Non Surgical Causes Of The Acute Abdomen

39 Pages·2016·1.81 MB·English

Pete Gorman
Physician Associate
Overview of the acute abdomen presentation

and the pitfalls of diagnosis
Overview of region related abdominal

pathology
Revisiting the RED FLAGS

A look at the potential medical causes
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3 interactive case studies

Questions

Term ‘ Acute abdomen‘ represents rapid onset of severe abdominal

symptoms

May indicate life-threatening intra-abdominal or on occasion extra

abdominal pathology

Pain is usually but not always a feature


Pain-free acute abdomen is more likely in the elderly, in children

and in the third trimester of pregnancy

The numerous potential causes, numerous organs within the

peritoneal cavity and the potential for referred pain make definitive
diagnosis difficult

Abdominal pain Ranks in the top three presenting complaints to

emergency departments, but only a few of those patients will have
an acute abdomen
Management should focus on careful assessment to reach a
differential diagnosis list

Close attention should be paid to history, symptoms and signs

Non surgical causes as well as surgical must be considered

Clinical scenario can change rapidly and conclusions previously
reached by you or your colleagues may need to be revised as events
evolve

Failure to be open-minded and review a previous diagnosis is often at
the heart of medico-legal claims relating to patients with an acute
abdomen.

This presentation will concentrate on diagnosing some important
medical causes in the acute setting.

 Confusion/impaired consciousness
 Signs of shock(hypotension/tachycardia)
 Systemically unwell/septic-looking
 Signs of dehydration
 Rigid abdomen
 Patient lying very still or writhing
 Absent or altered bowel sounds
 Associated testicular pathology
 Marked involuntary guarding/rebound tenderness
 Tenderness to percussion
 History of haematemesis/melaena or evidence of latter on PR
 Suspicion of a medical cause for abdominal pain
Cardiovascular
Inferior myocardial infarction
Pericarditis
Respiratory
Lower Lobe pneumonia
Pulmonary Embolism –pleurisy
Gastrointestinal
Hepatitis
IBD
Genitourinary
Pyelonephritis
Haematological
Sickle Cell crisis
Endocrine
Diabetic Ketoacidosis
HONK
Pharmacological
opiate withdrawal,
Infective
Typhoid
HIV Associated Lymphadenopathy
Rare
Acute Intermittent Porphyria
17 year old female

Presented with a 2 day history of nausea, vomiting,

severe abdominal pain, thirst and increased frequency
and volume of urination
Family had eaten take out Chinese food 3 days earlier

but no other member of the family had similar
symptoms
On Examination
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Temp 36.5, HR 96, BP, 85/62, RR 29, Sats 96% on air.

Clinically dehydrated
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Cardiovascular and respiratory examination normal
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Abdomen was diffusely and severely tender.

She had no documented significant medical history and

took no regular medication
What does you diagnostic brain think of ?

What condition(s) may this be?

What tests would you order?

The nurses are concerned that the patient is

breathing rapidly and report a sickly acetone smell
on the patients breath.
The patient is very thin and family report that she

has never thrived compared to siblings
Further thoughts ???

Why could the patient be breathing so rapidly?

What investigations might you do and why?
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