10. Acute Abdomen Flashcards by Isabelle -

What is the management of appendicitis?

Patient NBM

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What is diverticular disease?

Herniation of mucosa and sub-mucosa through muscle layer of colonic wall.
Pseudo - muscle layer does not outpouch
True - it does

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What is diverticular disease?

Herniation of mucosa and sub-mucosa through muscle layer of colonic wall.
Pseudo - muscle layer does not outpouch
True - it does

This is a diverticulum with symptoms!!

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How does a diverticula form?

Taeniae coli in bands, herniation of mucosa occurs in between these bands/

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How does a diverticula form?

Taeniae coli in bands, herniation of mucosa occurs in between these bands

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Risk factors for diverticular disease?

Low fibre diet
Obesity
Age over 50

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How does diverticulosis present?

These are asymptomatic diverticulum that may have blood in stools

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How does diverticulitis present?

This is diverticulum with symptoms. Left iliac fossa pain, fever, abdo pain and tachycardia.

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Investigations for diverticular disease?

FBC - high wcc and crp
Barium enema shows saw-tooth appearance
Colonocopy is diagnostic
CT can be done

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How do we manage diverticular disease?

Can’t reverse growth, but can prevent progression.
Increase fibre, fluids, weight reduction, exercise and smoking cessation.
ABx
If complication, IV ABx, fluids and analgesia.
CT-guided drainage of abscess if present.

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How do we manage diverticular disease?

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Complications of diverticular disease?

Diverticulitis recurrent
Abscess
Perforation

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Types of bowel obstruction?

Partial
Complete
Simple
Strangulated (compromised blood supply causing ischaemia and gangrene)

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Symptoms for bowel obstruction?

Abdo distention
Dehydration
Bilious vomiting
Hypovolaemia
Constipation
Severe colicky pain
Tinkling bowel sounds

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Causes of bowel obstruction?

Small intestine - mainly adhesions following surgery

Large intestine - malignancy

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How do we investigate a bowel obstruction?

Supine AXR
Small bowel - 3-5cm dilation with vulvulae coniventae (go all the way across)
Large bowel obstruction - >5cm dilation with haustra (lines are only partial)

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Management of bowel obstruction?

NBM and NG tube
Laparotomy
Conservative management if due to adhesions but check up

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What is a volvulus?

Rotation of a loop of bowel around the axis of its mesentery that results in bowel obstruction and potential ischaemia
Often sigmoid colon, can be caecum.

Risk factors for volvulus?

Long mesentry
Neonatal malrotation
Chronic constipation
Adhesions

Sign of volvulus of AXR?

Coffee bean sign

Management of bowel volvulus

Sigmoidoscopy with detorsion
If recurrence, need to do surgery, this is really common

For caecal only do surgery

What causes pancreatitis?

IGETSMASHED!

Go through this!

Symptoms of pancreatitis?

Severe epigastric pain that radiates to the back, worse on lying down
N+V
Fever
Hypovolaemia
Cullen's sign 
Grey's turner's sign (flank)

Investigations in acute pancreatitis?

Amylase and lipase x3 than normal
CT abdo
USS
Investigate cause!

How to treat acute pancreatitis?

``` Analgesia IV Fluids and electrolytes Oxygen support NG tube Control blood sugar ABx if infected ``` Treat cause - gallstones, necrosis

What is peritonitis?

Inflammation of peritoneal lining of the abdo cavity

What can cause peritonitis?

Primary bacterial infection - commonly ecoli, staph aureus etc. Secondary to pre-existing abdo condition that could be due to spillage

Symptoms and signs of peritonitis?

Sudden onset pain that is generalised and then localised Guarding Rebound tenderness and washboard rigidity Reduced bowel sounds Paralytic ileus N+V

Investigations in peritonitis?

Blood cultures for infection If ascities, do ascitic tapp. SBP neutrophils will be above 250 CXR causes air under the diaphragm

Management of peritonitis?

IV fluids, abx and NG tube Treat cause Lavage and removal of dead tissue

What is a hernia?

Protrusion of abdo contents through congenital/acquired weakness of wall e.g. pregnancy, coughing, weight lifting etc.

What do these terms mean in a hernia? Irreducible Incarcerated Obstructed Strangulated

Irreducible: if they cannot be pushed back into the right place Incarceration: contents of the hernia sac are stuck inside by adhesions Obstruction: when bowel contents can’t pass through GI hernia Strangulated: blood supply cut-off, so you get ischaemia of the hernia

What's an inguinal hernia?

Protrusion of peritoneal sac through a weakness, 2 types both at superficial injuinal ring.

2 types of inguinal hernia?

Direct - Protrusion through posterior wall weakness that going through the canal Indirect - protrusion follows through deep ring following inguinal canal

What a femoral hernia?

Infero-lateral to the public tubercle

Signs and symptoms of hernias?

``` Asymptomatic Lump in groin Ask to cough and it will be more visible Check if irreducible Pain if incarcerated/strangulated ```

Signs and symptoms of hernias?

``` Asymptomatic Lump in groin Ask to cough and it will be more visible Check if irreducible Pain if incarcerated/strangulated Inguinal points toward genitals Femoral is more lateral ```

Management of hernias?

Lifestyle changes Elective repair if uncomplicated, mesh repair or laparoscopy Emergency laparotomy if obstructed/strangulated

What is intestinal ischaemia?

Obstruction of mesenteric vessel leading bowel ischaemia and necrosis

What are the types of intestinal ischaemia?

``` Acute mesenteric (main type) - most commonly the superior mesenteric artery. Can be venous or non-occlusive e.g. shock, HF etc. Chronic mesenteric ischaemia - usually due to low flow state ``` Ischaemic colitis - inflammation of the colon caused by decreased blood supply.

Signs of intestinal ischaemia?

Intermittent colicky pain Diarrhoea Fever Rectal bleeding

Investigations for intestinal ischaemia?

VBG - raised lactace and acidosis!!!! CT Thumb print for ischaemic colitis on an AXR

How to manage intestinal ischaemia?

``` Acute mesenteric ischaemia Fluid resuscitation ABx to prevent bacterial translocation Heparin/thrombolytic Needs urgent surgery ``` Chronic mesenteric ischaemia Surgery to prevent ongoing risk of infarction Stent insertion to revascularize Ischaemic colitis Conservative Mx: Fluids resuscitation, ABx Surgery if conservative fails, or if perforation and/or peritonitis