Abdominal conditions

What are the 4 quadrants of the abdomen?

Left Upper, Right upper, Left lower, Right lower

What % of people attend ED for acute abdominal pain?

5%

What % of surgery admissions are due to abdominal pain?

13-40%

What % of cases of abdominal pain in ED are severe/ life threatening?

10%

What is NSAP?

Non-specific abdominal pain <7 days with no diagnosis after examination and investigations

What is a Bowel Obstruction?

A partial or complete obstruction of the small or large intestine.

What are signs and symptoms of a Bowel Obstruction?

What are symptoms of a bowel obstruction?

• Abdominal pain

• Nausea/ Vomiting

• Faecal vomiting

• Jelly stool

• Bile stained vomit

• Constipation

• Absence of wind

What is an Aortic Abdominal Aneurysm (AAA)?

The stretching and weakening of the aortic wall.

As the aneurysm expands, the aorta dilates and stretches causing the aortic wall to weaken and potentially rupture.

GET THIS PERSON TO AN ED NOW.

What is the mortality rate of AAA?

85%

What % of AAA have a pulsating mass?

What are 4 symptoms of AAA?

• Pallor

• Tachycardia/ threads pulse

• Hypotension

• Pain (tearing/ ripping)

What are 4 symptoms of AAA?

• Pallor

• Tachycardia/ threads pulse

• Hypotension

• Pain (tearing/ ripping)

What is an aortic dissection?

A tear within the intimate layer of the aorta.

Blood flow occurring within the outer layer of the tunica media.

What are the 2 types of gastrointestinal bleed and where is the point of division?

Upper GI bleed (above duodenum)

Lower GI bleed (below duodenum)

What are symptoms of a GI bleed?

• haematemesis (‘coffee grounds’)

• Melaena (tarry stool)

What may cause an Upper GI bleed?

• Peptic ulcer

• Gastritis

• Oesophageal varices

• Tumours

What may cause a lower GI bleed?

• Diverticular disease

• IBD

• Bowel Disease

• Haemorrhoids

• Tumours

What is appendicitis?

A swelling and infection of the appendix.

What are symptoms of appendicitis?

• Nausea/ vomiting

• Loss of appetite

• Pain in the lower right quadrant of the abdomen

• Constipation

• Diarrhoea

• Low temp

• Facial flushing

• Halitosis

• Tachycardia

What are symptoms of a peptic ulcer?

• Pain

• Pain in upper part of abdomen

• Burning pain

• Pain worse at night

What are symptoms of a peptic ulcer?

• Pain

• Pain in upper part of abdomen

• Burning pain

• Pain worse at night

What is the difference between diverticulitis and diverticulosis?

• diverticulosis is when there are diverticula in your bowel but there are no symptoms

• Diverticulitis is when the diverticular are causing symptoms and filling with fluid/ blood

What are symptoms of DIVERTICULITIS?

• LLQ pain

• Pain that gets worse after eating

• Pain that eases after passing wind or opening bowels

• Constipation

• Diarrhoea

• Blood in stool

• Bloating

• NOTE: symptoms can resemble colitis, IBD

What is a hernia?

When an internal part of the body pushes through a weakness in the muscle/surrounding wall tissue.

What is the risk of a strangulated hernia?

Can lead to an ischaemic bowel → bowel obstruction.

Medical Emergency.

Is ulcerative colitis an acute condition or a chronic condition?

Chronic

What is ulcerative colitis?

When the colon and rectum become inflamed over time producing ulcers that can bleed and produce pus.

What is Crohn’s disease?

• Gut inflammation

• Chronic condition

If a patient is undiagnosed, how would you tell the difference between Ulcerative Colitis and Crohn’s disease?

Ulcerative colitis is limited to the colon whereas Crohn’s disease can affect anywhere in the alimentary canal.

What is gastroenteritis?

A stomach bug

What are common types of bacteria that can cause gastroenteritis?

• Salmonellae typhi

• Salmonella enterica

• Adenovirus

• Campylobacter coli

• Staphylococcus aureus

• Rotavirus

• Escherichia Coli

What should you inspect when assessing abdominal pain?

• skin colour

• Bruising

• Masses

• ‘Pulsating’

• Pallor

• Scars

• Senior clinician only to palpate

How would you manage a patient with abdominal pain?

• DR<C>ABCDE correction

• Analgaesia for pain relief (check JRcalc)

• Position the patient in a way that is comfortable for them

• Escalate to SC