Abdomen and Peritoneum

Question 1

What does constant pain usually indicate?

Answer 1

Inflammation

Question 2

What does colicky pain usually indicate?

Answer 2

Pain is due to a blocked tube

Question 3

What does colicky pain progressing to constant indicate?

Answer 3

Blocked tube has progressed to inflammation

Question 4

What does raised temperature, tachycardia and raised WCC indicate?

Answer 4

Inflammation

Question 5

What are some causes of sudden onset abdominal pain?

Answer 5

Perforation
Rupture
Acute pancreatitis
Infarction

Question 6

What are some causes of back pain?

Answer 6

Pancreatitis
Rupture of aortic aneurism
Renal tract disease

Question 7

What does gradual onset pain indicate?

Answer 7

Inflammatory conditions

Question 8

What does continuous pain made worse by movement indicate?

Answer 8

Peritonitis

Question 9

What does persistent vomit suggest?

Answer 9

Obstructive lesion of the gut

Question 10

What is guarding and what does it indicate?

Answer 10

An involuntary spasm of the abdominal wall

Peritonitis

Question 11

What do high pitched tinkling bowel sounds indicate?

Answer 11

Fluid movement within dilated bowel lumen

Question 12

What are some causes of absent bowel sounds?

Answer 12

Peritonitis
Strangulation
Ischaemia
Ileus

Question 13

What is the main cause of acute appendicitis?

Answer 13

The lumen of the appendix becoming obstructed with faecolith

Question 14

What can acute appendicitis progress to if not treated?

Answer 14

Gangrene with perforation, leading to a localised abscess or generalised peritonitis

Question 15

How does acute appendicitis present?

Answer 15

Abdominal pain which is epigastric to start then moves to the RIF in the first few hours
Nausea, vomiting, anorexia and occasional diarrhoea can occur

Question 16

What features of acute appendicitis can be seen on examination?

Answer 16

Tenderness in the RIF
Guarding due to generalised peritonitis
May be a mass in RIF

Question 17

What investigations are done for acute appendicitis?

Answer 17

Inflammatory markers

CT or US

Question 18

Which conditions can present like acute appendicitis?

Answer 18

Non-specific mesenteric lymphadenitis
Acute terminal ileitis due to CD
Inflamed Meckel’s diverticulum
Functional bowel disease

Question 19

What is the management for acute appendicitis?

Answer 19

Usually laparoscopic surgical removal of the appendx

If a mass is present IV fluids and antibiotics and a later appendicectomy when the pain subsides and mass disappears

Question 20

What is localised peritonitis?

Answer 20

There is a low level of peritonitis in all acute inflammatory GI conditions
Causes pain and tenderness
Treated by treating underlying disease

Question 21

What is generalised peritonitis?

Answer 21

A serious condition resulting from irritation of the peritoneum caused by infection or chemical irritation from leakage of intestinal contents.
Peritoneal cavity becomes acutely inflamed and an inflammatory exudate spreads throughout the peritoneum
Leads to intestinal dilation and paralytic ileus

Question 22

What are the clinical features of peritonitis?

Answer 22

Acute severe abdominal pain followed by general collapse and shock
When secondary to inflammatory disease onset is less rapid

Question 23

What investigations are done for peritonitis?

Answer 23

US and/or CT for diagnosis
Erect CXR detects air under diaphragm
Serum amylase diagnoses acute pancreatitis

Question 24

How is peritonitis managed?

Answer 24

NG tube
IV fluids
Antibiotics
Surgery - peritoneal lavage of the abdominal cavity and treatment of underlying condition

Question 25

What complications can be caused by peritonitis?

Answer 25

Delay in treatment produces more toxaemia and septicaemia which can lead to multi-organ failure Local abscess formation suspected if patient remains unwell after treatment

Question 26

What is the most common cause of intestinal obstruction in adults?

Answer 26

Adhesions

Question 27

What are examples of small intestinal obstruction causes?

Answer 27

``` Adhesions Hernias Crohn's Intussusception Obstruction due to extrinsic involvement by cancer ```

Question 28

What are examples of colonic obstruction causes?

Answer 28

Carcinoma Sigmoid volvulus Diverticular disease

Question 29

What are the clinical features of intestinal obstruction?

Answer 29

Abdominal colic, vomiting and constipation without passage of wind Marked tenderness suggests strangulation

Question 30

When is vomiting in GI obstruction likely and unlikely?

Answer 30

Upper gut - profuse vomiting | Low gut - vomiting may be absent

Question 31

What is the investigation of choice in intestinal obstruction?

Answer 31

CT

Question 32

What is the management for intestinal obstruction?

Answer 32

Resuscitation | Conservative management usually works but if not urgent scanning is needed and possibly a laparotomy

Question 33

What is acute colonic pseudo-obstruction?

Answer 33

A clinical picture that seems like obstruction where there is no mechanical cause

Question 34

How do patients present with pseudo-obstruction?

Answer 34

Rapid and progressive abdominal distension and pain | AXR shows gas-filled large bowel

Question 35

What is the peritoneal cavity?

Answer 35

An enclosed space between visceral and parietal peritoneum

Question 36

Which cells line the peritoneal cavity and what are their functions?

Answer 36

Mesothelial cells | Produce surfactant which acts as a lubricant

Question 37

Why is there a gap in the visceral peritoneum at the diaphragm?

Answer 37

To allow fluid to exit through diaphragmatic lymphatics Some also drains through the parietal peritoneum This ensures fluid is circulating and not stagnant

Question 38

What does up regulation of mesothelial cells activate?

Answer 38

The complement system | This triggers the inflammatory cascade

Question 39

What is ascites?

Answer 39

A collection of exudate fluid with a high protein content

Question 40

Why do adhesions form?

Answer 40

As a result of abdominal or pelvic surgery, or inflammation the abdominal-peritoneal cavity

Question 41

What conditions do adhesions cause?

Answer 41

Adhesive small bowel obstruction Chronic abdominal pain Complications during further surgery Female infertility when they involve reproductive organs

Question 42

What is retroperitoneal fibrosis?

Answer 42

A rare condition where there is marked fibrosis over the posterior abdominal wall and retro-peritoneum