Acute Abdomen

• General name for presence of signs, symptoms of inflammation of peritoneum (abdominal lining)

Anatomic Landmarks

• Divided in quadrants RUQ, LUQ, RLQ, LLQ

• Anatomic:Epigastrium

Umbilical

Suprapubic (hypogastrium)

Pain

• Visceral pain is caused by distension, inflammation or ischemia in hollow viscous and solid organs.

• Parietal pain is localized to the dermatome above the site of stimulus and is initially unilateral.

Pain

• Referred pain produces symptoms, but not signs

• Usually lateralized

• Patterns of pain are based on embryologic sharing of dermatomes

Multiple Faces of Pain

• Pain can be characterized as:

Sharp

Stabbing

Burning

Heavy

Diffuse

Dull

Diagnosis

• History

Characterization of pain

Location? Duration?

Other symptoms

Nausea, vomiting? Bloody?

Inspection

• Description of abdominal habitusscaphoid,

Flat

Rotund

• Scars, wounds, erythema

• Anatomic Confines

Auscultation

• Listen with stethoscopeNot necessary in all quadrants

• QuantitativeAbsentDecreasedHyperactive

• QualitativeNormalBorbyrigmyObstructiveBruits

Percussion

• Abdomen Tympanitic gasDull fluid

• Liver Spanmid clavicular line by convention

• Bladder, UterusRising out of the pelvisPercussion is also a very sensitive sign of peritonitis

Palpation

Prepare the patient

warn them

make them comfortable

take tension off the abdominal wall• Pillow or bend the knees

Expose the entire abdomen• Xiphoid to pubis

Palpation

• Note the patient’s attitude (physically and emotionally)

• Watch their eyes as you touch them

• After percussion:Softly at first

Deeper• LUQ-RUQ note liver edge

• Then LLQ-RUQ

Laboratory Studies

Complete blood count

Urinalysis

Serum amylase and lipase

Liver function studies

HCG

Serum electrolytes

Imaging Tests

• X rays• Flat and upright abdo

minal films (the most common first step)Air

Calcific densities (stones, eggshell)

Mechanical obstruction / ileus

Imaging Tests

• Ultrasonography• CT scan• Specific organ studies

IVP

HIDA

• Angiography

Imaging Tests

• CT: 15-20% false negative for acute perforationPoor study for gallstones

Contrast obscures kidney stones

Undergo Operation

• Signs of peritonitis

• Increasing localized abdominal tenderness

• Abdominal pain with signs of sepsis

• Acute intestinal ischemia

• Certain radiographic findings

Appendicitis

• Usually due to obstruction with fecalith• Appendix becomes swollen, inflamed gangrene,

possible perforation

Appendicitis

• Pain begins periumbilical; moves to RLQ

• Nausea, vomiting, anorexia

• Patient lies on side; right hip, knee flexed

• Pain may not localize to RLQ if appendix in odd location

• Sudden relief of pain : possible perforation

Duodenal Ulcer Disease

• Steady, well-localized epigastric pain

• “Burning”, “gnawing”, “aching”

• Increased by coffee, stress, spicy food, smoking

• Decreased by alkaline food, antacids

Duodenal Ulcer Disease

• May cause massive GI bleed

• Perforation = intense, steady pain, pt lies still, rigid abdomen

Kidney Stone

• Mineral deposits form in kidney, move to ureter

• Often associated with history of recent UTI

• Severe flank pain radiates to groin, scrotum

• Nausea, vomiting, hematuria

• Extreme restlessness

Abdominal Aortic Aneurysm

• Localized weakness of blood vessel wall with dilation (like bubble on tire)

• Pulsating mass in abdomen

• Can cause lower back pain

• Rupture shock, exsanguination

Cholecystitis

• Inflammation of gall bladder

• Commonly associated with gall stones

• More common in 30 to 50 year old females

• Nausea, vomiting; RUQ pain, tenderness; fever

• Attacks triggered by ingestion of fatty foods

Bowel Obstruction

• Blockage of inside of intestine

• Interrupts normal flow of contents

• Causes include adhesions, hernias, fecal impactions, tumors

• Crampy abdominal pain; nausea, vomiting (often of fecal matter); abdominal distension

Gynecologic Disease

• A common cause

• A thorough history

• Complete pelvic and rectal exam

• Plain films of the abdomen

• Pelvic ultrasound

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