Professional Documents
Culture Documents
Zahir Mughal
1. RUQ
2. Epigastrium
3. LUQ
4. RLQ
5. LLQ
Approach to the acute abdomen
Initial impression
History
Examination
General and targeted investigations
General and targeted management
Initial impression
ABCDE
Does the patient look ill, septic or shocked?
Are they lying still (think peritonitis), or rolling
around in agony (think intestinal, biliary or renal
colic)?
History taking
Pain history
Systems review
Past medical/surgical history
Full clerking is important
Examination
Inspection
Palpation
Percussion
Auscultation
Palpate for hernias
Focus the examination to help rule in/out
differential diagnoses that you generated from the
history
Task
1. Rovsings sign
2. Psoas sign
Good
4. Cullens sign examination
technique is the
5. Grey-turners sign key to elicit
these signs
6. Murphys sign ACCURATELY
Investigations
General:
NBM
02 to maintain sats 94-98%
IV fluids
Analgesia
Targeted:
Depending on underlying condition e.g antibiotics for infective
cause, drip and suck for bowel obstruction, etc
Initial surgical management
Aetiology: GETSMASHED
Pathophysiology
Clinical features
Scoring system: modified Glasgow
Treatment
Case 3
We have discussed
The clinical approach to the acute abdomen.
Clinical assessment, investigations and treatment of common
causes of acute abdomen
Acute appendicitis
Acute pancreatitis
Leaking/rupture AAA
Acute diverticulitis