Non Surgical Causes Of The Acute Abdomen PDF
Preview Non Surgical Causes Of The Acute Abdomen
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 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 Temp 36.5, HR 96, BP, 85/62, RR 29, Sats 96% on air. Clinically dehydrated Cardiovascular and respiratory examination normal 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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