Abdomen Flashcards
Most likely conditions to cause Cullens
Pancreatitis
Ruptured ectopic
Imaging if pregnant lady has abdominal signs
CT
What appendicitis can cause negative rovsig sign
Retroceacal
Painless massive GI bleed in paeds 1-2 years
Merckels Diverticulum
Mesenteric ischaemia vs ischaemic colitis
MI- out of proportion to exam findings, bowel emptying (vomiting and diarrhea), and a potential embolic source
IC- bloody bowel movements, abdominal pain, and leukocytosis
Stoma that is swollen and presenting with obstructive symptoms
Incisional hernia
What part of GI tract should not show fluid filled level
Descending colon
IBS symptoms
Improvement with defecation.
Onset associated with a change in the frequency of stool.
Onset associated with a change in the form of the stool.
Blood test for IBD
Faecal calprotectin
Ix if blood stained discharge and abdo tenderness
Abdo and pelvic USS and pregnancy test
Spigelian hernia
hernia lateral to the rectus muscle at the level of the arcuate line
Richters hernia
part of the wall of the small bowel (usually the anti mesenteric border) is strangulated within a hernia (of any type)
Bochdalek hernia
Of the posterolateral diaphragm
Morgagni Hernia
Herniation through foramen of Morgagni- anterior
Usually located on the right and tend to be less symptomatic
Littres hernia
Hernia containing Meckels diverticulum
Intusseption sx
Screaming
Drawing legs up
The child may pass bloody mucus stool, which is a late sign. Examination of the abdomen is often normal as the sausage mass in the right upper quadrant is difficult to feel.
Most commons smooth abdo lump in children
Mesenteric cyst
commonest cause of acute abdominal pain in acute unselected surgical ‘take’
Non specific abdo pain
Femoral canal borders
Laterally- Femoral vein
Medially - Lacunar ligament
Anteriorly- Inguinal ligament
Posteriorly- Pectineal ligament
Pale opalescent liquid from chest drain
Damage to the lymphatic duct may occur during this procedure
Occurs in Ivor - Lewis oesophagogastrectomy
A 5 year old boy develops a persistent fever following an open appendicectomy for gangrenous appendicitis. On examination, he has erythema of the wound and some abdominal distension. What is the most appropriate course of action?
USS
Lining of meckel diverticulum
Most asymptomatic Meckels diverticulum will be lined by ileal mucosa. Those which present with bleeding are more likely to contain gastric type mucosa.
Causes of intusseption
CF
Merkels diverticulum
Polyps and inflammation of Peyers patches
After surgery, swinging fever and ileus investigation
CT with contrast
Causes of intrabdominal compartment syndrome and how it presents
Obese patients with ileus following major abdominal surgery are at increased risk of intra abdominal compartment syndrome
use of prosthetic meshes
Nasogastric aspirates increase, urine output falls and metabolic acidosis.
Blood supply of meckel diverticulum
Vitelline
Location of meckels diverticulum and epidemeology
60cm proximal to ileocaecal valve
2% population and 2 inches long, 2x as common in men
Pulsatile lump in groin in Hep C patent
False aneurysm
Associated with IVDU
Embryonic derivative of meckels diverticulum
vitello-intestinal duct.
After cholecystectomy drain starts draining 200ml of bile per day- cause and ix?
Most likely clip has come loose in big duct
ERCP and allows stent placement
Intusseption tx
Resuscitation first - fluid and abx
Then fluoroscopic reduction if ileocolic
Ileo-ileal intussusception require laparotomy
Why is a chest tube inserted after oesophagestomy
As lung is collapsed to access oesophagus
Splenic vein thrombosis ix and tx
CT angio
Causes gastric varies as shunts to them
Splenectomy
Child with facial oedema, abdo pain and fever
SBP - after nephrotic syndrome
What structure lies under deep inguinal ring
Inferior epigastric
Embryological origin of diaphragm
Septum transversum - Central tendon
Pleuroperitoneal membranes - Parietal membranes surrounding viscera
Cervical somites C3 to C5 - Muscular component of the diaphragm
