Abdomen Flashcards
What is jaundice?
High level of bilirubin causing yellowing of the skin/sclera and dark urine
What pathology causes jaundice?
Causes include:
Hepatitis
Liver Cirrhosis
Biliary Obstruction (e.g. due to gallstones or pancreatic cancer)
What is Aphthous Ulceration?
Round or Oval ulcers occurring in the mucous membranes in the mouth.
What causes Aphthous Ulceration?
Causes typically benign, but include:
Stress
Mechanical trauma
Can be associated with:
Iron and B12 deficiency
Crohn’s Disease
What is Haematemesis?
The vomiting of blood which can be:
Fresh red in colour
Or
Coffee ground in appearance.
What causes haematemesis?
Mallory-Weiss tear or Oesophageal Varaceal Rupture (FRESH RED APPEARANCE)
Gastric or Duodenal Ulcer (COFFEE GROUND APPEARANCE)
What is gastro-oesophageal reflux and how does it present?
Back flow of stomach contents into oesophagus.
Secondary to lower oesophageal sphincter incompetence.
Presents as:
Epigastric discomfort – burning in nature.
What is Odynophagia and list two potential causes?
Pain during swallowing.
Can be caused by:
Oesophageal obstruction
Or
Infection
What is a Mallory-Weiss Tear?
A tear or laceration of the mucous membrane
Most common at point where oesophagus and stomach meet.
(Gastroesophageal Junction)
What are the Signs and Symptoms of Mallory-Weiss Tear?
Abdominal pain
History of severe vomiting
Haematemesis
Involuntary effort to vomit (retching)
Coffee Grounds vomit
Malena
Common Causes of Mallory-Weiss tear?
In most instances – severe vomiting
Can be associated with:
Chronic alcoholism
Severe chest or abdomen trauma
Chronic Hiccups
Intense Snoring
Lifting and straining
Gastritis
Hiatus hernia
Complication of chemotherapy
Causes of abdominal distension.
Ascites
Constipation
Bowel obstruction
Organomegaly
Malignancy
Causes of Constipation.
Dehydration
Reduction in bowel motility
Medications ( opiates, ondansetron and iron supplements)
Causes of Diarrhoea
Infection
Irritable bowel syndrome
Inflammatory bowel disease
Medications (laxatives)
Constipation (with overflow)
Malignancy
What is Steatorrhoea and what are the causes?
Presence of fat in faeces, causing pale appearance and difficulty in flushing.
Causes:
Pancreatitis
Pancreatic cancer
Biliary obstruction
Celiac disease
What is Haematochezia?
Fresh red blood passed per rectum.
Caused by:
Haemorrhoids
Anal Fissures
Lower Gastrointestinal Malignancy
What is Ascites? List the causes.
Build up of fluid within the abdomen
Caused by:
Liver Cirrhosis – 75 percent of cases
Cancer – 15 percent
Other causes:
Heart failure
Inflammation of the pancreas
Infection
Kidney problems
What are the symptoms of Ascites?
Symptoms incluide:
Weight Gain
Reduced Appetite, Constipation and Indigestion
Nausea and Vomiting
Shortness of breath due to, increased pressure on lungs and build up of fluid in lungs
Complications of Ascites?
Infection within fluid
Medications used to reduce fluid can cause changes to salt and potassium levels
Can affect cardiac and kidney function
What are systemic gastrointestinal symptoms ?
Anorexia
Weight loss
Nausea
Fatigue
Pyrexia
Pruritus
Confusion
What is Acute Abdomen?
Rapid onset of:
Severe symptoms
That may indicate potentially life threatening intracranial-abdominal pathology
That requires urgent surgical intervention.
How does Acute Abdomen Present?
Sudden onset of abdominal pain
Associated nausea or vomiting
Obstructive causes of Acute Abdomen
Adhesions
Incarceration of hernias
Volvulus
Gallstones
Intussusception
Congenital anatomical abnormalities
Gastrointestinal Neoplasm
Inflammatory bowel disease
Inflammatory causes of Acute Abdomen
Cholecystitis
Appendicitis
Acute pancreatitis
Acute diverticulitis
Merkel’s diverticulitis
Ulcerative Colitis
Crohn’s Disease
Gynaecological causes of Acute Abdomen
Ectopic Pregnancy
Ruptured Ovarian Cyst
Ovarian Torsion
Pelvic Inflammatory Disease
Endometriosis
Infectious causes of Acute Abdomen
Hepatic abscess or Hepititis
Gastroenteritis
Infectious colitis
Typhilitis
Psoas abscess
Toxic causes of Acute Abdomen
Heavy metal poisoning (mercury, lead and arsenic)
Narcotic withdrawal from opioids
Ischaemic causes of Acute Abdomen
Acute mesenteric ischaemia and infarction
Ischaemic colitis
Splenic infarction
Sickle cell crisis
Budd-Chiari syndrome
Abdominal wall haematoma
Metabolic causes of Acute Abdomen
Uraemia
Diabetic Ketoacidosis
Addisonian crisis
Inherited metabolic disorders
Allergy/Anaphylaxis
Vascular causes of Acute Abdomen
Abdominal Aortic Dissection
Ruptured Aortic Aneurysm
Ruptured Splenic artery aneurysm
Urological causes of Acute Abdomen
Testicular Torsion
Kidney Stones
Pyelonephritis
Acute Appendicitis Symptoms
Acute abdominal pain starting in mid abdomen, later localising to the right lower quadrant
Associated with fever, anorexia, nausea and vomiting.
