does a sudden onset of pain typically indicate?
Which type of pain is commonly associated with bowel obstruction?
Which type of pain is commonly associated with bowel obstruction?
Which symptom is NOT typically associated with gastrointestinal bleeding?
Which symptom is NOT typically associated with gastrointestinal bleeding?
What does right shoulder pain potentially indicate when assessing abdominal pain?
What does right shoulder pain potentially indicate when assessing abdominal pain?
In which scenario should abdominal pain in a male over 50 be considered as an Abdominal Aortic Aneurysm (AAA)?
In which scenario should abdominal pain in a male over 50 be considered as an Abdominal Aortic Aneurysm (AAA)?
Which character of pain is worsened by movement or coughing?
Which character of pain is worsened by movement or coughing?
What does the acronym SOCRATES help assess regarding pain?
What does the acronym SOCRATES help assess regarding pain?
What is a typical characteristic of pain associated with perforation?
What is a typical characteristic of pain associated with perforation?
What effect might changes in urinary habits indicate in a medical assessment?
What effect might changes in urinary habits indicate in a medical assessment?
When taking the past medical history, which factor is critical for understanding potential complications?
When taking the past medical history, which factor is critical for understanding potential complications?
What best defines an 'acute abdomen'?
What best defines an 'acute abdomen'?
Which condition is NOT classified as a cause for an acute abdomen?
Which condition is NOT classified as a cause for an acute abdomen?
Which symptom is indicative of a perforation rather than an inflammation in abdominal pain history?
Which symptom is indicative of a perforation rather than an inflammation in abdominal pain history?
In examining a patient with an acute abdomen, which feature would most likely suggest an obstructive process?
In examining a patient with an acute abdomen, which feature would most likely suggest an obstructive process?
Which of the following statements about management plans for acute abdomen is TRUE?
Which of the following statements about management plans for acute abdomen is TRUE?
Which type of abdominal pain is typically associated with an inflammatory process?
Which type of abdominal pain is typically associated with an inflammatory process?
Which of these is a common presentation of an acute bowel obstruction?
Which of these is a common presentation of an acute bowel obstruction?
What characterizes peritonitis?
What characterizes peritonitis?
Which factor is NOT essential to take into account when eliciting a history for an acute abdomen?
Which factor is NOT essential to take into account when eliciting a history for an acute abdomen?
Which condition involves ischemia and could present symptoms related to an acute abdomen?
Which condition involves ischemia and could present symptoms related to an acute abdomen?
Which symptom is common in both duodenal and gastric ulcers?
Which symptom is common in both duodenal and gastric ulcers?
What specific pain description is typically associated with a perforated duodenal or gastric ulcer?
What specific pain description is typically associated with a perforated duodenal or gastric ulcer?
What is a common initial treatment approach for suspected appendicitis?
What is a common initial treatment approach for suspected appendicitis?
Which of the following is a potential complication of bowel obstruction?
Which of the following is a potential complication of bowel obstruction?
Which diagnostic imaging technique would be most appropriate for confirming a perforated duodenal ulcer?
Which diagnostic imaging technique would be most appropriate for confirming a perforated duodenal ulcer?
In cases of suspected appendicitis, where does the pain typically begin?
In cases of suspected appendicitis, where does the pain typically begin?
What is a typical clinical finding in a patient with bowel obstruction during an abdominal examination?
What is a typical clinical finding in a patient with bowel obstruction during an abdominal examination?
What characteristic symptom may be present with a kidney stone?
What characteristic symptom may be present with a kidney stone?
What is the most serious potential outcome of an abdominal aortic aneurysm (AAA)?
What is the most serious potential outcome of an abdominal aortic aneurysm (AAA)?
Which factor is known to precipitate peptic ulcer pain?
Which factor is known to precipitate peptic ulcer pain?
Study Notes
Acute Abdomen - Overview
- Acute abdomen refers to life-threatening intra-abdominal conditions requiring emergency intervention.
- Peritonitis indicates inflammation of the peritoneum, crucial to recognize for diagnosis.
Learning Outcomes
- Ability to define acute abdomen and list its common causes.
- Proficiency in eliciting historical details, conducting examinations, and creating differential diagnoses.
- Knowledge of appropriate investigations and management plans.
Causes of Acute Abdomen
- Inflammatory Conditions:
- Acute Appendicitis
- Acute Cholecystitis
- Acute Pancreatitis
- Acute Diverticulitis
- Perforated Peptic Ulcer
- Ruptured AAA (Abdominal Aortic Aneurysm)
- Obstructive Causes:
- Small and Large Bowel Obstruction
- Intussusception
- Torsion
- Gynaecological Emergencies
Medical History Assessment
- Pain Characteristics:
- Onset: Sudden may indicate perforation, gradual suggests inflammation.
- Location: Ask the patient to indicate pain by pointing or drawing.
- Character: Constant pain likely indicates inflammation; colicky pain suggests obstruction.
- Associated Symptoms:
- Anorexia, nausea, vomiting, changes in bowel and urinary habits.
Physical Examination
- Assess vital signs: Heart rate, blood pressure, respiratory rate, temperature, oxygen saturation, and urinary output.
- Conduct thorough abdominal inspection and palpation, noting any tenderness, guarding, or rigidity.
- Check for signs of dehydration and fluid retention.
- Perform necessary percussion and auscultation to evaluate organ status.
Investigations
- Bedside: History and examination, ECG, urine dipstick.
- Laboratory: FBC, CRP, ABG/VBG, kidney function tests, liver function tests, serum amylase/lipase, coagulation profile.
- Imaging: Erect CXR, abdominal X-rays (erect and supine), ultrasound, CT, MRI, ERCP.
Management Plan
- Initiate immediate admission and assess airway, breathing, circulation, and expose the patient as needed.
- Administer oxygen; start IV fluids cautiously.
- Provide analgesia, preferably opiates, while monitoring for any adverse effects.
- Administer antibiotics and consider NPO (nothing by mouth) if vomiting occurs.
- DVT prophylaxis is critical, especially if surgical intervention is anticipated.
Specific Conditions
- Acute Cholecystitis: Symptoms include RUQ pain, nausea, and +Murphy’s sign.
- Pancreatitis: Characterized by constant severe epigastric pain that may radiate to the back, commonly due to gallstones or alcohol.
- Peptic Ulcer Disease: Results in well-localized epigastric pain influenced by food intake. Can present with complications like GI bleed or perforation.
- Appendicitis: Starts with periumbilical pain, often migrates to the RIF (right iliac fossa). Monitor for perforation which can lead to abscess formation.
Additional Considerations
- Abdominal Aortic Aneurysm (AAA): Presents as a pulsating abdominal mass; requires urgent repair if ruptured.
- Kidney Stones: Severe flank pain radiating to groin, often with blood in urine and nausea.
- Always be vigilant for surgical and medical differential diagnoses and ensure commencing treatment according to ABCDE protocol.
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Description
This quiz provides a comprehensive introduction to acute abdomen, a critical topic in Year 2 Surgery at RCSI. Students will learn to define acute abdomen, identify common causes, and examine its salient features during clinical history taking and physical exams.
