Abdomen Masterclass

Question 1

Causes of LUQ pain?

Answer 1

Gastritis

Splenic disorders; abscess, rupture

Question 2

Causes of RUQ pain?

Answer 2

Cholecystitis and biliary colic
Congestive hepatomegaly
Hepatitis or hepatic abscess
Perforated duodenal ulcer

Question 3

Causes of RUQ/ LUQ pain?

Answer 3

Acute pancreatitis 
Herpes zoster
Lower lobe pneumonia
Myocardial ischaemia
Radiculitis

Question 4

Causes of LLQ pain?

Answer 4

Sigmoid diverticulitis

Question 5

Causes of RLQ pain?

Answer 5

Appendicitis
Cecal diverticulitis
Meckel’s diverticulitis
Mesenteric adenitis

Question 6

Causes of LLQ/RLQ pain?

Answer 6

Abdominal or psoas abscess
Abdominal wall haematoma
Cystitis 
Endometriosis
Incarcerated or strangulated hernia 
IBS
Mittelscherz
PID
Renal stone
Ruptured AAA
Ruptured ectopic pregnanc
Torsion of ovarian cyst or teste

Question 7

Causes of diffuse abdominal pain?

Answer 7

Acute pancreatitis
DKA
Gastroenteritis
Intestinal obstruction 
Mesenteric ischaemia
Peritonitis
Sickle cell crisis
Spontaneous peritonitis
Typhoid fever

Question 8

What are the top 5 causes of acute abdominal pain presentation?

Answer 8

1st: non-specific
2nd; appendicitis
3rd + 4th; bowel obstruction and urinary system disorder
5th: diverticulitis

Question 9

What is an AXR commonly used for?

Answer 9

Obstruction 
Perforation (pneumoperitoneum on erect CXR)

Question 10

For what conditions is an MRI used?

Answer 10

Hepatobiliary
Small bowel
Pelvis

Question 11

Symptoms of acute appendicitis?

Answer 11

Periumbilical pain, N+V

Localizes in RIF

Question 12

How is acute appendicitis diagnosed?

Answer 12

CT and USS
1st line: USS
CT if inconclusive

Question 13

What is acute diverticulitis?

Answer 13

Infection of diverticula (outpouchings of large bowel)

Question 14

What are complications of acute diverticulitis?

Answer 14

Abscess
Obstruction
Perforation
Fistulae

Question 15

What type of fistula is commonly assoc with acute diverticulitis complications?

Answer 15

Colovesical

Question 16

Imaging pathway for acute diverticulitis?

Answer 16

Plain x-ray; exclude obstruction/ perforation

Diagnose with CT

Question 17

What is acute cholecystitis diagnosed based on?

Answer 17

One local sign of inflammation (RUQ pain)
One sign of inflammation (fever, WCC, CRP_
Confirmatory imaging

Question 18

What can USS detect in the context of acute cholecystitis?

Answer 18

Gallstones
GB wall thickening
Local fluid

Question 19

Is a CT or MRCP preferred in investigation of acute cholecystitis?

Answer 19

MRCP

CT can be false -ve

Question 20

What is emphysematous cholecystitis?

Answer 20

Air in gallbladder wall

Question 21

Who commonly gets emphysematous cholecystitis?

Answer 21

Diabetics

Question 22

Treatment for acute cholecystitis?

Answer 22

Medial/ conservative
Percutaneous (IR)
Cholecystectomy

Question 23

What can cause a small bowel obstruction?

Answer 23

Adhesions
Cancer
Herniae
Gallstone ileus

Question 24

Symptoms of small bowel obstruction?

Answer 24

Vomiting
Pain
Distention

Question 25

Signs of small bowel obstruction?

Answer 25

Tinkling bowel sounds Tenderness Palpable loops

Question 26

What is the purpose of imaging in a small bowel obstruction?

Answer 26

Site Cause Severity Complications (perforation, ischaemia)

Question 27

Initial investigation in a small bowel obstruction?

Answer 27

X-ray | BUT can miss fluid filled loops

Question 28

What is a key finding on CT in small bowel obstruction?

Answer 28

Transition from dilated bowel to normal bowel | This tells you where the issue is

Question 29

Causes of a large bowel obstruction?

Answer 29

Colorectal cancer Volvulus Diverticulitis

Question 30

Why is the state of the caecum important when diagnosing a large bowel obstruction?

Answer 30

If big; COULD POP

Question 31

What can result in a perforation in the GI tract?

Answer 31

Perforated ulcer Diverticular 2nd to cancer 2nd to ischaemia

Question 32

What are the downfalls to AXR for perforation diagnosis?

Answer 32

May miss small pockets of gas | Does not show site origin

Question 33

Benefits of CT for perforation?

Answer 33

High sensitivity and specificity Shows free fluid Will show clues to site of origin: distribution of gas, defect in wall, localised inflammatory changes

Question 34

Causes of bowel ischaemia?

Answer 34

Arterial; 60-70% Venous; 5-10% Non occlusive hypoperfusion; 20-30%

Question 35

Symptoms of bowel ischaemia?

Answer 35

Severe abdo pain Vomiting, diarrhoea, distention inconsistent Borderline amylase, raised WCC, ACIDOTIC (ALWAYS CHECK LACTATE)

Question 36

DDx for bowel ischaemia?

Answer 36

Perf Pancreatitis Obstruction Diverticulitis

Question 37

Imaging of choice for bowel ischaemia?

Answer 37

Biphasic CT; will determine if arterial or venous, site of occlusion and length of affected bowel

Question 38

Is gas surrounding the bowel in ischaemia an early or late sign?

Answer 38

LATE; THIS IS BAD

Question 39

What does gas in the portal vein suggests?

Answer 39

Imminent death; VVV serious

Question 40

How can a ruptured AAA be treated?

Answer 40

Aortic balloon for haemorrhage control | EVAR definitively

Question 41

Role of USS in acute abdo pain?

Answer 41

RUQ/ RIF pain

Question 42

Role of CT in acute abdo pain?

Answer 42

Primary imaging technique for acute abdo pain EXCEPT for acute cholecystitis/ appendicitis