Summary
Summary Essential Notes: Gastrointestinal Medicine: Acute Abdomen
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Acute abdomen Biliary colic- RUQ- gallstone lodged in bile duct,provoked by eating fatty meal
No fever + inflammatory markers are normal (In
contrast to acute cholecystitis)
Acute Cholecystitis
RUQ- inflammatory/infection of the gall bladder
secondary to impacted gallstones
Murphy’s sign positive arrest of inspiration on
palpation of RUQ, fever + raised inflammatory
Hepatobiliary
markers
Ascending cholangitis
Bacterial infection of the biliary tree. The most
common predisposing factor is gallstones
Charcot’s triad RUQ pain, fever, jaundice
Acute pancreatitis
Epigastrium- sometimes radiate to back, usually due
to alcohol/gallstones, pain is severe
O/E: tenderness, ileus, low grade fever
Renal colic
Loin groin severe + intermittent pain
Pts are restless, visible/non-visible haematuria
Infective gastroenteritis, appendicitis, diverticulitis, pyelonephritis, present
cholecystitis, cholangitis, PID, hepatitis, pneumonia Acute pyelonephritis
Inflammatory pancreatitis, peptic ulcer Urology Loin pain fever + rigors are common as is
Vascular ruptured AAA, mesenteric ischaemia, MI vomiting
Traumatic ruptured spleen, perforated viscus Urinary retention
Metabolic renal/ureteric stone, DKA Suprapubic pain- obstruction to the bladder outflow
tract
Peptic ulcer disease epigastrium Hx of NSAID use/alcohol M>F + Hx of BPH
excess (Pregnant until proven otherwise)
Upper Duodenal ulcers epigastric pain relieved by eating Ectopic- RIF/LIF- Typically pain + Hx of
GI Gastric ulcers epigastric pain worsened by eating, features of Gynaecology
amenorrhoea for the past 6-9 weeks
upper GI haemorrhage (e.g. haematemesis/malaena)
Vaginal bleeding may be present
Duodenal ulcer > Gastric ulcers
Appendicitis Ruptured AAA
RIF- pain initially central radiates to RIF, anorexia, tachycardia, Central abdominal pain back – catastrophic (e.g.
low grade fever, tenderness in RIF sudden collapse) or sub-acute (persistent severe
Rovsing’s sign more pain in RIF when LIF palpated central abdominal pain / developing shock)
Lower
Acute diverticulitis Vascular Shocked (hypotension, tachycardia)
LIF- colicky pain, diarrhoea (sometimes bloody), fever, raised Mesenteric ischaemia
GI
inflammatory markers, raised WCC Central abdominal pain- Hx of AF/other CVD
Intestinal obstruction Diarrhoea, rectal bleeding, metabolic acidosis is
Hx of malignancy (intraluminal obstruction)/previous operations
often seen ‘due to dying tissue’
(adhesions) vomiting, not opened bowels recently, ‘tinkling’ bowel
sounds
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