Abdominal Flashcards
Indications for renal replacement therapy
Uraemia
Resistant hyperkalaemia
Pulmonary oedema with oliguria (resistant)
Drug toxicity e.g. lithium
Resistant metabolic acidosis
End-stage renal failure eGFR<15
Which medications do you monitor following a renal transplant and how?
Calcineurin inhibitor e.g. cyclosporin and tacrolimus - monitor for HTN, hyperglycaemia (CVD risks), renal function
Corticosteroids - diabetes, osteoporosis
Different abdominal regions
Right hypochondriac, epigastric, left hypochondriac
Right lumbar, umbilical, left lumbar
Right iliac, hypogastric/suprapubic, left iliac
Different abdominal scars and their indications
Kocher (right upper) - cholecystectomy
Rooftop (whole upper) - oesophagectomy, pancreatic surgery
Midline - bowel resection, bariatric, hysterectomy in woman
Paramedian (less bleeding, less pain, more complications, longer recover) - retroperitoneal space e.g. adrenalectomy, lumbar spine surgery
Pararectal - colectomy
Periumbilical - laparoscopic e.g. access liver, gallbladder, stomach
Transverse - gallbladder, spleen, pancreas
Pfannenstiel - c-section, hysterectomy
Gridiron (diagonal) - appendicectomy, less cosmetically acceptable
Lanz (transverse) - appendicectomy
Rutherford-Morrison incision - adrenalectomy
Hockey-stick incision - renal transplant
Where is McBurney’s point and what does it show?
1/3 from ASIS to umbilicus
Appendix location
Signs of liver failure
Stable
- Spider naevi
- Dupuytren’s contracture
- Gynaecomastia
- Palmar erythema
Decompensation
- Splenomegaly
- Ascites
- Encephalopathy
- Varices
- Failed liver function e.g. poor clotting
Cause of haematomas on abdomen
Insulin injections
Blood clotting disorders
Blood thinning medication
Trauma
Surgery
What is an ileo-anal pouch and when is it used?
Ileum is connecting to an anus in a way that mimics the function of the large intestine
Allows patient to store and eliminate faeces more naturally
Used in IBD and cancer colectomy
Types of surgery for IBD
Colectomy
Proctocolectomy (colon and rectum)
Ileostomy
Ileal pouch-anal anastomosis
Post-op management of abdominal surgery
Pain e.g. opioids, NSAIDs
Fluids
Antibiotics
Nutrition
Mobilise early
Monitor for complications e.g. fever, vomiting
How is the mucosa different in the different types of stomas?
Ileostomy - thinner, smoother
Colostomy - thicker, more convoluted (haustral folds)
What is gallstone ileus and how is it different to paralytic ileus?
Gallstone ileus - gallstone pases to small intestine causing blockage, tinkling sounds (treat with surgery)
Paralytic ileus - reduced intestinal contractions, no sounds, caused by surgery, medications (opioids), infections (treat with cholinergics and electrolytes collecting any imbalances)
Causes of splenomegaly
Sickle cell disease
Malignancy: lymphoma, leukaemia
Liver disease: portal hypertension
Infections: EBV, malaria
Causes of hepatomegaly
Hepatic: hepatitis, cirrhosis, fatty liver, hepatocarcinoma
Congestive heart failure
Medication: methotrexate
How is a urostomy formed and why would it be formed?
Ileum removed to create channel from ureters out through abdominal wall
Done in bladder cancer, neurogenic bladder, incontinence
When is a nephrostomy done?
Large kidney stone
Cancer blocking ureter
Stricture in ureter
Trauma to ureter
UTI not responding to other treatments
Management of a hernia (inguinal, femoral, parastomal)
Inguinal (superior, medial) - mesh repair, hernia truss if unfit for surgery (support)
Femoral (inferior, lateral) - laparoscopic repair
Parastomal - conservative (supportive belt), surgical reinforcement, monitoring
Causes of pain following surgery
Normal inflammation
Infection
Nerve damage
Muscle spasm
Adhesions
Peripheral signs of IBD
Uveitis
Erythema nodosum
Arthritis
Management of IBD
Ulcerative colitis
Induce remission: topical/oral mesalazine
Maintain remission: topical/oral mesalazine
Severe colitis: IV steroids
Crohn’s disease
Induce remission: glucocorticoids
Maintain remission: glucocorticoids
Manegement of cholecystitis
Fluids
Analgesia
IV abx
Laparoscopic cholecystectomy within 1 week
Management of acute cholangitis
1) IV abx (broad spectrum until blood culture results)
2) ERCP and stent
What is a Hartmann’s procedure, abdomino-perineal resection, and anterior resection, and the end results i.e. stomas, end-pouch, anastomosis
Hartmann’s procedure: Emergency sigmoid colectomy in obstruction, tumour perforation, diverticulitis. End colostomy that may be reversed (50% patients).
Abdominal-perineal resection: Sigmoid to anus removed. Rectal cancer <4cm from anal verge. Single lumen (loop) colostomy.
Anterior resection: Sigmoid to rectum removed. Rectal cancer >4cm from anal verge. Colorectal anastomosis covered by temporary loop ileostomy, as rectal blood supply is poor.
When is a loop ileostomy formed compared to an end ileostomy?
Loop ileostomy made to protect distal anastomosis, usually reversed but permanent if complications/not candidate for reversal.
End ileostomy if colon removed, or colon is healing from disease. Can be temporary, or permanent if colon removed completely/ other reasons.
Is there a stoma in the hemicolectomies?
None usually
RIF pain causes. Investigation, management of key ddx
Appendicitis
Ectopic
Kidney stones
Constipation
Raised CRP with hx + examination enough
Can see high neutrophils
USS in females if pelvic organ pathology suspected
Appendicectomy
Prophylactic IV abx
Abdominal lavage if perforated
LIF pain causes. Investigation, management of key ddx
Diverticulitis
Ectopic
Kidney stones
Constipation
CT - best modality
Avoid colonoscopy due to perforation
Oral abx, liquid diet, analgesia
Admit for IV abx if symptoms don’t settle
