Acute Abdomen

Definition
an intra-abdominal process often
causing severe pain and often
requiring surgical intervention.

1.
2.
3.
4.
5.

Inflammatory
Mechanical
Vascular
Traumatic
Congenital

 Patients are assessed and treatment

priorities established based on their injuries,
vital signs, and injury mechanisms
ABCDEs of emergency care
A
B
C
D
E

Airway and c-spine protection

Breathing and ventilation
Circulation with hemorrhage control
Disability/Neurologic status
Exposure/Environmental control

 Full Examination including DRE +/PVE

Bloods: FBE, UEC, CMP, LFT,
Coagulation Profile, Blood group +
cross match, amylase, lipase, lactate,
BGL, ketones,
Urine FWT + M/C/S

 XRAY
CT
FAST

The Easily Missed

A women developed diarrhoea, vomiting, and mild

abdominal discomfort and spoke to an out-of-hours
GP. A provisional diagnosis of gastroenteritis was
made. Her own GP visited the next morning and
admitted her to Hospital where the JMOs continued
to treat her for gastroenteritis

...... until she was in extremis. At

autopsy, a ruptured ectopic pregnancy
was found.

Renal Colic
?Leaking abdominal aortic aneurysm
Renal colic the most common
misdiagnosis
First presentation of renal colic in over
60s uncommon
Abdominal palpation for AAA less than
10% sensitivity
Females over 60 and Men over 50
presenting with renal colic should
have AAA excluded by imaging

 A 68yo female with phx of AF, AMI, IHD

presents with severe abdominal pain, and
shocked. Examination reveals a generally
severely tender abdomen with no distention.
Bloods NAD including lactate.
Abdominal XRAY NAD.
ECG reveals sinus rhythm.
What is your next step of management

A women presented to ED in early third

trimester with epigastric pain and was
diagnosed as having gastritis and sent
home

 where she collapsed and died

shortly afterwards. Autopsy showed a
cerebral hemorrhage and typical
histological features of pre-eclampsia.

 26yo male presents with 2 days of

acute onset epigastric pain and
anorexia. Worse pain and tenderness
in RIF. WCC 17 with neutrophillia, CRP
15.
Dx ?
Imaging ?

 26yo female presents with 2 days of

acute onset epigastric pain and
anorexia. Worse pain and tenderness
in RIF. WCC 17 with neutrophillia, CRP
15.
Dx?
Imaging ?