Acute Abdomen Review - A Surgeon's Discussion on Causes, Diagnosis and Treatment
Published at : 28 Oct 2020
The Acute Abdomen is the essence of General Surgery! Is the acute abdominal pain due to appendicitis, gastroenteritis or constipation? Could it be cholecystitis or pancreatitis? Does the patient need emergent surgery, resuscitation or more data? What are the causes, how do you make the diagnosis and how do you initiate treatment for the acute abdomen?
In this surgery tutorial on the acute abdomen I'll take you through my clinical approach to patient consults in the ER including:
1.). My Pain History - SRNOPDSARA
2.). Physical Exam - CHANDLER and the 9 regions
3.). Important Labs - The helpful ones
4.). The Imaging Ladder - Only get what you need
This data helps you answer two very important questions in the Acute Abdomen:
1.). What is the diagnosis?
2.). Does the patient need emergent surgery?
To start off the talk I'll take you through a clinical example of a child that presented with acute abdominal pain and show you a brief video of the surgery, then we'll get into the discussion.
When I approach a patient with abdominal pain I will go through my pain history and since I was a medical student I have been using the same 10 questions in the same order: SRNOPDSARA. Having a process to ask your questions allows you to ask the same questions every time.
For the physical exam it all begins with inspection and my CHANDLER acronym which I've been using for over a decade. As soon as I walk into the room, like breathing I go through a set of question before I even say hello.
How is their color? Hydration? Alertness? Nutritional status? Disability? Limbs? What external support are they on? Are they in respiratory distress?
After we go through my approach to the physical exam we'll tackle each region of the abdomen and discuss the different pathologies you could expect in particular clinical scenarios.
We'll talk about the labs you may need and we'll discuss my imaging ladder, get the imaging data you need and no more to make the clinical decision.
Check out www.citizensurgeon.com for more information on review sheets, the blog and other great resources!
Disclaimer: While my aim is to help educate you for the ward, the surgical ICU, the operating room and your exams remember these are not a replacement for your reading, your medical school and residency preparation and most important your own decision making. Good luck and enjoy!