13. Abdominal Catastophes Flashcards
What is the definition of an abdominal catastrophe?
An event within or behind the abdominal cavity that poses an imminent threat to life.
What nerves supply the parietal peritoneum and so pain is perceived as being at the site of the inflammation?
Same nerves that supply the skin of the abdomen.
What nerves supply the visceral peritoneum and therefore produce deferred pain?
Autonomic nervous system.
What is somatic pain?
Pain detected by nerves in the skin and deep tissues.
What is somatic referred pain?
Pain caused by a noxious stimulus to the proximal part of a somatic nerve that is perceived in the distal dermatome of the nerve.
What is visceral pain?
Pain detected by nerves in organs.
What is visceral referred pain?
Pain perceived by the CNS as coming from the somatic portion of the body supplied by the spinal cord segments that give rise to the preganglionic sympathetic fibres that the visceral afferent pain fibres follow back to the spinal cord.
What 2 things cause visceral pain?
Abnormally strong muscle contraction and stretch.
Inflammation.
Ischaemia.
Where is foregut pain felt?
Epigastric region.
Where is midgut pain felt?
Periumbilical region.
Where is hindgut pain felt?
Suprapubic region.
If a patient suddenly drops down on the floor, rolling around in pain, what is the likely diagnosis?
Ureteric colic.
Why do patients with a small intestinal obstruction become rapidly dehydrated?
Fluid loss occurs due to accumulation of fluids, increased secretion and decreased reabsorption. This causes loss of isotonic salt water resulting in isotonic contraction of the ECF volume and so dehydration occurs. 3-4 litres of isotonic fluid can sequester in the gut, and so when vomiting begins this is removed, leaving space in the gut for more to be sequestered. Therefore rapidly lose fluid from ECF.
What can be seen in a blood test as indicators of dehydration in small intestine obstruction?
Raised haematocrit and raised serum urea.
Give 3 common causes of bleeding into the gut and how is the bleeding seen clinically with each?
Bleeding oesophageal varices - haematemesis and melaena.
Bleeding peptic ulcer - haematemisis and melaena.
Bleeding diverticulum disease - haematochezia.
What artery is likely to be eroded in a bleeding duodenal ulcer, and so where on the duodenum is the ulcer?
Posterior duodenal ulcer - gastroduodenal artery.
What is happening is a patient has haematemesis and haematochezia?
Patient is bleeding massively from the upper GI tract.
If serum creatinine is normal, what does a rise in blood urea in a patient with oesophagus/gastric bleeding help indicate?
The source of the bleeding (stomach or oesophagus).
The higher the blood urea rise, the larger the bleed.
What are the 2 commonest causes of retroperitoneal bleeding?
Ruptured abdominal aortic aneurysm.
Patient on anticoagulants bleeding from torn retroperitoneal veins.
What is usually the INR of a patient who is bleeding from torn retroperitoneal veins?
> 5.0.
Give 3 ways that a patient with a ruptures AAA can present.
Sudden death.
Sudden onset of severe abdominal and back/loin pain.
Sudden collapse.
Presents to the emergency department with ‘shock’.
A women presents to A and E with lower abdominal pain, vaginal bleeding, collapse and left shoulder top pain on lying down. She is also of reproductive age. What is the likely diagnosis?
Ruptured ectopic pregnancy.
How might fluid that has entered into the lesser sac from a perforated gastric ulcer enter into the greater sac?
Epiploic (mental) foramen.
What leads to chemical peritonitis?
Perforated peptic ulcer.
