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CSI > 2.5// Abdominal Pain > Flashcards

2.5// Abdominal Pain Flashcards

1
Q

What does the term acute abdomen refer to?

A

the rapid onset of severe symptoms of abdominal pathology

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2
Q

What amy an acute abdomen indicate?

A

a potentially life-threatening condition that requires urgent surgical intervention

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3
Q

What should immediate assessment focus on?

A
  • what quadrant (it can be any quadrant of the abdomen)?
  • intermittent, sharp, dull, achy or piercing pain?

*radiating from a focal site?

*accompanied by nausea and vomiting?

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4
Q

What reduces unnecessary admission for abdomen issues?

A

experienced surgeon

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5
Q

How may a patient with acute surgical pathology deteriorate?

A

rapidly

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6
Q

What do patients with severe, unremitting symptoms warrant?

A

thorough investigation and close monitoring

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7
Q

acute abdomen can occur without pain in who?

A

older people
children
immunocompromised
last trimester of pregnancy

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8
Q

How does abdominal pain in older people, the immunocompromised, and pregnant women often present, and what does this lead to?

A

atypically

leading to delayed diagnosis of life-threatening abdominal pathology

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9
Q

An acute abdomen is diagnosed by a combination of what? (4)

A

history
physical examination
imaging
laboratory results

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10
Q

What are the commonest causes of acute abdomen?

A

nonspecific abdominal pain
renal colic
biliary colic
cholecystitis
appendicitis
diverticulitis

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11
Q

What are diverticula?

A

small bulges or pockets that can develop in the lining of the intestine as you get older

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12
Q

How do people usually know they have diverticula and why?

A

usually they get no symptoms and only know they have them when they have a scan

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13
Q

What is having diverticula without symptoms called?

A

diverticulosis

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14
Q

When diverticula do cause symptoms, what is often that symptom?

A

pain in the lower tummy

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15
Q

What is it called when diverticula do cause pain?

A

diverticular disease

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16
Q

What can lead to diverticula causing severe symptoms?

A

them being inflamed or infected

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17
Q

What is it called when diverticula are inflamed or infected?

A

diverticulitis

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18
Q

What are the different parts of the colon? (6)

A

appendix
caecum
ascending colon
trasverse colon
descending colon
sigmoid colon

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19
Q

How should you asses a patient?

A

systematic approach (evaluating airway, breathing, circulation, disability, exposure)

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20
Q

How do you correct hypovolaemia?

A

fluids and/or blood products

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21
Q

How do you treat ruptured abdominal aortic aneurysm (AAA) or aortic dissection?

A

especially careful fluid management

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22
Q

When should an urgent urological consultation be obtained?

A

if testicular torsion is suspected

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23
Q

What should you include with your full blood count in all patients?

A

electrolytes, creatinine, urea

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24
Q

What should you give to patients suspected to have an ongoing haemorrhage?

A

antifibrinolytic such as tranexamic acid

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25
Q

When are prophylactic antibiotics recommended?

A

for patients with a perforated viscus, diverticulitis, appendicitis, mesenteric ischaemia, ruptured AAA

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26
Q

What should you consider in patients with epigastric pain, particularly accompanied by sweating?

A

myocardial infarction

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27
Q

What are the key components of the history?

A
  • a detailed evaluation of the pain
  • type and time of last meal or other oral intake
  • past medical and surgical history, medication use, and family history.
  • a detailed evaluation of the pain (site, onset, character, radiation, referral, associated symptoms and signs, time course, exacerbating and relieving factors, and severity)
  • type and time of last meal or other oral intake (information required if surgery is indicated)
  • past medical and surgical history, medication use, and family history.
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28
Q

In what order should the physical examination be done?

A

Measure vital signs: blood pressure, temperature, and pulse rate.

  • Inspection-Make a general assessment of how ill the patient appears.
  • Auscultation-chest and abdomen
  • Percussion
  • Palpation
  • Other important examinations: rectal, pelvic, scrotal/testicular
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29
Q

Why do you do auscultation before palpation?

A

to put the patient at ease and increase cooperation

also palpation may stimulate bowel activity and thus falsely increase bowel sounds if performed before auscultation

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30
Q

What are the anatomical parts of the male pelvic area?

A

bladder
prostate
penis
urethra
scrotum
tunica vaginalis
testis
epididymis
vas deferens
anus
seminal vesicles
rectum

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31
Q

What are common differentials for abdominal pain?

