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Y1 - Gatrointestinal > Abdomen and Peritoneum > Flashcards

Abdomen and Peritoneum Flashcards

1
Q

What does constant pain usually indicate?

A

Inflammation

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2
Q

What does colicky pain usually indicate?

A

Pain is due to a blocked tube

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3
Q

What does colicky pain progressing to constant indicate?

A

Blocked tube has progressed to inflammation

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4
Q

What does raised temperature, tachycardia and raised WCC indicate?

A

Inflammation

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5
Q

What are some causes of sudden onset abdominal pain?

A

Perforation
Rupture
Acute pancreatitis
Infarction

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6
Q

What are some causes of back pain?

A

Pancreatitis
Rupture of aortic aneurism
Renal tract disease

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7
Q

What does gradual onset pain indicate?

A

Inflammatory conditions

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8
Q

What does continuous pain made worse by movement indicate?

A

Peritonitis

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9
Q

What does persistent vomit suggest?

A

Obstructive lesion of the gut

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10
Q

What is guarding and what does it indicate?

A

An involuntary spasm of the abdominal wall

Peritonitis

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11
Q

What do high pitched tinkling bowel sounds indicate?

A

Fluid movement within dilated bowel lumen

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12
Q

What are some causes of absent bowel sounds?

A

Peritonitis
Strangulation
Ischaemia
Ileus

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13
Q

What is the main cause of acute appendicitis?

A

The lumen of the appendix becoming obstructed with faecolith

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14
Q

What can acute appendicitis progress to if not treated?

A

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

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15
Q

How does acute appendicitis present?

A

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

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16
Q

What features of acute appendicitis can be seen on examination?

A

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

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17
Q

What investigations are done for acute appendicitis?

A

Inflammatory markers

CT or US

18
Q

Which conditions can present like acute appendicitis?

A

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

19
Q

What is the management for acute appendicitis?

A

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

20
Q

What is localised peritonitis?

A

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

21
Q

What is generalised peritonitis?

A

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

22
Q

What are the clinical features of peritonitis?

A

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

23
Q

What investigations are done for peritonitis?

A

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

24
Q

How is peritonitis managed?

A

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

25
Q

What complications can be caused by peritonitis?

A

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

26
Q

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

A

Adhesions

27
Q

What are examples of small intestinal obstruction causes?

A 
Adhesions
Hernias
Crohn's
Intussusception
Obstruction due to extrinsic involvement by cancer
28
Q

What are examples of colonic obstruction causes?

A

Carcinoma
Sigmoid volvulus
Diverticular disease

29
Q

What are the clinical features of intestinal obstruction?

A

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

30
Q

When is vomiting in GI obstruction likely and unlikely?

A

Upper gut - profuse vomiting

Low gut - vomiting may be absent

31
Q

What is the investigation of choice in intestinal obstruction?

A

CT

32
Q

What is the management for intestinal obstruction?

A

Resuscitation

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

33
Q

What is acute colonic pseudo-obstruction?

A

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

34
Q

How do patients present with pseudo-obstruction?

A

Rapid and progressive abdominal distension and pain

AXR shows gas-filled large bowel

35
Q

What is the peritoneal cavity?

A

An enclosed space between visceral and parietal peritoneum

36
Q

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

A

Mesothelial cells

Produce surfactant which acts as a lubricant

37
Q

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

A

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

38
Q

What does up regulation of mesothelial cells activate?

A

The complement system

This triggers the inflammatory cascade

39
Q

What is ascites?

A

A collection of exudate fluid with a high protein content

40
Q

Why do adhesions form?

A

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

41
Q

What conditions do adhesions cause?

A

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

42
Q

What is retroperitoneal fibrosis?

A

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

Y1 - Gatrointestinal (31 decks)

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