Abdo pain + Perioperative Flashcards
What are the key elements to consider when taking a history of abdominal pain?
S - Site, O - Onset, C - Character, R - Radiation, A - Associated features, T - Time course, E - Exacerbating/Relieving factors, S - Severity
What are the possible underlying intra-abdominal organs associated with upper abdominal pain?
Gallbladder, Stomach, Duodenum, Pancreas
Which organs may be responsible for middle abdominal pain?
Small bowel, caecum, kidney, and other retroperitoneal structures
List organs that could be implicated in lower abdominal pain.
Appendix, caecum, bladder, uterus, ovaries, sigmoid colon
Define visceral abdominal pain and describe its characteristics.
Visceral pain is poorly localized and originates from distention, traction, or ischaemia of intra-abdominal organs. It is often felt centrally in the abdomen and mediated by the autonomic nervous system.
What is colic pain and what causes it?
Colic pain is characterized by fluctuating severity due to obstruction in a muscular tube. It occurs when there is obstruction to a hollow viscus.
Explain parietal abdominal pain and its characteristics.
Parietal pain results from inflammation of the parietal peritoneum. It is well-localized, caused by inflammatory conditions, and mediated by the somatic nervous system.
Provide an example of a condition that initially presents with poorly localized visceral pain that later becomes well-localized parietal pain.
Appendicitis - it begins with vague central abdominal pain and later localizes to the right iliac fossa.
What is referred pain and how does it occur?
Referred pain is felt at a site distant from the primary stimulus due to the convergence of afferent nerve fibers in the dorsal horn.
An example is shoulder tip pain caused by diaphragmatic irritation from a ruptured spleen (c4 - phrenic nerve)
What are the 6 causes of abdominal distention often remembered by the “6Fs”?
Foetus, Flatus, Faeces, Fat, Fluid, Fibroids/solid tumours
Name the six regions of the abdomen from left to right, top to bottom.
Left Hypochondrium
Epigastrium
Right Hypochondrium
Left Lumbar
Umbilical
Right Lumbar
Left Iliac Fossa
Hypogastrium
Right Iliac Fossa
How does diabetes mellitus impact perioperative considerations?
1) Perioperative hyper and hypoglycemia
2) Predisposition to infection; poor glycaemic control exacerbates this.
3) Tissue healing impaired due to factors like microvascular disease.
4) Other sequelae of diabetes like renal impairment and IHD need management.
What steps should be taken preoperatively for diabetic patients undergoing surgery?
- Optimize glycaemic control and consider delaying elective surgery if control is not achieved.
- Withhold regular insulin on the morning of surgery and initiate IV infusion of insulin and dextrose, titrated to blood glucose levels.
- Consider prophylactic antibiotics.
How should postoperative care be tailored for diabetic patients?
Continue insulin and dextrose infusion until a normal diet is re-established.
Reintroduce the patient’s usual insulin regimen and withdraw the sliding scale dextrose-insulin infusion.
Monitor blood glucose levels closely, as insulin requirements may increase due to the stress response to surgical trauma.
Why is surgery a risk factor for Myocardial Infarction (MI), especially for patients with a history of previous MI?
Surgery increases the risk of MI, and in patients with a history of previous MI, this risk is elevated by 40-fold.
? stress on body leading to cardiac demand, tissue damage -> thrombosis
What is the importance of preoperative work-up for patients with a history of Ischaemic Heart Disease (IHD)?
It involves maximizing medical therapy, including angiography and coronary revascularization if necessary, to optimize the patient’s cardiac condition before surgery.
What is the recommended waiting period before elective surgical procedures for patients who have experienced an acute MI?
Elective surgical procedures should be deferred for at least 6 months after an acute MI to reduce the risk of reinfarction.
Why is it important to continue low dose aspirin in patients with Ischaemic Heart Disease during the perioperative period?
Despite the potential for increased bleeding, low dose aspirin should be continued due to its secondary preventative effects on the cardiovascular system.
Why is it crucial to continue beta-blockers in the perioperative period for patients with Ischaemic Heart Disease?
Sudden withdrawal of beta-blockers in patients with IHD is associated with ischaemic events, making it important to maintain this medication during the perioperative period.
How does smoking impact surgical risk beyond its respiratory and cardiovascular effects?
Smoking impairs immune function, which can increase the risk of complications after surgery.
What is the benefit of initiating smoking cessation prior to surgery, and how close to the surgery should abstinence be achieved?
The earlier smoking cessation is initiated before surgery, the greater the benefit. Even abstaining from smoking 24 hours prior to surgery reduces risk by eliminating nicotine and carbon monoxide.
Why is it important to exercise caution in administering antibiotic prophylaxis?
Overuse of antibiotic prophylaxis can expose patients to the risk of anaphylaxis, complications like pseudomembranous colitis, unnecessary costs, and contribute to antibiotic resistance.
