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MedEd Tutorials > 10. Acute Abdomen > Flashcards

10. Acute Abdomen Flashcards

1
Q

What is the management of appendicitis?

A

Patient NBM

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2
Q

What is diverticular disease?

A

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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3
Q

What is diverticular disease?

A

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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4
Q

How does a diverticula form?

A

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

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5
Q

How does a diverticula form?

A

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

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6
Q

Risk factors for diverticular disease?

A

Low fibre diet
Obesity
Age over 50

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7
Q

How does diverticulosis present?

A

These are asymptomatic diverticulum that may have blood in stools

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8
Q

How does diverticulitis present?

A

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

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9
Q

Investigations for diverticular disease?

A

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

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10
Q

How do we manage diverticular disease?

A

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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11
Q

How do we manage diverticular disease?

A

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.
Osmotic laxatives post-surgery

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12
Q

Complications of diverticular disease?

A

Diverticulitis recurrent
Abscess
Perforation

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13
Q

Types of bowel obstruction?

A

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

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14
Q

Symptoms for bowel obstruction?

A 
Abdo distention
Dehydration
Bilious vomiting
Hypovolaemia
Constipation
Severe colicky pain
Tinkling bowel sounds
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15
Q

Causes of bowel obstruction?

A

Small intestine - mainly adhesions following surgery

Large intestine - malignancy

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16
Q

How do we investigate a bowel obstruction?

A

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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17
Q

Management of bowel obstruction?

A

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

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18
Q

What is a volvulus?

A

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.

19
Q

Risk factors for volvulus?

A

Long mesentry
Neonatal malrotation
Chronic constipation
Adhesions

20
Q

Sign of volvulus of AXR?

A

Coffee bean sign

21
Q

Management of bowel volvulus

A

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

For caecal only do surgery

22
Q

What causes pancreatitis?

A

IGETSMASHED!

Go through this!

23
Q

Symptoms of pancreatitis?

A 
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)
24
Q

Investigations in acute pancreatitis?

A

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

25
Q

How to treat acute pancreatitis?

A 
Analgesia
IV Fluids and electrolytes
Oxygen support 
NG tube
Control blood sugar
ABx if infected

Treat cause - gallstones, necrosis

26
Q

What is peritonitis?

A

Inflammation of peritoneal lining of the abdo cavity

27
Q

What can cause peritonitis?

A

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

28
Q

Symptoms and signs of peritonitis?

A

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

29
Q

Investigations in peritonitis?

A

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

30
Q

Management of peritonitis?

A

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

31
Q

What is a hernia?

A

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

32
Q

What do these terms mean in a hernia?

Irreducible
Incarcerated
Obstructed
Strangulated

A

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

33
Q

What’s an inguinal hernia?

A

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

34
Q

2 types of inguinal hernia?

A

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

35
Q

What a femoral hernia?

A

Infero-lateral to the public tubercle

36
Q

Signs and symptoms of hernias?

A 
Asymptomatic
Lump in groin
Ask to cough and it will be more visible
Check if irreducible
Pain if incarcerated/strangulated
37
Q

Signs and symptoms of hernias?

A 
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
38
Q

Management of hernias?

A

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

39
Q

What is intestinal ischaemia?

A

Obstruction of mesenteric vessel leading bowel ischaemia and necrosis

40
Q

What are the types of intestinal ischaemia?

A 
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.

41
Q

Signs of intestinal ischaemia?

A

Intermittent colicky pain
Diarrhoea
Fever
Rectal bleeding

42
Q

Investigations for intestinal ischaemia?

A

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

43
Q

How to manage intestinal ischaemia?

A 
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

MedEd Tutorials (32 decks)

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