Acute Abdomen

Acute Pancreatitis

EMKF

  • Pancreatitis is diagnosed by a combination of clinical features (epigastric pain with radiation to back, nausea/vomiting etc) and diagnostic tests (lipase 3x normal, CT scan)
  • A RUQ US should be performed looking for gallstones as this finding significantly alters management
  • The focus of management is on supportive care. IV fluids, while central to therapy, should be given judiciously and titrated to end organ perfusion
  • BISAP Score (Wu 2008, Papachristou 2010) is a clinical score used to predict mortality from pancreatitis.

  • Patients with mild pancreatitis who are tolerating oral intake and can reliably follow up, can be discharged home

 

Mesenteric Ischaemia – Time is Bowel

EMKF

What is the “CLASSIC” presentation of Mesenteric Ischemia?

Acute Abdominal pain which out of proportion to examination in an elderly patient. An elevated lactate level should raise suspicion of mesenteric ischaema. High lactate suggests BOWEL NECROSIS.

Classic presentations are not always seen.

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DID YOU KNOW: Peritonitis

EMKF

Determining the presence or absence of peritonitis is a primary objective of the abdominal examination. All the methods alone are inaccurate. Thoracic inflammatory process adjacent to the diaphragm, a voluntary contraction of the abdominal wall in apprensive patients, a rough painful examination, may be misleading. But what is more interesting is that NO TEST ALONE is useful in ruling out a diagnosis of peritonitis. Furthermore a gentle percussion is as inaccurate as the rebound test is, but it saves unnecessary pain.