The Acute Abdomen
Yingda Li
6th Oct, 2011
Royal Melbourne Hospital
Objectives
1. Develop a rational approach to assessing and
managing the acute abdomen
2. Identify ‘red flags’ on history and examination
3. Have a set of ‘rules’ as safety nets
4. Familiarise with style of questions commonly asked in
exams
Overview
 Definitions




History
Examination
Investigations
Management
 Multiple choice questions
Definitions




Pain
Acute
Severe
Requiring urgent attention
 Not always surgical
 Not always abdominal source
Rule 1. Epigastric
pain may be from
supra-diaphragmatic
source
Rule 2. Women of
History
childbearing age
 Demographics




are
pregnant
till
Rule
3. Never
proved
otherwise
underestimate
abdominal
Rule 4.
Sudden pain in
elderly
onset pain the
equals
Tempo
Site, radiation
perforation,
Quality
vascular or torsion
Associated symptoms
Rule 5. Vomiting
 Risk factors
is a key associated
 Previous surgery
symptom
 Gynaecological history
 AMPLE
Red flags
Examination
 Preparation (privacy, consent, exposure, positioning, chaperone)
Rule 6. Vital signs
 End-of-the-bed appearance
are vital
 Vital signs
 Look, listen, feel
 PR, PV, testicular
 Eponymous signs
Rule 7. Is there
peritonism, is
there a hernia and
is there a AAA?
 Bedside tests (FWT, bhCG, ECG, BSL)
 Symptoms out of proportion to signs
Investigations


Diagnostic
Pancreatic enzymes,
Laboratory cardiac enzymes
MSU
XR, USS, CT, MR
Radiology Laparoscopy, ERCP
Prognostic
CRP, platelets, clotting
profile
CT
Criteria
Supportive
Inflammatory markers
UEC, LFTs
Lactate
Preoperative
Group and screen
Crossmatch
Management
Resuscitation
Airway
Breathing
Circulation
General measures
NBM, IV fluids, analgesia, antiemesis
NGT, IDC
Serial examination
Specific measures
Antibiotics
Open surgery, laparoscopy
ERCP, image-guided percutaneous drainage,
sigmoidoscopic decompression, angioembolisation
MCQs
1.
2.
3.
4.
5.
Hepatitis serology
Upper abdominal ultrasound
Full blood examination
ERCP
Liver biopsy
A.
B.
C.
D.
E.
CT kidney, ureter and bladder
Ultrasound renal tract
24-hour urinary calcium excretion
Plain X-ray kidney, ureter and bladder
Mid-stream urine for phase microscopy