Abdominal Core Conditions Flashcards
What are the causes of small bowel obstruction?
INTRINSIC: Malignancy, Crohn’s, diverticular disease
EXTRINSIC:Prev surgery (ADHESIONS), Intestinal malignancy, Inguinal HERNIA w/incarceration, INTUSSUSCEPTION
LUMINAL: Constipation, foreign bodies
What are the signs & symptoms of s.bowel obstruction?
Failure to pass stool or flatus Abdo pain & tenderness Vomiting Obstipation Fever S.lethargy Palpable abdo/rectal mass Absent/tinkling bowel sounds
How is a bowel obstruction investigated?
Abdo x-ray: Dilated bowel loops, pneumoperitoneum
Small:Absence of gas in rectum, distension >2.5cm, valvulae conniventes seen
Large: Taeniae Coli seen,
Bloods: FBC, CRP, U&E, LFTs, glucose, amylase, group & save
ECG
Ado CT: Cause & location
USS/MRI
How is bowel obstruction treated?
Cannula insertion IV 0.9% saline Analgesia (Morphine) Antiemetic (Cyclizine) NG decompression Urinary Catheter Emergency laparotomy Broad spec Abx S.bowel obstruction: Try to treat conservatively
What is the nerve innervation to the bowel?
Parasympathetic & sympathetic NS
Myenteric plexus: Propulsive contractions
Sympathetic: Sensation of visceral pain
What is the mechanism that leads to bowel perforation?
- Build up of fluid & gas proximal to obstruction
- Dilatation of bowel & abdo distension
- Fluids shifts into peritoneum +/- perforation
- Irritation of peritoneum (peritonitis)
- Vascular shifts into peritoneal cavity
- HypoV, dehydration & shock
What specific investigation needs to be carried out for l.bowel obstruction?
Contrast enema/colonoscopy
Differentiate between pseudo-obstruction & actual obstruction
Different Tx
Pseudo: Colonoscopic decompression
Real: Operative- Colonic stenting, resection
What are the causes of L.bowel obstruction?
Malignancy Volvulus Benign stricture/adhesions Hernia Gynae
How is a volvulus treated?
Endoscopic detorsion
Extra-peritonealisation of the colon
Peritonitis: Emergency midline laparotomy
What is the mechanism of perforation of the appendix?
- Obstruction of the lumen
- Intra-luminal pressure ruses & appendix distends
- Ulceration occurs as pressure rises & bacteria leak into appendix wall
- Gangrene
- Perforation/ appendix mass/abscess
- Peritonitis
What are the signs & symptoms of appendicitis?
Colicky central abdo pain that moves 6-12hours to RIF- McBurneys point
Anorexia
N&V
Constipation
Guarding & rigidity
Rebound tenderness
Psoas sign- lift flexed thigh against hand & pain in RIF
How is appendicitis investigated?
Urinalysis Urine bHCG- exclude ectopic Bloods: FBC, CRP, WCC Abdo Xray USS CT
How is appendicitis managed?
Resus Analgesia: Morphine Nil by mouth Appendicetomy Prophylactic Abx
What is diverticulitis?
Inflammation of a diverticulum
What is the cause of diverticulitis?
Infection
Compacted faeces
Lack of fibre in diet
Refined foods
How is diverticulitis investigated?
Bloods: FBC, CRP
CXR & abdo
USS/CT
Contrast enema
How is diverticulitis managed?
Abx: Metronidazole 400mg/8hours
Analgesia NOT Morphine
Fluids
Prevention: Bland, low fibre diet
What are the signs & symptoms of diverticulitis?
Abdo pain- LIF
Pyrexia
Palpable mass/distension
Tachycardia
What are the causes of renal colic?
Renal Calculi formed by low urine volume
What are the most common compositions of renal stones?
Calcium Oxalate Phosphate Struvite Cystine Uric acid
What are the signs & symptoms of renal colic?
Sudden unilateral, colicky loin to groin/ renal pain
Writhing in agony
N&V
Radiates to scrotum/tip of the penis, labia majora
Haematuria
Dec renal function
How is renal colic investigated?
Abdo USS
Urinalysis & culture: Microscopic haematuria, pyuria
Rx stones = 24hour urine collection
Bloods: FBC, Electrolyte, amylase, phosphate, urate, Ca, bicarb
Abdo & KUB Xray
IV urography
CT-KUB
How is renal colic managed?
Often spontaneous <5mm Analgesia: NSAIDs, Opioids Stenting Extra-corporeal shockwave lithotripsy Nephrostomy
How are peptic ulcers characterised?
Mucosal damage from pepsin & gastrin commonly found in the stomach & proximal duodenum
What are the causes of PUD?
H.Pylori
NSAIDs
Other: Smoking, meds, Zollinger-Ellison syndrome, Meckels diverticulum
How do NSAIDs cause mucosal damage?
- Inhibition of prostaglandin synthesis by inhibiting COX1
- Reduces mucous & bicarb secretion
What are the signs & symptoms of PUD?
-Episodic epigastric pain (gnawing/burning)
Duodenal ulcers: Relief of pain after food/milk, Nightime awakening because of pain
Gastric ulcers: Pain after food, early satiety, N&V, relieved by antacids
Haemodynamically unstable: Bleeding, obstruction, perforation
ALARM features assessed
How is PUD investigated?
Upper endoscopy
Biopsy of ulcer rim & base
H.Pylori test: 13C-urea breath test & faecal antigens
Bloods: FBC, U&E, LFTs, Amylase, G&S/cross-match
ECG
Endoscopy if triple therapy but recurrent symptoms
How is PUD managed?
H.Pylori: Triple therapy- Omeprazole & Amoxicillin & Clarithromycin
ALARM signs: Admission/urgent referral for further investigation
What are the clinical signs of a perforated ulcer?
Sudden, severe abdo pain rapidly worsening
Pain radiated to back or shoulder
Generalised abdo tenderness w/guarding & hypoactive bowel sounds
Tachycardia, hypoT w/fever +/- oliguria
How is a PUD perforation treated?
Resus
Broad spec IV Abx: Cephalosporin & metronidazole/Tazocin
Surgery: Laparotomy, mental patch & washout
Bleed: IM Adrenaline 1:10000, vessel clipping, heat application
What are the uses of endoscopy in PUD?
- Haemorrhage control in upper GI bleed
- Confirm PUD in pts w/persistent dyspepsia
- Biopsy for confirmation of H.Pylori/neoplasia
- Reassess ongoing symptoms
What are the local & systemic complications of pancreatitis?
L: Necrosis, pseudocyst
S: SIRS, multiorgan failure
What are the signs & symptoms of acute pancreatitis?
Epigastric pain radiating to back w/persistent N&V
Tender upper abdo w/guarding
Jaundice
Paralytic ileum after 12-24hours
LATE: Cullens & Grey-Turners, fasciculations
How is acute pancreatitis investigated?
Urinalysis Bloods: FBC, U&E, LFT (Alk Phos+), Glucose+, CRP, Ca-, Amylase++, Lipase+++ ABG ECG CXR
How is acute pancreatitis managed?
High flow O2 IV access & 1-2L normal saline Analgesia Anti-emetic Nil by mouth Catheter IV broad spec Abx Surgical: ERCP within 72hours- gallstones, cholecystectomy