A
  • Adhesions
  • Incarcerated/strangulated hernia
  • Cholecytitis
  • Perforate gastric ulcer
  • Appendicitis
  • Ectopic pregnacy
  • Pelvic inflammatory disease
  • acute pancreatitis
  • acute diverticulitis-RF up until here
  • Ulcerative colitis
  • Chohn´s disease
  • cholelithiasis
  • gastrointestinal malignancy-RF
  • Mallory-Weiss tear
  • Diabetic ketoacidosis-RF
  • Opioid withdrawal
  • hepatitis
  • gastroenteritis
  • infectious colitis
  • sickle cell crisis
  • endometriosis
  • testicular torsion
  • kidney stones
  • pyelonephritis
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32
Q

What is pyelonephritis?

A

a type of urinary tract infection where one or both kidneys become infected

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33
Q

What is a mallory-weiss tear?

A

a tear of the tissue of your lower esophagus

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34
Q

What are abdominal adhesions?

A

bands of scar tissue that form between abdominal organs- mainly the small intestine

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35
Q

What are imaging tests that can be done?

A

Plain abdominal x-ray:

Erect chest x-ray if perforation is suspected:

Computed tomography (CT) of abdomen:

ultrasound

Magnetic resonance imaging (MRI):

Fluoroscopy:

endoscopy

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36
Q

What are the indications for the erect chest radiograph (CXR)?

A

to exclude free gas under the diaphragm as a result of a perforated viscus

and to attempt to exclude an intrathoracic condition asa cause for the abdominal symptoms

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37
Q

What is a perforated viscus also known as?

A

intestinal or bowel perforation

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38
Q

What is a perforated viscus/ intestinal or bowel perforation?

A

a full thickness disruption of the intestinal wall, with subsequent leakage of enteric contents into the peritoneal cavity

39
Q

What is fluoroscopy?

A

a type of medical imaging that shows a continuous x-ray image on a monitor

40
Q

What is cholecystitis?

A

inflammation of gallbladder

41
Q

What is the WBC count in cholecystitis?

A

raised

42
Q

What else may be elevated in cholecystitis?

A

elevated alkaline phosphatase, bilirubin, aminotransferase

43
Q

What can be caused by cholecystitis and why?

A

Jaundice in acute cholecystitis due to reduced excretion which may be caused by pressure on the ducts by the distended gallbladder

44
Q

What may the presence of abdominal scars give clues to?

A

previous and current pathology and the likelihood of adhesions

45
Q

When can rebound tenderness be present?

A

appendicitis, diverticulitis and any condition where there is irritation of the parietal peritoneum

46
Q

What can be palpated with ectopic pregnancy?

A

there is often a palpable adnexal mass with or without tenderness, and vaginal bleeding on speculum examination

47
Q

What is adnexal mass?

A

a lump in tissue near the uterus, usually in the ovary or fallopian tube

48
Q

What lab tests should be done?

A

Full blood count

Serum electrolytes

Urinalysis

Pregnancy test

Coagulation studies:

Comprehensive metabolic panel

Serum amylase and lipase levels

Serum lactic acid levels

49
Q

What is biliary colic?

A

it is defined as pain in the abdomen, due to obstruction usually by stones in the cystic duct of the biliary tree

50
Q

What is the pain caused by in biliary colic?

A

due to contraction

51
Q

What is causing it to contract in biliary colic?

A

CCK (cholecystokinin)

52
Q

What are the parts of the abdomen involved in biliary colic?

A

gallbladder
cystic duct
hepatic duct
liver
common bile duct
pancreatic duct
duodenum

53
Q

What is cholecystitis?

A

it is a redness and swelling (inflammation) of the gallbladder

54
Q

When does cholecystitis occur?

A

when bile gets trapped in the gallbladder

55
Q

What usually causes cholecystitis?

A

gallstones blocking tubes that lead out of gallbladder

56
Q

What is the difference between biliary colic and cholecystitis?

A

inflammation

57
Q

What is cholangitis?

A

inflammation of the bile duct system

58
Q

What are causes of acute cholangitis?

A

bacterial infection
gallstones
blockages
tumour

59
Q

What is RUQ pain?

A

Acute right upper quadrant pain

60
Q

What is LUQ pain?

A

acute left upper quadrant pain

61
Q

Is there RUQ pain, fever or jaundice with biliary colic?

A

there is RUQ pain
there is no fever or jaundice

62
Q

Is there RUQ pain, fever or jaundice with cholecystitis?

A

there is RUQ pain and fever
no jaundice

*jaundice is present in 10% of cholecystitis cases

63
Q

Is there RUQ pain, fever or jaundice with cholangitis?

A

there is RUQ pain, fever and jaundice

64
Q

How does a patient with biliary colic present?

