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Jess GI > 11: Acute Abdomen > Flashcards

11: Acute Abdomen Flashcards

1
Q

What does VITAMIN CDEF stand for in terms of differentials for an acute abdomen

A

Vascular, infective/inflammatory, trauma, autoimmune, metabolic (i.e diabetes), iatrogenic, neoplastic, congenital, degenerative/developmental, endocrine/environmental, functional

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2
Q

Name the presenting complaints to check for in a GI history taking
*Hint: there’s 10

A
  1. Dysphasia
  2. Dyspepsia (indigestion; heart burn, acid)
  3. Nausea/vomiting and hematemesis
  4. Abdominal pain
  5. Rectal bleeding and malaena
  6. Abdominal distension
  7. Anorexia and weight loss
  8. Jaundice
  9. Anemia
  10. Constipation
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3
Q

What aspects of a past medical history, drug and FH would you be interested in when taking a GI history?

A

PMH: Previous surgical history, chronic bowel disease, associated conditions

Drug: NSAIDs, antibiotics and any GI side effects

FH: IBD, coeliac, peptic ulcers, hereditary liver disease, bowel cancer

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4
Q

What aspects of a social and occupational history would you be interested in when taking a GI history?

A

Social: tattoos, social contacts, foreign travel, IDU

Occupational: exposure to hepatotoxins and health workers

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5
Q

Other than GI symptoms, what other aspects of a systems review would you want to ask when finishing a GI history?

A

GU symptoms: dysuria, frequency, urgency, hematuria, incontinence

Gynaecology: vaginal discharge and bleeding

General: fever, nausea

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6
Q

Describe how typical ‘visceral pain’ feels, where does it originate from? Where is visceral pain generated from a

A

Steady ache or vague discomfort to colicky pain, poorly localized and is generated from hollow or solid organs. Pain may be in the midline due to bilateral innervation

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7
Q

Name three structures might be involved in pain of each of the following regions
A) epigastric/foregut
B) periumbilical/midgut
C) suprapubic/hindgut

A

A) stomach, DD, biliary tract
B) small bowel, appendix, caecum
C) colon, sigmoid, GU tract

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8
Q

How does parietal pain differ from visceral pain? How might a patient present with parietal pain?

A

More localized and involves the parietal peritoneum, patient may have tenderness and guarding which progresses to rigidity and rebound (sharp) pain as peritonitis develops

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9
Q

What causes referred pain and where/what might be the origin of the pain if it presents in the following areas?
A) testicular
B) shoulder or supraclavicular
C) back or proximal lower extremity
D) R infra scapular
E) Epigastric, neck, jaw or upper extremity pain

A 
Based on developmental embryology 
A) Ureteral obstruction
B) sub diaphragmatic irritation 
C) gynaecological 
D) biliary disease
E) MI
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10
Q

What aspects of a GI examination would you be looking for? What signs may specifically indicate peritonitis?

A

Distension, tenderness/guarding/rebound, absent bowel sounds

Peritonitis: pain on deep inspiration or cough may indicate peritonitis (diaphragm pushes down), patient stays very still

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11
Q

What aspects of the following investigations may indicate an acute abdomen problem?
FBC, urea and electrolytes, CRP, LFT, amylase, glucose, blood cases

A

FBC: raised WBC
U&E: Increased creatinine and urea, low or high K/Na
CRP: raised
LFT: raised ALT and bilirubin
Amylase: raised
Glucose - variable
Blood gases: acidosis may indicate pancreatitis

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12
Q 
What observations relating to the abdomen would be important when performing the following investigations 
A) CXR
B) Abdominal plain film
C) ultrasound 
And CT
A

A) lung pathology and air under the diaphragm
B) toxic megacolon (ulcerative colitis)
C) renal and biliary stones
CT: for more detail and renal stones

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13
Q

Name three issues that should be kept in mind if pain arises in the RUQ and five issues for the LUQ

A

RUQ: Gall stones, pancreatitis, stomach ulcer

LUQ: Stomach ulcer, duodenal ulcer, pancreatitis, spleen, left colic flexure

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14
Q

Name five issues that should be kept in mind if pain arises in the epigastric region

A

Indigestion/dyspepsia, epigastric hernia + RUQ: pancreatitis, stomach ulcer, gallstones

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15
Q

Name the issues that should be kept in mind if pain arises in the R lumbar and L lumbar regions

A

R Lumbar mainly: lumbar hernia
L Lumbar mainly: diverticulitis, IBD

Both: renal stones, UTI, constipation

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16
Q

Name six issues that should be kept in mind if pain arises in the umbilical region

A

Pancreatitis, early appendicitis, stomach ulcer, IBD, small bowel problems, umbilical hernia

17
Q

Name the issues that should be kept in mind if pain arises in the R iliac fossa and L iliac fossa

A

R Iliac fossa mainly: Appendicitis, inguinal hernia
L iliac fossa mainly: diverticula

Both: constipation, pelvic AND groin pain

18
Q

Name five issues that should be kept in mind if pain arises in the suprapubic region

A

Appendicitis, UTI, Diverticulitis, IBD, pelvic pain

19
Q

Name three potential conditions that may arise from pain below the inguinal ligament

A

Torsion of the testis, groin abscess, issues with the femoral artery

20
Q

Name two major conditions occurring above the diaphragm (from the slide)

A

Acute coronary syndrome (ACS): blockage of coronary artery

Pneumonia

21
Q

What age group does acute appendicitis peak?

