The Acute Abdomen

Mr P Vaughan-Shaw
December 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 man
You have 8 questions
You have 1 investigation
http://www.youtube.com/watch?v=XU0__k
gLWFc&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=07xcVlEoi
dU
 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 options
You have 1 more investigation
You 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