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    Acute Abdominal Pain

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    LM Mys
    The document provides guidance on evaluating and managing a patient presenting with acute abdominal pain. It emphasizes starting with ABCDE assessment and providing analgesia to aid diagnosis. Based on pain response to opioids, various conditions can be suspected such as vascular ischemia, pancreatitis, or peritonitis. Further assessment involves vital sign and organ function monitoring along with basic blood tests and imaging. Generalized peritonitis specifically presents urgently with severe abdominal pain and tenderness, rigid distension, and absent bowel sounds, requiring prompt resuscitation, antibiotics, and peritoneal wash-out.

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    Acute Abdominal Pain

    Uploaded by

    LM Mys
    118 views5 pages
    The document provides guidance on evaluating and managing a patient presenting with acute abdominal pain. It emphasizes starting with ABCDE assessment and providing analgesia to aid diagnosis. Based on pain response to opioids, various conditions can be suspected such as vascular ischemia, pancreatitis, or peritonitis. Further assessment involves vital sign and organ function monitoring along with basic blood tests and imaging. Generalized peritonitis specifically presents urgently with severe abdominal pain and tenderness, rigid distension, and absent bowel sounds, requiring prompt resuscitation, antibiotics, and peritoneal wash-out.

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    Acute abdomen

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    The document provides guidance on evaluating and managing a patient presenting with acute abdominal pain. It emphasizes starting with ABCDE assessment and providing analgesia to aid diagnosis. Based on pain response to opioids, various conditions can be suspected such as vascular ischemia, pancreatitis, or peritonitis. Further assessment involves vital sign and organ function monitoring along with basic blood tests and imaging. Generalized peritonitis specifically presents urgently with severe abdominal pain and tenderness, rigid distension, and absent bowel sounds, requiring prompt resuscitation, antibiotics, and peritoneal wash-out.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    118 views5 pages

    Acute Abdominal Pain

    Uploaded by

    LM Mys
    The document provides guidance on evaluating and managing a patient presenting with acute abdominal pain. It emphasizes starting with ABCDE assessment and providing analgesia to aid diagnosis. Based on pain response to opioids, various conditions can be suspected such as vascular ischemia, pancreatitis, or peritonitis. Further assessment involves vital sign and organ function monitoring along with basic blood tests and imaging. Generalized peritonitis specifically presents urgently with severe abdominal pain and tenderness, rigid distension, and absent bowel sounds, requiring prompt resuscitation, antibiotics, and peritoneal wash-out.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 5

    Acute Abdominal Pain

    Analgesia adequate pain relief will aid your diagnosis


    o If pain is excruciating and not relieved by opioid analgesia, suspect a vascular
    ischaemic event, e.g. ruptured AAA, mesenteric ischaemia
    o A severe pain relieved by opioid analgesia suggests widespread inflammation, e.g.
    pancreatitis, or generalised peritonitis from a viscus perforation
    o If acute pain relieved by parental analgesia, suspect a less severe cause, e.g. biliary or
    renal colic

    ABCs
    1. Ensure the patients airway is clear and stabilise the cervical spine
    2. Assess the pts lungs, chest wall and diaphragm, administering oxygen if necessary
    3. Assess the pts pulse, BP, and look for signs of shock
    4. Determine the pts neurological status using the Glasgow Coma Scale
    5. Expose the patient and perform physical examination
    6. Take an Abdominal X-ray

    After ABCDE these crucial investigations should be performed


    1. ECG To monitor cardiac function
    2. ABG To assess severity of shock and the pts degree of compensation
    3. X-rays an erect chest and abdominal X-ray will aid your diagnosis
    4. Urinary catheter to monitor fluid balance
    INVESTIGATIONS
    o Observation chart look for changes in pattern to indicate deterioration,
    haemorrhage, shock, elevating fever or respiratory distress
    o Baseline blood tests to assess vital organs
    o UE, CRP, FBC, LFTs
    o INR (if you suspect the pt will need a prompt intervention)
    o Serum amylase & lipase
    o Serum amylase elevated to 5x normal levels in the first 5 days after symptoms
    begin = pancreatitis (normal: 40 140 U/L)
    o Elevated CRP < 200 mg/l in the first day indicates a severe attack
    o Abdominal X-ray small/large bowel obstruction can be seen on a plain film of the
    abdomen
    o Large dilated loops of bowel with visible haustra = an obstruction in the large
    bowel
    o Erect Chest X-ray
    o Perforation of the bowel causes air to enter the abdominal cavity
    o On an erect CXR the air rises to the top can be seen under the diaphragm =
    pneumoperitoneum

    SUMMARY
    - A patient presenting with acute abdominal pain, remember these essential steps
    before you do a thorough clerking
    o ABCDE always comes first
    o Give analgesia helps with next steps and eases the pt
    o Focused History and examination to rule out life threatening conditions
    o Ensure vital organs are functioning and your pt is stable with simple
    investigations

    COMMON CONDITIONS
    1. Peritonitis
    2. Perforated peptic/duodenal ulcer
    3. Acute pancreatitis
    4. Cholecystitis & gall stone disease
    5. Appendicitis
    6. Bowel obstruction
    7. Acute diverticulitis
    PERITONITIS

    Local peritonitis
    - Inflammation of a single viscera e.g. appendicitis, diverticulitis & cholecystitis can
    irritate the local parietal peritoneum
    - This causes localised abdominal pain, tenderness & guarding, that begins after the
    initial onset of visceral pain

    - Treatment is for the underlying disease, but dont forget to monitor and correct fluid
    balance, and provide analgesia
    - Monitor for signs of complications or progression to generalised peritonitis

    Generalised peritonitis
    - Widespread inflammation of the peritoneal lining is a serious condition that requires
    urgent surgical attention

    Causes
    1. Chemical irritation from perforated peptic or duodenal ulcer
    2. Leaking bile from cholecystitis
    3. Infection from ruptured appendix
    4. Faecal matter from diverticulitis
    5. Deterioration of local peritonitis from inflammatory condition

    Clinical Presentation
    - Severe abdominal pain, worse on movement
    - Patient lies very still
    - Tender abdomen with washboard rigidity, rebound tenderness, guarding, and absent
    bowel sounds
    - Hypovolaemic shock may occur
    o Hypotension
    o Weak, thready pulse
    o Sinus tachycardia
    o Tachypnoea
    o Low urine output
    o Cool clammy peripheries
    o Hypothermia
    o Confusion
    o Weakness
    o Thirst
    Investigations:
    - CT abdomen (determines the cause)
    - Serum amylase (rule out pancreatitis)
    Management:
    - Resuscitate with IV fluids with careful fluid balance monitoring until a good urinary
    output is maintained (NG tube, urinary catheter, IV fluids)
    - Infuse IV Antibiotics
    - Prompt laparotomy/laparoscopy (peritoneal wash-out, and treatment of the
    underlying condition)
    - Monitor for development of post-operative complications
    o Suspect a peritoneal abscess formation if the pt develops
    A swinging fever
    Swelling
    Raised White Cell Count
    Increasing or sustained pain
    Ultrasound/CT scan necessary, followed by percutaneous drainage or
    laparotomy
    - If treatment is delayed, peritonitis can rapidly deteriorate with further toxaemia,
    septicaemia, and multi organ-failure.

    Summary
    Generalised peritonitis presents with
    - Generalised pain & tenderness
    - Rigid, distended abdomen
    - Absent bowel sounds
    Urgent resuscitation, ABX and peritoneal wash-out required.

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