A

10-20 years

22
Q

What is the purpose of the appendix

A

Stores beneficial bacteria and is lymphoid tissue (with IgA)

23
Q

What causes acute appendicitis and what can happen as a consequence?

A

Obstruction of the lumen: lymphoid hyperplasia, faecolith (feces), filarial worms

Leads to inflammation, bacterial invasion (infection), ischemia and perforation

24
Q

What is the classic presentation of acute appendicitis?
*Including the presentation of pain

Where might pain be felt in a pelvic appendix and in males?

A

Anorexia, nausea, vomiting
Pain: Periumbilical pain and pain localized to RIF. 26% are retro caecal and cause pain in the flank (and 4% in RUQ)

Pelvic appendix: suprapubic pain, dysuria

Males may have pain in the testicles

25
Q

What notable findings might be found on examination of a patient with acute appendicitis?

A
  • Rebound pain, voluntary guarding/rigidity
  • Psoas and obturator sign
  • Fever (a late findings)
26
Q

What might be observed on a urinalysis and CT scan in a patient with appendicitis?

A

Urinalysis: abnormal in 19-40%

CT scan: fluid collection, abscess, peri caecal inflammation

27
Q

What might you do in the following scenarios:
A) clinical appendicitis
B) maybe appendicitis
c) suspect a patient does not have appendicitis

A

A) surgery
B) CT scan
C) observe 6-12 hours or re-examine in 12 hours

28
Q

How is appendicitis treated?

A

IVFs and No eating

Preoperative antibiotics (to decrease incidence of postoperative wound infections) to cover anaerobes, gram -ve and enterococci

Analgesia

29
Q

How would McBurney point tenderness be found?

A

The pressure of the finger exactly between 1.5-2 inches between ASIS and the umbilicus

30
Q

What is a positive Rosving sign and what causes it? What can it be indicative of?

A

Indicative of appendicitis: positive when pressure over the patient’s LLQ causes pain in the RLQ (due to the travelling of gas)

31
Q

Explain LRs and their significance

A

LR means likelihood ratio of having appendicitis (has diagnostic weight)

The higher the LR, the greater increase in probability.
The closer the # is to 0, the greater the decrease in probability
LR of 1 doesn’t change the probability of disease at all

Various tests (either + or -ve) will have different LRs that increase or decrease the probability of having appendicitis

32
Q

What other scoring system is used as a diagnostic tool for appendicitis?

A

The Alvarado score

33
Q

What conditions are encompassed in the term gallstone disease?

A
  1. Asymptomatic gall stones
  2. Symptomatic gall stone in the gall bladder/bile duct (biliary colic). Can progress to cholecystitis: inflammation of GB, may also have fever and constant pain.
  3. Cholangitis is inflammation due to obstruction (usually caused by bacteria/infection)
  4. Pancreatitis
34
Q

Describe the pain felt with gallstone disease, what exacerbates the pain and what might be felt along with it?

A

Colicky pain in RUQ to epigastric region, transient; 30 min-2 hours, mild-very bad, may also present with a metallic taste and is worse when eating fatty foods

35
Q

What happens in gall stone ileus?

What might be the cause of long standing GB inflammation?

A

Gallstone causes a fistula between GB and ileum, causing inflammation. It eventually becomes impacted at the ileocecal valve causing an ileus

Long standing GB inflammation may be due to GB cancer

36
Q

What observation and investigation points to bile duct stones?

A

Deranged LFT and jaundice

37
Q

What is Charcot’s triad and what is it indicative of?
What ‘Pentad’ is it related to?
What happens if there is bacterial

A

Means cholangitis: RUQ pain, fever, jaundice

Related to Reynold’s pentad; can also have altered mental status + hypotension

38
Q

Define bacterial translocation, what can occur if this happens?

A

When bacteria passes from the GIT to extra-intestinal sites, can cause septic shock

39
Q

How is cholangitis treated? What diagnostic procedure should be done and where might they be sent?

A

IV fluids, broad spectrum antibiotics and surgery

ERCP (endoscopic retrograde cholangio-pancreatography) can be done for diagnosis, and the patient may be sent to HDU (high dependency unit) of hospital

Jess GI (17 decks)

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