Surgery Year 2: Acute Abdomen Introduction

Questions and Answers

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?

Family history (correct)

Blood pressure

Respiratory rate

Heart rate

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?

Gallstones Signup and view all the answers

Which of the following laboratory investigations can indicate inflammation?

C-reactive protein (CRP) Signup and view all the answers

What is a common initial management step for a patient suspected of having pancreatitis?

Initiate IV fluids Signup and view all the answers

Which symptom is least likely to be associated with pancreatitis?

Gallbladder tenderness Signup and view all the answers

What is crucial to monitor if a patient is NPO (nil per os)?

Urinary output Signup and view all the answers

Which procedure is least likely to be performed for acute abdomen workup?

MRI Abdomen & Pelvis Signup and view all the answers

What is the recommended approach for pain management in a surgical setting?

Analgesia with care, usually opioids Signup and view all the answers

What does a sudden onset of pain typically indicate?

Perforation or hemorrhage Signup and view all the answers

Which type of pain is commonly associated with bowel obstruction?

Colicky pain Signup and view all the answers

Which symptom is NOT typically associated with gastrointestinal bleeding?

Jaundice Signup and view all the answers

What does right shoulder pain potentially indicate when assessing abdominal pain?

Gallbladder issues (Collin's sign) Signup and view all the answers

In which scenario should abdominal pain in a male over 50 be considered as an Abdominal Aortic Aneurysm (AAA)?

When in the back or flank Signup and view all the answers

Which character of pain is worsened by movement or coughing?

Constant pain due to inflammation Signup and view all the answers

What does the acronym SOCRATES help assess regarding pain?

Onset and character of pain Signup and view all the answers

What is a typical characteristic of pain associated with perforation?

Constant and of sudden onset Signup and view all the answers

What effect might changes in urinary habits indicate in a medical assessment?

Kidney or urinary tract issues Signup and view all the answers

When taking the past medical history, which factor is critical for understanding potential complications?

Previous abdominal operations Signup and view all the answers

What best defines an 'acute abdomen'?

A group of potentially life-threatening intra-abdominal conditions that require emergency treatment Signup and view all the answers

Which condition is NOT classified as a cause for an acute abdomen?

Chronic Gastritis Signup and view all the answers

Which symptom is indicative of a perforation rather than an inflammation in abdominal pain history?

Sudden onset of pain Signup and view all the answers

In examining a patient with an acute abdomen, which feature would most likely suggest an obstructive process?

Colicky pain Signup and view all the answers

Which of the following statements about management plans for acute abdomen is TRUE?

Resuscitation and initial treatment are crucial for outcomes. Signup and view all the answers

Which type of abdominal pain is typically associated with an inflammatory process?

Continuous dull pain Signup and view all the answers

Which of these is a common presentation of an acute bowel obstruction?

Vomiting of fecal matter Signup and view all the answers

What characterizes peritonitis?

Inflammation of the peritoneum Signup and view all the answers

Which factor is NOT essential to take into account when eliciting a history for an acute abdomen?

Patient's dietary habits in the last month Signup and view all the answers

Which condition involves ischemia and could present symptoms related to an acute abdomen?

Acute Bowel Ischemia Signup and view all the answers

Which symptom is common in both duodenal and gastric ulcers?

Steady epigastric pain Signup and view all the answers

What specific pain description is typically associated with a perforated duodenal or gastric ulcer?

Sudden onset, intense, and steady Signup and view all the answers

What is a common initial treatment approach for suspected appendicitis?

Immediate surgical intervention Signup and view all the answers

Which of the following is a potential complication of bowel obstruction?

Perforation Signup and view all the answers

Which diagnostic imaging technique would be most appropriate for confirming a perforated duodenal ulcer?

Erect chest X-ray Signup and view all the answers

In cases of suspected appendicitis, where does the pain typically begin?

Periumbilical region Signup and view all the answers

What is a typical clinical finding in a patient with bowel obstruction during an abdominal examination?

Increased bowel sounds if mechanical Signup and view all the answers

What characteristic symptom may be present with a kidney stone?

Severe flank pain radiating to the groin Signup and view all the answers

What is the most serious potential outcome of an abdominal aortic aneurysm (AAA)?

Rupture and shock Signup and view all the answers

Which factor is known to precipitate peptic ulcer pain?

Spicy foods Signup and view all the answers

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.