Session 10 Assessment of acute abdominal conditions

• Tensing of the abdominal wall muscles to guard inflamed organs from the pain of pressure upon them. - Guarding
• Involuntary tightening of the abdominal musculature that occurs in response to underlying inflammation. - Rigitdity
• Pain or discomfort on removal of pressure to the abdomen rather than application - rebound tenderness
• Causes of acute pancreatitis (GET SMASHED)?

  • Gallstone
  • Ethanol
  • Trauma
  • Steroids
  • Mumps
  • Autoimmune diseases
  • Scorpion venom
  • Hypercalcaemia/Hyperlipidaemia
  • Endoscopic Retrograde Cholangio-Pancreatography (ERCP)
  • Drugs
• testicles hang in your scrotum and swing freely, like a clapper in a bell - bell clapper deformity

  • risk of testicular torsion
• Spermatic cord and contents twist compromise blood supply - testicular torsion
• alleviation of scrotal pain by lifting of the testicle - Prehn's sign
• Testicular torsion investigations?

  • USS
  • Urinanalysis
• testicular torsion signs?

  • Absent cremasteric reflex
  • Prehn's sign negative
  • High swollen and tender testis
• Murphy’s triad – N+V, low-grade fever and RIF pain - acute appendicitis
• Positive Murphy’s sign • Apply pressure to RUQ • Ask patient to inspire • Positive sign when inspiration is halted due to pain. - cholecystitis
• Mirizzi syndrome - Obstructive jaundice caused by a stone located in Hartmann's pouch or in the cystic duct.
• Diverticulum - Outpouching of the bowel wall.
• Femoral hernia – inferior and lateral to pubic tubercle

  Inguinal hernia – superior and medial to pubic tubercle
• Femoral canal borders?

  1. Anteriorly: Inguinal ligament
  2. Posteriorly: Pectineus
  3. Laterally: Femoral vein
  4. Medially: Lacunar ligament