1. The Acute Abdomen Mr P Vaughan-Shaw December 2010

2. definition Sudden, acute, severe abdominal pain

3. Abdominal pain Visceral – From viscera – Vague – Poorly localised Fore-gut  epigastrium Mid-gut  peri-umbilical Hind-gut  lower abdomen Somatic – From surface structures e.g. Parietal peritoneum – Accurately localised – Eased by lying still, worse with movement

4. Mechanism Haemorrhage Perforation Obstruction Inflammation Infarction

5. haemorrhage AAA Aortic dissection Ruptured ovarian cysts Ruptured ectopic Rectus sheath haematoma Abdominal trauma

6. Case 1 75 year old male. Abdominal Pain You have 10 questions What are you differentials? You have 1 investigation You have 3 phone calls

8. Perforation Peptic ulcer Diverticular disease CRC UC Perforated cholecystitis Perforated appendicitis Perforated obstructed bowel

9. Case 2 58 year old, unkempt man You have 8 questions You have 1 investigation

11. http://www.youtube.com/watch?v=XU0__k gLWFc&feature=related

12. obstruction Renal colic Biliary colic SBO – Adhesional – Hernias – internal, inguinal, incisional, femoral LBO – CRC – Inflammatory stricture Volvulus – Sigmoid – Caecal

13. Case 3 69 year old lady with abdominal pain and distention You have 6 questions You have 2 investigations You have 2 phone calls

22. http://www.youtube.com/watch?v=07xcVlEoi dU

23. Case 4 85 year old demented man with distention You have 5 questions You have 1 investigation You have 1 intervention

26. Treatment

28. inflammation Appendicitis Cholecystitis Pancreatitis Salpingitis Mesenteric adenitis Crohn’s disease Ulcerative colitis Meckel’s diverticulitis

29. Case 5 27 year old Southampton FC supporter Under the medics for 1 week with abdominal pain, bloody diarrhoea You have 4 questions You have 1 investigation

31. You have 2 options You have 1 more investigation You have 1 treatment

33. infarction Torsion of viscus Ischaemic bowel

34. Case 6 74 year old man Abdominal pain, distention You have 5 questions You have 2 investigations You have 1 treatment