18. Abdominal Pain Flashcards
What are the commonest causes of abdominal pain?
Non specific abdominal pain Acute appendicitis Intestinal obstruction Urinary tract disease Biliary tract disease Abdominal trauma Abdominal malignancy Perforated peptic ulcer Pancreatitis
What is acute compartment syndrome?
Tissue pressure with a osseo-fascial compartment rises above the perfusion pressure of the tissues leading to cell death
It is a surgical emergency`
What are the are the 4 leg compartments?
Superior posterior compartment
Deep posterior compartment
Lateral compartment
Anterior compartment
What muscles, nerves and arteries are in the anterior compartment?
Tibialis anterior
Extensor Digitorum Longus (EDL)
Extensor Hallicis Longus (EHL)
Fibularis Tertius (all muscles dorsiflex and invert foot)
Deep fibular nerve
Anterior tibial artery
What muscles are in the anterior compartment?
Tibialis anterior
Extensor Digitorum Longus (EDL)
Extensor Hallicis Longus (EHL)
Fibularis Tertius
Deep fibular nerve
Anterior tibial artery/vein
What are the muscles nerves and arteries that occur in the lateral compartment?
Fibularis longus Fibularis Brevis (Both plantarflex and evert foot)
Superficial Fibular Nerve
What are the muscles nerves and arteries in the deep posterior compartment of the foot?
Popliteus (Externally rotates tibia)
TIbilais Posterior
Flexor Hallicus Longus
Flexor Digitorum Longus (all muscles plantarflex)
Tibial Nerve
Posterior tibial artery
What are the muscles nerves and ateries in the deep posterior compartment of the foot?
Popliteus (Externally rotates tibia)
TIbilais Posterior
Flexor Hallicus Longus
Flexor Digitorum Longus (all muscles plantarflex)
Tibial Nerve
Posterior tibial artery
Describe the pathophysiology of compartment syndrome?
Injury within the fascial compartment leads to bleeding and swelling. Reduced perfusion leads to swelling and oedema
Ischemia will result in permanent damage and disability if not recognised and treated within 6 hours of onset
What are the most common injuries leading to acute compartment syndrome?
Fractures (most common tibial shaft)
Crush injuries
Burns
What iatrogenic causes are there of acute compartment syndrome?
Tight dressing/casts
Extravasation of fluids
What iatrogenic causes are there of acute compartment syndrome?
Tight dressing/casts
Extravasation of fluids
What is a reperfusion injury?
Ischeamia leads to cell death and increased capillary permeability
Reperfusion rushed blood into the leaky environment causing a rapid rise in intra-compartmental pressure
What is phlegmasia cerulean dolens
Rare disease that causes a rare discolouration of the leg due to a massive DVT
What are the 5 P’s of an acute limb?
Pain Pulselessness Parasthesia Paralysis Pallor
Apart from pain, what other symptoms may be present in compartment syndrome?
Swelling
Tense, woody compartments on palpation
Pink discolouration
Non blanching
Apart from pain, what other symptoms may be present in compartment syndrome?
Swelling
Tense, woody compartments on palpation
Pink discolouration
Non blanching
If you suspect acute compartment syndrome what is the immediate management
NOT ABCDE (for once)
Elevate limb Remove all compressing dressings/clothing Reassess every 30 mins Contact surgery Follow Boast guidlines
What investigations can be done if you are not certain of the diagnosis of compartment syndrome
X-ray
GCS
Compartment monitoring
What common complication do those with compartment syndrome develop?
Acute renal failure secondary to rhabdomyolosis
In Rhabdomyolosis myoglobin, creatining kinase ad urate are released into systemic circulation
This is because myoglobin is nephrotoxic
How do you test for rhabdomyolsis
Serum creatinine kinase
What is the treatment for rhabdomyolosis
Start IV fluids and maintain a high urine output
Monitor U&E’s and CK regualrly
