Abdomen and Peritoneum Flashcards
What does constant pain usually indicate?
Inflammation
What does colicky pain usually indicate?
Pain is due to a blocked tube
What does colicky pain progressing to constant indicate?
Blocked tube has progressed to inflammation
What does raised temperature, tachycardia and raised WCC indicate?
Inflammation
What are some causes of sudden onset abdominal pain?
Perforation
Rupture
Acute pancreatitis
Infarction
What are some causes of back pain?
Pancreatitis
Rupture of aortic aneurism
Renal tract disease
What does gradual onset pain indicate?
Inflammatory conditions
What does continuous pain made worse by movement indicate?
Peritonitis
What does persistent vomit suggest?
Obstructive lesion of the gut
What is guarding and what does it indicate?
An involuntary spasm of the abdominal wall
Peritonitis
What do high pitched tinkling bowel sounds indicate?
Fluid movement within dilated bowel lumen
What are some causes of absent bowel sounds?
Peritonitis
Strangulation
Ischaemia
Ileus
What is the main cause of acute appendicitis?
The lumen of the appendix becoming obstructed with faecolith
What can acute appendicitis progress to if not treated?
Gangrene with perforation, leading to a localised abscess or generalised peritonitis
How does acute appendicitis present?
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
What features of acute appendicitis can be seen on examination?
Tenderness in the RIF
Guarding due to generalised peritonitis
May be a mass in RIF
What investigations are done for acute appendicitis?
Inflammatory markers
CT or US
Which conditions can present like acute appendicitis?
Non-specific mesenteric lymphadenitis
Acute terminal ileitis due to CD
Inflamed Meckel’s diverticulum
Functional bowel disease
What is the management for acute appendicitis?
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
What is localised peritonitis?
There is a low level of peritonitis in all acute inflammatory GI conditions
Causes pain and tenderness
Treated by treating underlying disease
What is generalised peritonitis?
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
What are the clinical features of peritonitis?
Acute severe abdominal pain followed by general collapse and shock
When secondary to inflammatory disease onset is less rapid
What investigations are done for peritonitis?
US and/or CT for diagnosis
Erect CXR detects air under diaphragm
Serum amylase diagnoses acute pancreatitis
How is peritonitis managed?
NG tube
IV fluids
Antibiotics
Surgery - peritoneal lavage of the abdominal cavity and treatment of underlying condition
What complications can be caused by peritonitis?
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
What is the most common cause of intestinal obstruction in adults?
Adhesions
What are examples of small intestinal obstruction causes?
Adhesions Hernias Crohn's Intussusception Obstruction due to extrinsic involvement by cancer
What are examples of colonic obstruction causes?
Carcinoma
Sigmoid volvulus
Diverticular disease
What are the clinical features of intestinal obstruction?
Abdominal colic, vomiting and constipation without passage of wind
Marked tenderness suggests strangulation
When is vomiting in GI obstruction likely and unlikely?
Upper gut - profuse vomiting
Low gut - vomiting may be absent
What is the investigation of choice in intestinal obstruction?
CT
What is the management for intestinal obstruction?
Resuscitation
Conservative management usually works but if not urgent scanning is needed and possibly a laparotomy
What is acute colonic pseudo-obstruction?
A clinical picture that seems like obstruction where there is no mechanical cause
How do patients present with pseudo-obstruction?
Rapid and progressive abdominal distension and pain
AXR shows gas-filled large bowel
What is the peritoneal cavity?
An enclosed space between visceral and parietal peritoneum
Which cells line the peritoneal cavity and what are their functions?
Mesothelial cells
Produce surfactant which acts as a lubricant
Why is there a gap in the visceral peritoneum at the diaphragm?
To allow fluid to exit through diaphragmatic lymphatics
Some also drains through the parietal peritoneum
This ensures fluid is circulating and not stagnant
What does up regulation of mesothelial cells activate?
The complement system
This triggers the inflammatory cascade
What is ascites?
A collection of exudate fluid with a high protein content
Why do adhesions form?
As a result of abdominal or pelvic surgery, or inflammation the abdominal-peritoneal cavity
What conditions do adhesions cause?
Adhesive small bowel obstruction
Chronic abdominal pain
Complications during further surgery
Female infertility when they involve reproductive organs
What is retroperitoneal fibrosis?
A rare condition where there is marked fibrosis over the posterior abdominal wall and retro-peritoneum
