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GASTRO > 11: Acute Abdomen > Flashcards

11: Acute Abdomen Flashcards

1
Q

How does acute abdominal pain localise?

A

Localises according to embryological divisions of the gut:

  • Foregut: localises to Epigastric Area
  • Midgut: localises to Periumbilical Area
  • Hindgut: localises to Suprapubic Area
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2
Q

What are the key features of a History of a patient with Acute Abdominal Pain? (5 things)

A
  1. Past Medical History
  2. Drug History
  3. Family History
  4. Social History
  5. Occupational History
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3
Q

What features of Past Medical History are relevant in a patient with Acute Abdominal Pain? (3 things)

A
  1. Previous surgical history
  2. Chronic Bowel Disease
  3. Associated conditions
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4
Q

What features of Drug History are relevant in a patient with Acute Abdominal Pain? (3 things)

A
  1. GI side fx of drugs they’re taking
  2. NSAIDs
  3. Abx
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5
Q

What features of Family History are relevant in a patient with Acute Abdominal Pain? (5 things)

A
  1. Inflammatory Bowel Disease
  2. Coeliac Disease
  3. Peptic Ulcer
  4. Hereditary Liver Disease
  5. Bowel Cancer
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6
Q

What features of Social History are relevant in a patient with Acute Abdominal Pain? (4 things)

A
  1. Tattoos
  2. Drug use
  3. Social contacts
  4. Recent foreign travel
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7
Q

What features of Occupational History are relevant in a patient with Acute Abdominal Pain? (2 things)

A
  1. Exposure to hepatotoxins
  2. Health workers
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8
Q

What are the key sings associated with Acute Abdominal Pain? (9 things)

A
  1. Dysphagia (difficulty swallowing)
  2. Dyspepsia (indigesion)
  3. Nausea / vomiting
  4. Altered bowel habits
  5. Rectal bleeding
  6. Abdominal distension
  7. Anorexia / weight loss
  8. Jaundice
  9. Anaemia
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9
Q

What are the different types of Acute Abdominal Pain? (3 things)

A
  1. Visceral
  2. Parietal
  3. Referred
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10
Q

What are the features of VISCERAL Acute Abdominal Pain? (4 things)

A
  1. Hollow / solid organs
  2. Midline pain because bilateral innervation
  3. Vague discomfort → colicky pain
  4. POORLY localised
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11
Q

What does Visceral EPIGASTRIC Acute Abdominal Pain suggest is affected? (3 things)

A
  1. Stomach
  2. Duodenum
  3. Biliary Tract
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12
Q

What does Visceral PERIUMBILICAL Acute Abdominal Pain suggest is affected? (3 things)

A
  1. Small Bowel
  2. Appendix
  3. Rectum
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13
Q

What does Visceral SUPRAPUBIC Acute Abdominal Pain suggest is affected? (2 things)

A
  1. Sigmoid Colon
  2. Genitourinary Tract
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14
Q

What are the features of PARIETAL Acute Abdominal Pain? (3 points)

A
  1. Involves Parietal Peritoneum
  2. LOCALISED Pain
  3. Tenderness & Guarding (develops → Rigidity & Rebound @ Peritonitis)
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15
Q

What is guarding?

A

Tensing abdominal muscles to guard inflammed organs

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16
Q

What is rebound?

A

Pain @ sudden release of pressure on abdomen

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17
Q

Where is pain referred to from Uretal Obstruction?

A

Testicular pain

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18
Q

Where is pain referred to from Sub diaphragatic irritation? (2 things)

A
  1. Ipsilateral shoulder
  2. Supraclavicular pain
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19
Q

Where is pain referred to from Gynaecological Pathologies? (2 things)

A
  1. Back
  2. Thigh
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20
Q

Where is pain referred to from Biliary Disease?

A

Right Infra scapular pain

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21
Q

Where is pain referred to from MI? (4 things)

A
  1. Epigastric
  2. Neck
  3. Jaw
  4. Arm
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22
Q

What blood tests are used to invesigate Acute Abdominal Pain? (7 things)

A
  1. FBC
  2. Urea & Electrolytes
  3. CRP (C-Reactive Protein)
  4. Liver function tests
  5. Amylase
  6. Glucose
  7. Blood gases
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23
Q

What might be seen in a FBC in a person with Acute Abdominal Pain?