A

steady severe pain in the RUQ
symptoms last between 15mins and 5h

65
Q

How does a patient with cholecystitis present?

A

biliary pain lasting more than 5 hours accompanied by features of inflammation e.g., fever, marked RUQ tenderness, leukocytosis

66
Q

How does a patient with cholangitis present?

A

sudden onset epigastric or LUQ pain whicvh may radiate to the back, nausea and vomiting common causes are gallstones and excessive alcohol consumption

67
Q

Would you expect inflammation in biliary colic?

A

No

68
Q

Why is there jaundice with cholangitis?

A

bilirubin would not secreted from the liver, so you would have jaundice

elevation of LFT (aka elevated liver enzymes)

69
Q

Where is Murphy’s sign seen?

A

acute cholecystitis

70
Q

What is Murphy’s sign?

A

pain on inspiration when you palpate on the RUQ, absent in LUQ

71
Q

Label.

A
72
Q

What would you see in an ultrasound in cholecystitis?

A

gallstones

hyperechoic gallstone with posterior shadowing

73
Q

What are the two types of gallstones?

A

pigment gallstones
cholesterol gallstones (80%)

74
Q

What are risk factors for cholesterol gallstone disease?

A

obesity
aging
oestrogen treatment
pregnancy
diabetes

75
Q

What are risk factors for pigment gallstones?

A

haemolytic anaemia

black pigment gallstones form whenever an increased load of bilirubin reaches the liver

76
Q

What is the general pathogenesis of gallstones?

A

there is supersaturation
gallstones made of water, bilirubin and salts

Imbalances in the constituents of bile and biliary sludge secondary to gallbladder hypokinesis can lead to the precipitation of insoluble stones. When these gallstones cause physical blockages in the biliary tree and beyond, pain, inflammation, and infection can result in damage to the gallbladder and a host of other organs.

77
Q

What are some complication caused by gallstones?

A

gallstone pancreatitis

acute cholecystitis

causing biliary obstruction

gallstone ileus

biliary fistula

bouveret syndrome

mirizzi’s syndrome

78
Q

What is Mirizzi’s syndrome?

A

Mirizzi’s syndromeis a rare complication in which a gallstone becomes impacted in thecystic ductor neck of thegallbladdercausing compression of the common hepatic duct, resulting in obstruction and jaundice.

defined as common hepatic duct obstruction caused by extrinsic compression from an impacted stone

79
Q

What is bouveret syndrome?

A

Bouveret syndromerefers to agastric outlet obstruction secondary to impaction of a gallstone in the pylorus or proximalduodenum. Thus, it can be considered a very proximal form ofgallstone ileus.

80
Q

What do impacted gallstones in the cystic duct cause?

A

acute cholecystitis

81
Q

What is gallstone ileus?

A

it is an uncommon cause of a mechanical small bowel obstruction

*small bowel ileus is different to bowel ileus

82
Q

When does gallstone ileus occur?

A

when stone obstructs ileocecal valve after migrating through the fistula

83
Q

What is a fistula?

A

A fistula is an abnormal connection between two body parts, such as an organ or blood vessel and another structure

84
Q

What are types of biliary fistula? (5)

A

Cholescystoduodenal

Cholecystocolic

cholecystogastric

cholecystocholedochal

choledochoduodenal

85
Q

What are some finding in gallstone ileus?

A

Areas of perforation in ischemic fundus

radiograph shows gas in billiary tree

Radiograph shows obstruction of small intestine

Gallbladder perforations area serious complication of acute cholecystitisand represent an advanced stage of the disease.

86
Q

What is the treatment for symptomatic gallstones?

A

a laparoscopic cholecystectomy

87
Q

What do you need to gain consent for a laparoscopic cholecystectomy?

A

knowledge of procedure

explain diagnosis

treatment options

purpose of procedure

risks-what will you do to mitigate the risks?

explain advantages and disadvantages of antimicrobial chemoprophylaxis

patient has capacity unless proven otherwise

complications-may need to be open up

consent-clinicians providing the treatment.

88
Q

What are the two types of complications?

A

general vs specific

early vs late

89
Q

What are examples of general complications?

A

(in any procedure)

bleeding
around infection
blood clots

90
Q

What are specific complications?

A

(in a specific surgery)

bile duct injury
damage to other structures

91
Q

What are early post-operative complications?

A

risk of infection, wound cleaning, patient factors, anaesthetic factors

92
Q

What are some complications after undergoing cholecystectomy?

A

the development of diarrhea or bloating due to alteration of biliary flow

there is also the possibility of having a cystic duct remnant that could potentially lead to stone formation and cause mirizzi syndrome

93
Q
A

CSI (3 decks)

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