The Acute Abdomen

Mr P Vaughan-ShawDecember 2010

definition

• Sudden, acute, severe abdominal pain

Abdominal pain• Visceral

– From viscera– Vague– Poorly localised

• Fore-gut epigastrium• Mid-gut peri-umbilical• Hind-gut lower abdomen

• Somatic– From surface structures e.g. Parietal peritoneum– Accurately localised– Eased by lying still, worse with movement

Mechanism

• Haemorrhage• Perforation• Obstruction• Inflammation• Infarction

haemorrhage

• AAA• Aortic dissection• Ruptured ovarian cysts• Ruptured ectopic• Rectus sheath haematoma• Abdominal trauma

Case 1

• 75 year old male. Abdominal Pain• You have 10 questions• What are you differentials?• You have 1 investigation• You have 3 phone calls

Perforation

• Peptic ulcer• Diverticular disease• CRC• UC• Perforated cholecystitis• Perforated appendicitis• Perforated obstructed bowel

Case 2

58 year old, unkempt manYou have 8 questionsYou have 1 investigation

http://www.youtube.com/watch?v=XU0__kgLWFc&feature=related

obstruction• Renal colic• Biliary colic• SBO

– Adhesional– Hernias – internal, inguinal, incisional, femoral

• LBO– CRC– Inflammatory stricture

• Volvulus– Sigmoid– Caecal

Case 3

• 69 year old lady with abdominal pain and distention

• You have 6 questions• You have 2 investigations• You have 2 phone calls

• http://www.youtube.com/watch?v=07xcVlEoidU

Case 4

• 85 year old demented man with distention• You have 5 questions• You have 1 investigation• You have 1 intervention

• Treatment

inflammation

• Appendicitis• Cholecystitis• Pancreatitis• Salpingitis• Mesenteric adenitis• Crohn’s disease• Ulcerative colitis• Meckel’s diverticulitis

Case 5

• 27 year old Southampton FC supporter• Under the medics for 1 week with abdominal

pain, bloody diarrhoea• You have 4 questions• You have 1 investigation

You have 2 optionsYou have 1 more investigationYou have 1 treatment

infarction

• Torsion of viscus• Ischaemic bowel

Case 6

• 74 year old man• Abdominal pain, distention• You have 5 questions• You have 2 investigations• You have 1 treatment