Acute Abdomen Assessment

= -Generalised: peritonitis (e.g. perforation), DKA, ischemic bowel, volvulus, AAA

-RUQ: hepatitis, cholecystitis
-LUQ: peptic ulcer, pancreatitis
-Lower quadrants: GI (appendicitis, IBD, diverticulitis), GUS (UTI/pyelonephritis, renal calculi), O&G (ectopic, ovarian tortion, PID)

Introduction
Wash hands, Introduce self, ask Patients name & DOB, Explain you want to ask them some questions and examine them

Focussed history
PC
HPC:
o Explode symptoms as usual e.g. SOCRATES for pain (see OSCEstop notes on exploding symptoms)
o Systems reviews (important parts)
General: how feel generally, fever
Gastro: N&V, abdominal pain, bowel habit, weight loss
Urological: dysuria, urinary frequency
Gynaecological: LMP, PV discharge, contraception
PMHx
DHx + allergies
SHx: smoking and alcohol

Check observations
Ask for observations chart. Check:
RR
O2 saturations
BP
HR
Temperature
(+ capillary glucose)
>If observations are critical, use an ABCDE management approach
>If observations not critical, go on to perform the relevant focussed examination before managing the patient

Focussed examination
Quickly:
Surroundings: drips, medications, catheters, monitoring
General inspection: well/unwell, breathing pattern, in pain, pale, jaundice
Hands: shut down, clubbing, cap refill, signs of chronic liver disease
Pulse: volume (central and peripheral)
Eyes: pallor, jaundice
Mouth: dry mucus membranes
Abdomen:
Inspect (distension, movement with respiration, Grey-Turners/Cullens signs, scars)
Guarding and rebound tenderness
Quickly palpate liver, spleen, kidneys, for AAA and for hernias
Murphys sign, Rovsings sign
Percussion tenderness
Bowel sounds
Also consider examining external genitalia, doing digital rectal exam and PV exam

Investigations to find cause

BOXES
o Bloods + cannulate (mark as urgent): all standard bloods (i.e. FBC, CRP, U&Es, LFTs) plus amylase, G&S + INR
o Orifice tests: urine dip culture, urine HCG
o X-rays/imaging: erect CXR, others e.g. abdominal XR, US/CT abdomen and pelvis (see OSCEstop acute abdomen notes)
o ECG if tachycardia
o Special tests: depending on likely cause (see OSCEstop acute abdomen notes)

2013 Dr Christopher Mansbridge at www.OSCEstop.com, a source of free OSCE exam notes for medical students finals OSCE revision
Management
ABCDE-type management as necessary (see OSCEstop ABCDE notes)
o Oxygen if low sats (e.g. 15L via non-rebreather mask if no COPD)
o Fluids if hypotensive (e.g. bolus 500ml Hartmanns if no heart failure)
Prescribe
o Analgesia (e.g. 10mg morphine IV titrated slowly to pain if severe) anti-emetic anti-pyretic
o Presentation-specific treatments (see OSCEstop acute management notes)
o Regular medications
o VTE prophylaxis (enoxiparin anti-embolism stockings) + do VTE assessment
Other presentation-specific managements
o Keep patient NBM (surgery may be required)
Then
o Document in notes (see OSCEstop admission clerking notes)
o Chase investigations (and change plan as necessary)
o Discuss with seniors and refer to relevant team

2013 Dr Christopher Mansbridge at www.OSCEstop.com, a source of free OSCE exam notes for medical students finals OSCE revision