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The Acute Abdomen

An overview of the approach to the acute abdomen for final year medical students (and other interested parties).

Jim Higginson

on 21 December 2010

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Transcript of The Acute Abdomen

The Acute Abdomen What is it? What do I do about it? Abdominal pain

Of less than a week's duration

Requiring admission to hospital

Not previously investigated But... Definitions are mostly useful for research In real life, you don't get a definition, you get this: What's wrong doctor? I'm scared The Acute Abdomen in real life is one of those things where 'you know it when you see it.' The patient with acute belly pain could have anything
from Ruptured AAA to Trapped wind So... a scary fact for you: or... There are 225 days left until you are a house officer 225 days until this is your problem! So let's do a little role-playing as a group Imagine the scene:

You're in the doctor's mess on a night shift, 'enjoying' a rather grey-looking
cup of coffee at about 2 am, having clerked in all the elective patients.

You're just starting to think about some shut-eye, when... It's the HCA on the acute surgical ward:
" A patient's just turned up on the ward!
They look geet poorly and they've got real
bad bellyache - 10/10 in agony" What do you do first? "Elevator thoughts" Use the time travelling to see the patient to think about what could be going wrong. In the context of a phone-call as useless as this one, your differential diagnosis is as wide as the entirety of the acute abdomen... What is your differential? Peptic ulcer Pancreatitis Appendicitis Diverticulitis Cholecystitis Cholangitis Bowel obstruction Ureteric colic Urinary retention Surgical Mesenteric ischaemia Vovlulus Toxic megacolon Boerhaave's syndrome Perforation Medical Gynaecological Ruptured AAA Ectopic pregnancy Torsion of ovarian cyst Ovarian cyst rupture PID Fibroid degeneration Mittelschmertz Endometriosis MI Pneumonia Gastritis Gastroenteritis Mesenteric
adenitis UTI Curtis-FitzHugh
Syndrome Sickle cell
crisis Herpes
zoster Hepatitis Pyelonephritis DKA Alternatively... Common Terrifying Other Cholecystitis Diverticulitis Appendicitis Ureteric colic UTI Gastritis Pancreatitis Ectopic pregnancy MI Toxic megacolon Cholangitis Ruptured AAA Perforation Mesenteric ischaemia Endofthebedogram What next? "I think I have a perforated Meckel's
diverticulum, doctor." Data acquisition History Examination Investigations HPC PMHx PSHx SHx DHx Focused review ßHCG "visceral pain" "Parietal pain" Distension Peritonism Murphy's sign Inspection Incisions X-rays Bloods ABG What's missing? Other radiology SURGERY! Invasive monitoring Laparotomy Laparoscopy Surgery won't be your job; what will? Admission for observation... and...? Analgesia Preparing the patient for surgery Resuscitation Bloods Tubes Recognise the really sick patients Acquire good data to make good decisions Don't miss important details Try and have everything done before they ask for it! Thankyou!

Any questions? james.higginson@gmail.com
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