Osce- acute abdomen

 Acute Abdomen
o History
 Character of pain: sharp implies peritoneal pain; dull, diffucse pain is
commonly visceral pain. Note location , shifting, radiation, onset, severity,
exacerbating and ameliorating factors, temporal nature (constant v. colicky).
 GI and systemic symptoms (e.g. anorexia, nausea/emesis); ask about
constipation, bloody diarrhea or hematochezia.
 Hematuria (GU disorders), STD risk factors (PID is a common cause of
abdominal pain), fever/chills
 Note the patient’s menstral history, family history (acute intermittent
porphyria, familial Mediterranean fever), and past medical and surgical
history (vasculitis, SLE, sickle cell disease).
o Physical
 Low BP and high HR are signs of shock or impending shock. High fever in the
presence of abdominal pain is a concern.
 Abdominal distention suggests a surgical abdomen.
 Manipulate the lower extremity to elicit pain (suggestive of appendicitis)
and check for CVA tenderness (pylo)
o Differential
 Abrupt, excrutiating pain
 Biliary colic
 Utereral colic
 MI
 Perforated ulcer
 Ruptured aneurysm
 Rapid onset of severe, constant pain
 Acute pancreatitis
 Mesenteric thrombosis, strangulated bowel
 Ecgtopic pregnancy
 Gradual, steady pain
 Acute cholecystitis, acute cholangitis, acute hepatitis
 Appendicitis, acute salpingitis
 Diverticulitis
 Intermittent, colickypain, crescendo with free intervals
 Early pancreatitis(rare)
 SBO
 IBD
o Evaluation
 CBC/lytes, amylase, ABG if pt hypoxic or unstable, lactate, LFTs, PT/PTT,
UA/Cx, and stoll guiac.
 All women of childbrearing age need B-HCG
 Abdominal plain X-ray followed by studies based onclinical suspicion.
 Contrast studeies are often performed – NO barium if a lower bowel
obstruction is suspected
 If RUQ pain do US/HIDA scan for cholecystitis.
 Paracentesis if there is acites
o Treatment
 Emergency surgery
 D/C oral feeds, insert NG tube if obstruction
 Provide analgesia and supportive care
 Type and Cross all