Abdomen Flashcards
How do you look for bowel perforation
Erect CXR
Look for gas (black) under the diaphragm
Is it normal to see gas in the stomach
Yes
This is known as the gastric bubble
List some of the complications of pancreatitis
abscess, pseudocyst, thrombosis of the splenic vein, pseudoaneurysm and haemorrhage of one of the surrounding arteries (coeliac vessels)
What are the primary and secondary abdominal imaging techniques
Primary abdominal imaging: XR, CT, USS
Secondary: MRI, fluoroscopy
Which patients may not tolerate the IV contrast used in CT
those with renal impairment - as the contrast affects the kidneys
Allergies
Which test can be used to exclude bowel obstruction and perforation
X-ray
What is the risk of using CT
Radiation exposure
How do you confirm a diagnose of appendicitis
USS first then CT if inconclusive
How does appendicitis present
Periumbilical pain which then localises to the RIF
Nausea and vomiting
What does gas in the bladder suggest
Colo-vesical fistula
Air should not be able to get into the bladder
How do you diagnose acute cholecystitis
One local sign of inflammation (RUQ pain etc)
One sign of inflammation (fever ,WCC, CRP)
Confirmatory imaging - USS
What is MRCP
MRI imaging of the biliary system - uses contrast
Used to look for gallstones
What is emphysematous cholecystitis
Air in gallbladder wall
Rare form of cholecystitis seen in diabetics
What are the signs and symptoms of small bowel obstruction
Vomiting, pain and distension
Increased bowel sounds, tenderness, palpable loops (only in thin patients)
What are the common causes of small bowel obstruction
adhesions, cancer, hernia and gallstone ileus
How can you treat small bowel obstruction
Conservative – drip and suck (IV fluids and NG tube to decompress stomach)
Or surgery if severe
What are the common causes of large bowel obstruction
Colorectal cancer is most common
Volvulus
Diverticulitis
How does bowel ischaemia present
Severe abdominal pain
Vomiting, diarrhoea, distension inconsistent
Borderline amylase, raised WCC, acidotic
How can you investigate bowel ischemia
Biphasic CT
Arterial and Venous phase CTs - assesses both vessel types
How is an aortic balloon used
If there is a ruptured/leaking AAA
Put balloon into the aorta via the femoral artery and inflate – this is just to buy you time and stop the bleed