A

High WBC (neutrophils)

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24
Q

What might be seen in the Urea & Electrolytes in a person with Acute Abdominal Pain?

A
  1. High creatinine
  2. High urea
  3. High / Low K/Na
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25
Q

What might be seen in the C-Reactive Protein (CRP) blood test in a person with Acute Abdominal Pain?

A

High CRP

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26
Q

What might be seen in the Liver function tests in a person with Acute Abdominal Pain? (2 things)

A
  1. High ALT (alanine aminotransferase)
  2. High bilirubin
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27
Q

What might be seen in the Amylase blood test in a person with Acute Abdominal Pain?

A

High amylase

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28
Q

What might be seen in the Blood gases test in a person with Acute Abdominal Pain?

A

Acidosis (means patient has pancreatitis)

29
Q

What Radiology tests are done to investigate a patient with Acute Abdominal Pain? (4 things)

A
  1. CXR (erect)
  2. Abdominal Plain Film
  3. US
  4. CT
30
Q

What might be seen on a CXR (erect) in a patient with Acute Abdominal Pain?

A

Lung pathology

31
Q

What might be seen on a Abdominal Plain Film in a patient with Acute Abdominal Pain? (2 things)

A
  1. Trapped gas bubble
  2. Intestinal Obstruction
32
Q

What might be seen on a US in a patient with Acute Abdominal Pain? (2 things)

A
  1. Renal stones
  2. Biliary stones
33
Q

What might be seen on a CT in a patient with Acute Abdominal Pain?

A

More detailed things

34
Q

What does Right Hypochondrium pain suggest? (3 things)

A
  1. Gall stones
  2. Pancreatitis
  3. Stomach ulcer

GPS

35
Q

What does Epigastric pain suggest? (5 things)

A
  1. Indigestion / Dyspepsia
  2. Epigastric Hernia
  3. Gall stones
  4. Pancreatitis
  5. Stomach ulcer

I.E GPS

36
Q

What does Left Hypochondrium pain suggest? (4 things)

A
  1. Duodenal Ulcer
  2. Biliary colic
  3. Stomach ulcer
  4. Pancreatitis

DBS Person

37
Q

What does Right Lumbar pain suggest? (4 things)

A
  1. Constipation
  2. Lumbar Hernia
  3. UTI
  4. Renal stones

CLUR (like claire lol)

38
Q

What does Umbilical pain suggest? (6 things)

A
  1. Pancreatitis
  2. Umbilical Hernia
  3. Early Appendicitis
  4. Stomach ulcer
  5. Inflammatory Bowel Disease
  6. Small Bowel problems

PUE SIS (like poo sis)

39
Q

What does Left Lumbar pain suggest? (4 things)

A
  1. Diverticulitis
  2. Inflammatory Bowel Disease
  3. Constipation
  4. Kidney stones

DICK

40
Q

What does Right Iliac Fossa pain suggest? (5 things)

A
  1. Groin Pain
  2. Inguinal Hernia
  3. Constipation
  4. Appendicitis
  5. Pelvic Pain (gynae)

GI-CAP

41
Q

What does Suprapubic pain suggest? (5 things)

A
  1. Inflammatory Bowel Disease
  2. UTI
  3. Pelvic Pain
  4. Appendicitis
  5. Diverticulitis

I U PAD

42
Q

What does Left Iliac Fossa pain suggest? (4 things)

A
  1. Constipation
  2. Groin Pain
  3. Appendicitis
  4. Pelvic Pain

C GAP

43
Q

What are the Pain presentations of Appendictis? (4 things)

A
  1. Periumbilical Pain → R Iliac Fossa
  2. Guarding & Rebound
  3. NO Relieving factors
  4. Aggrevated by MOVEMENT
44
Q

What are the non-pain presentations of Appendicitis? (2 things)

A
  1. Fever
  2. Tacchycardia
45
Q

What are the findings of the investigations for Appendicitis? (2 things)

A
  1. High WBC (neutrophils)
  2. High CRP (C-reactive protein)
46
Q

Why won’t Abx work alone for appendicitis treatment?

