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Whenever the CK scenario tells you about a really sick patient with generalized abdominal tenderness plus rebound tenderness + guarding and rigidity and perhaps they mention some abnormal vital signs, fever and silent abdomen then you must think of Acute Surgical Abdomen and then your next step is invariably Laparotomy.
In practice that might not be the case as most ERs have quick access to CT scan and so they do it while the patient is prepped for the OT. But if you have two options of CT scan and laparotomy then choose laparotomy is the next step.
Exceptions:
The clinical scenario is equivocal like you don't have all the classic signs of acute abdomen mentioned above then you might think of the following:
In practice that might not be the case as most ERs have quick access to CT scan and so they do it while the patient is prepped for the OT. But if you have two options of CT scan and laparotomy then choose laparotomy is the next step.
Exceptions:
The clinical scenario is equivocal like you don't have all the classic signs of acute abdomen mentioned above then you might think of the following:
- Primary peritonitis - Antibiotics is the next step
- MI - ECG, CXR, and Enzymes are the next steps
- Lower lobe pneumonia - CXR is the next step
- Pulmonary embolism - Spiral CT is the next step
- Pancreatitis - Serum amylase is the next step
- Renal stones - CT scan is the next step