Sandbox:Shivani

Acute abdomen:

Classification of acute abdomen based on the etiology		Presentation	Symptoms						Signs								Lab findings	Preferred diagnostic test	Additional findings
			Fever	Jaundice	Nausea/ Vomiting	Diarrhea	Constipation	Abdominal Pain Location	General Appearance	Bowel Sounds	Abdominal tenderness		Shifting dullness	Rigidity	Rebound tenderness	Shock
											Superficial	Deep
Common causes of peritonitis	Primary peritonitis	Spontaneous bacterial peritonitis	✔	✔/✘	✔/✘	✘	✘	diffuse	lies supine motionless tense abdomen due to ascites	diminished	✔	✘	✔	✘	✘		Ascitic fluid PMN>250cells/mm3 Single organism on culture of the ascitic fluid	ascitic fluid PMN count	Altered mental status usually seen.
	Inflammatory disorders and perforations causing Secondary peritonitis	Perforated gastro-duodenal ulcers	✔	✘	✔	✘	✘	right upper quadrant	Scaphoid, tense abdomen	✘	✔	✘	✘	✔	✔		Fulfillment of 2/3 runyon's criteria: glucose < 50mg/dl total protein > 1g/dl LDH ascites > normal LDH serum	upright chest x-ray, CT scan
		Acute cholangitis	✔	✔	✘	✘	✘	Right upper quadrant	Toxic look	normal	✘	✘	✘	✘	✘			Ultrasound, CT, ERCP, MRCP, PTC	Charcot triad ( RUQ pain, jaundice,fever) Reynold pentad ( RUQ pain, jaundice,fever, confusion,shock)
		Acute cholecystitis	✔		✔	✘	✘	Right upper quadrant or epigastrium may radiate to the right shoulder or back			✔ right upper abdomen	✘	✘	✘	✘			Ultrasound	Murphy's sign (pain on inspiration causing a cessation of breathing) may be present
		Acute pancreatitis	✔		✔			midepigastrium, right upper quadrant, diffuse, or, infrequently, confined to the left side with a band-like radiation to the back			✔epigastrium	✘	✘	✘	✘		Serum amylase/lipase	CT scan
		Acute appendicitis	✔			✘	✘	vague periumbilical initially that eventually localises to right lower quadrant			✔right lower quadrant							CT scan, ultrasound
		Acute diverticulitis	✔	✘	✔	✔/✘	✔/✘	Left lower quadrant pain			✔left lower quadrant							CT scan	leukocytosis
		Acute salpingitis	✔
Hollow Viscous Obstruction		small Intestinal obstruction			✔			periumbilical and crampy, with paroxysms of pain occurring every 4-5minutes.Pain progresses from crampy to constant and more severe indicating impending strangulation	Dissension of the abdomen									Flat and upright film, CT scan
		Volvulus			✔		✔ in sigmoid volvulus	steady pain, with a superimposed colicky component
		Biliary Colic			✔			right upper quadrant										CT scan	hepatomegaly and a palpable gallbladder(courvoisier sign) pancreatic head tumor
		Renal Colic						colicky and radiates to the flank or groin											Hematuria
Vascular disorders	Ischemic	Mesenteric ischemia			✔			severe periumbilical pain out of proportion to physical examination findings	Soft duffy fullness		Severe pain out of proportion to examination						increased lactic acid and leukocytosis	Abdominal x-ray, CT Angiogram, MRI
		Acute ischemic colitis																CT scan, Colonoscopy
	Hemorrhagic	Ruptured abdominal aortic aneurysm	✘	✘	✘	✘	✘	variable depending on the location of the rupture(proximal or distal aorta)	toxic	normal	✘	✘	✘	✘	✘	✔	White blood cell count, fibrinogen, D-dimer, troponin T, N-terminal pro-brain natriuretic peptide, and high-sensitivity C-reactive protein	abdominal ultrasound and computed tomography (CT) of abdomen are most useful	patients presenting with abdominal/back/flank pain, hypotension, pulsatile mass should undergo emergency surgery. cullen sign(bruising around the umbilicus)
		Intraabdominal or Retroperitoneal hemorrhage																	Grey turner sign(bruising in the flank)
Gynecologic Causes	Ovarian Cyst Complications	Torsion			✔			lower abdominal pain
		Rupture						focal,unilateral lower abdominal pain accompanied by light vaginal bleeding									measurement of human chorionic gonadotropin and alpha-fetoprotein	transvaginal ultrasonography
	Ruptured Ectopic Pregnancy		✘	✘	✔/✘	✘	✘	lower abdominal quadrant and pelvis	toxic look	normal	✘	✘	✘	✘	✘		urine b-hcg +,	transvaginal ultrasonography and serial testing of hCG	Amenorrhea and vaginal bleeding.

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