A

Because there is necrosis & iscahemia → perforations

47
Q

What is the treatment for appendicitis?

A

Emergency appendicectomy

48
Q

What is Gall Stone Disease an umbrella term for? (3 things)

A
  1. Cholecystitis
  2. Pancreatitis
  3. Asymptomatic gall stones in gall bladder
49
Q

What are the Pain presentations of Gall Stone disease? (5 things)

A
  1. Wave like pain from RUQ → Epigastric
  2. Radiates → back / shoulders
  3. Dull + achy → sharp + localised
  4. Lasts 6 hours +
  5. Worse when eating fatty foods
50
Q

What are the non-pain presentations of Gall Stone Disease? (3 things)

A
  1. Nausea / vomiting
  2. Anorexia
  3. Fever

NAF

51
Q

What are the findings of the investigations of Gall Stone Disease? (5 things)

A
  1. High alkaline phosphatase
  2. High lipase (means gall stone pancreatitis)

RUQ US findings:

  1. Thick gall bladder wall
  2. Pericholecystic fluid
  3. Gall stones
52
Q

What is the treatment for Gall Stone Disease? (4 things)

A
  1. IV fluids
  2. Correct electrolyte abnormalities
  3. Analgesia
  4. Abx
53
Q

What is Diverticulitis?

A

Outpouching of bowel (sigmoid colon) to form a sac

54
Q

What are the Pain presentations of Diverticulitis? (3 things)

A
  1. LIF pain
  2. Localised tenderness
  3. Rebound & guarding
55
Q

What are the non-pain presentations of Diverticulitis? (4 things)

A
  1. Fever
  2. Change in bowel habits
  3. Tenesmus (always wanna poo)
  4. Small bowel obstruction
56
Q

What are the findings of the investigations of Diverticulitis? (3 things)

A
  1. Leucocytosis

CT (IV & oral contrast) findings

  1. Thick bowel wall
  2. Peri-diverticular abscess
57
Q

What is the treatment for Diverticulitis? (3 things)

A
  1. Fluids
  2. Correct electrolyte abnormality
  3. Abx
58
Q

What are some Large Bowel obstructions? (3 things)

A
  1. Carcinoma
  2. Diverticulitis
  3. Volvulus (loop of intestinal twists)
59
Q

What are some Small Bowel obstructions? (2 things)

A
  1. Hernias
  2. Adhesions
60
Q

What is the type of pain for Intestinal Obstructions?

A

Colicky pain

61
Q

Where is the pain for Intestinal Obstructions?

A

Umbilical / Suprapubic

62
Q

What are the non-pain presentations of Intestinal Obstructions? (6 things)

A
  1. Constipation
  2. Distension
  3. Vomiting
  4. Dehydration
  5. Hyperactive on auscultation
  6. Empty rectum
63
Q

What are the findings of the investigations for Intestinal obstruction? (4 things)

A
  1. High WBC

X-Ray findings

  1. Dilated loops of bowel
  2. Less gas in bowel + rectum

CT

  1. Identifies obstruction cause
64
Q

What is the treatment for Intestinal obstruction? (3 things)

A
  1. Fluids
  2. Analgesia
  3. Abx
65
Q

What are the Pain presentations of Renal Colic? (5 things)

A
  1. Acute severe pain
  2. Flanks
  3. Radiates → Abdomen / groin (testicles)
  4. Non tender @ palpation
  5. Pain comes and goes in waves
66
Q

What are the non-pain presentations of Renal Colic?

A

Nausea

67
Q

What are the investigations for Renal Colic? (5 things)

A
  1. Urinalysis
  2. FBC
  3. Urea + electrolytes
  4. US
  5. CT
68
Q

What is the treatment for Renal Colic? (3 things)

A
  1. IV fluids
  2. Analgesia
  3. Remove with US
69
Q

What are some other misceallaneous causes for Acute Abdominal Pain?

A
  1. Strangulated hernia
  2. Ectopic pregnancy

GASTRO (10 decks)

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