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Acute Abdomen Pain - Coggle Diagram

- - - - gallstone lodged
        in bile duct
      - RUQ
      - pain
        
        lasts 6 hours
        
        dull & constant
        
        worse after eating spicy/fatty foods
      - investigations
        
        ultrasound
        
        CT scan
        
        OGD
      - management
        
        self-limiting
        
        oral pain relief
        
        clear fluids
        
        lifestyle = low fat diet, weight loss, avoid trigger foods
        
        severe pain = emergency cholecystectomy
  - - - pain
        
        more than 6 hours
        
        progressively worse
        
        pain radiates to RIGHT shoulder
      - systemically unwell
        
        vomiting
        
        fever
      - RUQ
      - MURPHY'S SIGN
        
        painful inspiratory 'catch'
        when RUQ palpated
    - - bloods
        
        raised WCC
        
        raised CRP
        
        LFTS = raised ALP
      - ultrasound
      - CT scan
    - - hospital admission
      - A-E assessment
      - ABX - trust guidelines
        (oral or IV)
      - emergency laparoscopic
        cholecystectomy
  - - - Charcot's triad
        
        RUQ pain
        
        jaundice
        
        fever (rigors)
      - sepsis
        
        high HR
        
        low BP
        
        high RR
        
        confusion
    - - blood tests
        
        obstructive jaundice LFTs
        *raised ALP + GGT
        
        raised inflammatory marker
        
        raised lactate
      - MRCP (if stable)
        
        CT scan (if unstable)
    - - SEPSIS 6
      - call senior
      - consider ICU
      - ERCP asap
  - - - epigastric abdo pain
        
        radiates to back
        
        relieved sitting forward
      - diarrhoea
      - fever/sweats
    - - bloods
        
        raised CRP/WCC
        
        cholestatic LFTs
      - SERUM AMYLASE/LIPASE
        
        amylase short half life
        
        lipase more sensitive
      - CT scan
        
        USS
        
        MRCP
    - - IV fluids
        
        analgesia (IV paracetamol)
        
        continued eating + drinking
        
        ERCP to extract stone
        
        cholecystectomy
- - - - pain relieved by eating
    - - pain worsened by eating
    - - bloods
        
        FBC, U&Es, LFTs
      - H. PYLORI TESTING
      - OGD
        oesophago-gastro-duodenoscopy
    - - lifestyle modification
      - H. pylori NEGATIVE
        
        8 week PPI
      - H. pylori POSITIVE
        
        7 day triple therapy
        
        PPI + amoxicillin + clarithromycin
- - - - Rovsing sign
        (palpate LLQ + pain in LRQ)
  - - - uncomplicated
        
        outpatients
        
        abx
      - complicated
        
        abx
        
        IV fluids
        
        analgesia
        
        surgery
      - Hartmann's
        
        sigmoid colectomy w/ end colostomy
      - colonoscopy/CT colonography
        6 weeks post
  - - - colicky abdo pain
        
        bloating
        
        nausea/vomiting
        
        absolute constipation
      - high pitched/absent bowel sounds
        
        empty rectum on PR
    - - bedside
        
        vital signs
        
        pregnancy test
      - labs
        
        FBCs, U&E, CRP
        
        lactate
        
        group & save
      - imaging
        
        abdominal x-ray
        
        CT abdo & pelvis
    - - EMERGENCY SURGERY
- - - - bedside
        
        vital signs
        
        urinalysis (haematuria)
        
        urine microscopy, culture & sensitivity
      - labs
        
        FBC (neutrophils), U&E, CRP
        
        lactate
      - imaging
        
        CT KUB
        
        USS
        
        X-ray
    - - CONSERVATIVE <5mm
        
        fluids
        
        wait for small stone to pass
        
        review 4 weeks
      - MEDICAL
        
        NSAIDs for pain
        
        tamsulosin for small distal stones
      - SURGICAL
        
        stent or nephrostomy (infection)
        
        ureteroscopy or ESWL (non-infected)
- - - - bedside
        
        vital signs
        
        urine pregnancy test
        
        urinalysis
        
        vaginal swab
      - labs
        
        FBC, U&E, CRP
        
        coagulation
        
        serum hCG
        
        group & save
      - imaging
        
        transvaginal USS
    - - A-E assessment
      - DEFINITIVE
        expectant
        
        monitor serum hCG and USS
        
        medical
        
        methotrexate
        (if unruptured + hCG <1500IU/L)
        
        surgical
        
        lap salpingectomy
        (significant pain, fetal heartbeat or hCG >5000IU/L)
- - - - <5.5cm = conservative
        
        lifestyle
        
        aspirin
        
        statins
        
        antihypertensives
      - 5.5cm or rapidly growing = surgery
        – EVAR or Open repair
      - if ruptured = SURGERY