Tests to assess for Appendicitis
Rosving’s
Psoas
Obturator
What is Mesenteric Adenitis?
Swelling of the lymphatic tissue of the mesentery, secondarily caused by viral or bacterial infection.
What population group does Mesenteric Adenitis most commonly affect?
Children
How does Mesenteric Adenitis present?
LLQ and LRQ abdominal pain.
Will not present with true green bile vomiting.
Symptoms of Acute Diverticulitis
Pyrexia
Tachycardia
Malaise
Lower Iliac Fossa Pain
Abdominal Distension
Palpable Mass
In RARE cases Diverticulitis can progress to?
Fistula
Abscess
Peritonitis
Perforation
Haemorrhage
Bowel obstruction
Crohns Disease affects?
Any part of the gastrointestinal tract
Causing discontinuous patchy inflammation
Transmural (affects the full thickness of the bowel wall)
Ulcerative Colitis affects?
The large intestine only.
Causing continuous inflammation
Mucosal and submucosal layers are affected
What is the Ruptured Aortic Aneurysm Triad?
Abdominal/Back pain
Pulsatile Abdominal Mass (only sensitive in thin patients with AAA >5CM)
Hypotension
What is Acute Cholecyctitis?
Acute Gallbladder Inflammation – major complication of gallstones.
Caused by obstruction or passage of gallstones into neck or cystic duct, causing acute inflammation of gallbladder wall.
Impacted gallstone causes bile to become trapped, causing irritation and increases in pressure in gallbladder.
Fill in the blank
Patients with Peritonitis are usually_______ with or without shock.
Septic
What are the complications of a perforated viscus?
Bowel contents, bile, urine, exudate and blood can irritate the peritoneum and lead to peritonitis.
Your patient is still, reluctant to be examined due to pain, guarding their abdomen, with rigidity and rebound tenderness present. What is your impression ?
Peritonitis
What tissue does Merkel’s Diverticulum consist of and where does it reside?
Pancreatic and stomach tissue inside the small intestine.
What can Merkel’s Diverticulum Cause?
Hydrochloride acid release
Volvulus
What is a Volvulus?
The bowel twisting on itself causing an obstruction
Symptoms of a Volvulus?
Abdominal pain
Distension
Vomiting – look out for green bile
Blood in stool
Constipation/overflow diarrhoea
Haemodynamic instability
Most common age group for a Volvulus?
Age >70 years
But can occur in utero, through to adulthood.
What is Intussusception?
Telescoping action where part of intestine slides into adjacent part of intestine.
Often blocking food or fluid from passing through.
Can also cut off blood supply to affected part of intestine.
What age group most likely to get an Intussusception?
Occurs at any age but:
Most common in 2-24 months
Intussusception – classic symptoms triad in paediatric patients?
Palpable mass
Intermittent abdominal pain
Red currant coloured stools.
Symptoms associated with Intussusception?
Pallor
Lethargy
Diarrhoea
Shock
Vomiting (look out for green bile)
Cause of Peptic Ulcer Disease
Epigastric pain
Nausea
Vomiting (rarely, may relieve pain)
Lethargy due to anaemia
Weight Loss
Can be asymptomatic.
Presentation of Acute Pancreatitis
Sudden onset of Abdominal pain
Nausea and vomiting are often present
History of Gallstones or excessive alcohol intake
Signs include:
Epigastric Tenderness
Pyrexia
Tachycardia
List treatment plan for Acute Abdo presenting with Hypotension and Tachycardia ?
- suggestive of fluid loss, hypovolaemia or sepsis.
- require prompt, aggressive fluid resuscitation with adequate large bore IV access.
- Tranexamic acid indicated for AAA.
Priority Call - broad spectrum antibiotics, administered promptly due to infection peritoneal spoilage or sepsis differentials.
Adequate pain relief using opioids and use of anti-emetics
