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Acute Abdomen

From Mediwikis

When assessing a patient with a suspected acute abdominal presentation, you should consider two priorities:

  • Are they stable? (Think ABCDE)
  • Do they require surgery?

History

  • SOCRATES of pain
  • Change in bowel/urinary habit
  • Vomiting
  • Last Menstrual Period- rule out pregnancy including Ectopic
  • Previous surgery, current medical problems

Examination

Perform a full Abdominal Examination, looking for:

  • Shocked appearance- pale, unresponsive, reduced GCS
  • Tenderness/Guarding (Guarding is involuntary)
  • Bowel sounds (absent = peritonitis, high pitch = obstruction)

A vaginal examination may be necessary if ectopic pregnancy is likely

Investigations

Consider all of the following, directed by history and examination:

  • FBC (WCC raised in inflammation)
  • Amylase - 5x upper limit = pancreatitis. Otherwise raise is non-specific
  • U+E for general kidney function + hydration
  • Urine hCG test for pregnancy
  • X-Ray Abdomen (obstruction) + Chest (perforation)
  • USS for biliary conditions and AAA
  • CT is most accurate in the acute abdominal presentation
  • Diagnostic laparoscopy prior to definitive surgery