acute abdomen

1. require laparotomy
   1. organ rupture
      1. spleen, aorta, ectopic preg
      2. signs
         1. SHOCK !!
         2. abdo swell
      3. hx of trauma? (blunt -> spleen, penetrating -> liver)
   2. peritonitis

      Nota:

      • inflamm of peritoneum caused by infection
      1. PERFORATION of peptic or duodenal ulcer, diverticulum, appendix, bowel, gallbladder
      2. signs
         1. prostration, shock, lying still, cough test, tenderness (+/-rebound/percussion pain), board-like abdo rigidity, guarding, no bowel sounds
            1. NB//acute pancreatitis causes these signs but does NOT req laparotomy SO always check SERUM AMYLASE
      3. investigs
         1. erect CXR for gas under diaph
   3. don't rush to theater! anesthesia compounds shock, so resuc properly first unless blood loss too great to replace
2. may not req laparotomy
   1. local peritontitis
      1. eg diverticulitis, cholecystitis, salpingitis, appendicitis
      2. if abscess suspected (swelling, swinging fever, WCC up) do US or CT
         1. can do percutaneous guided drainage or by laparotomy
      3. look for sentinel loop (localised loop of small bowel dilation)
   2. colic
      1. regularly waxing/waning pain, caused by musc spasm in hollow viscus/tube
      2. causesRESTLESSNESS and pt will be pacing (unlike peritonitis)
   3. acute pancreatitis
3. tests
   1. U+ E, FBC, amylase, LFT, CRP, ABG (is there mesenteric ischemia?), urinalysis, erect CXR (may show air beneath diaphragm), AXR (obstruction), laproscopy- may avert open surg, CT if no delay, USS (for free fluid)
   2. always exclude preg +/- ectopic in repro age F

1. IBS = chief cause
2. MI, pneumonia, gastroenteritis or UTI, thyroid storm, phaeochromoctoma, DM, zoster, malaria (big spleen!), sickle cell crisis,bornholm disease, TB, typhoid fever, pneumococcal peritonitis, porphyria, cholera, henrch-schonlein, narcotic addiction, yersinia, tubes dorsalis, PAN, lead colic

   Nota:

   • phaeochromocytoma = neuroendocrine tumor of the medulla of the adrenal glands (secretes high catecholamines)

Nota:

• unsuspected, undectable unless looked for, deadly

1. mesenteric ischemia
2. acute pancreatitis
3. leaking AAA
4. nonspecific symps, signs mild, so always think of + hopefully spot!