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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
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
Case 4 85 year old demented man with distention You have 5 questions You have 1 investigation You have 1 intervention
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
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