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ACC > Abdominal Core Conditions > Flashcards

Abdominal Core Conditions Flashcards

1
Q

What are the causes of small bowel obstruction?

A

INTRINSIC: Malignancy, Crohn’s, diverticular disease
EXTRINSIC:Prev surgery (ADHESIONS), Intestinal malignancy, Inguinal HERNIA w/incarceration, INTUSSUSCEPTION
LUMINAL: Constipation, foreign bodies

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2
Q

What are the signs & symptoms of s.bowel obstruction?

A 
Failure to pass stool or flatus
Abdo pain & tenderness
Vomiting
Obstipation
Fever
S.lethargy
Palpable abdo/rectal mass
Absent/tinkling bowel sounds
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3
Q

How is a bowel obstruction investigated?

A

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

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4
Q

How is bowel obstruction treated?

A 
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
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5
Q

What is the nerve innervation to the bowel?

A

Parasympathetic & sympathetic NS
Myenteric plexus: Propulsive contractions
Sympathetic: Sensation of visceral pain

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6
Q

What is the mechanism that leads to bowel perforation?

A
  • 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
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7
Q

What specific investigation needs to be carried out for l.bowel obstruction?

A

Contrast enema/colonoscopy
Differentiate between pseudo-obstruction & actual obstruction
Different Tx
Pseudo: Colonoscopic decompression
Real: Operative- Colonic stenting, resection

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8
Q

What are the causes of L.bowel obstruction?

A 
Malignancy
Volvulus
Benign stricture/adhesions
Hernia
Gynae
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9
Q

How is a volvulus treated?

A

Endoscopic detorsion
Extra-peritonealisation of the colon
Peritonitis: Emergency midline laparotomy

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10
Q

What is the mechanism of perforation of the appendix?

A
  • 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
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11
Q

What are the signs & symptoms of appendicitis?

A

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

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12
Q

How is appendicitis investigated?

A 
Urinalysis
Urine bHCG- exclude ectopic
Bloods: FBC, CRP, WCC
Abdo Xray
USS
CT
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13
Q

How is appendicitis managed?

A 
Resus
Analgesia: Morphine
Nil by mouth
Appendicetomy
Prophylactic Abx
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14
Q

What is diverticulitis?

A

Inflammation of a diverticulum

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15
Q

What is the cause of diverticulitis?

A

Infection
Compacted faeces
Lack of fibre in diet
Refined foods

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16
Q

How is diverticulitis investigated?

A

Bloods: FBC, CRP
CXR & abdo
USS/CT
Contrast enema

17
Q

How is diverticulitis managed?

A

Abx: Metronidazole 400mg/8hours
Analgesia NOT Morphine
Fluids
Prevention: Bland, low fibre diet

18
Q

What are the signs & symptoms of diverticulitis?

A

Abdo pain- LIF
Pyrexia
Palpable mass/distension
Tachycardia

19
Q

What are the causes of renal colic?

A

Renal Calculi formed by low urine volume

20
Q

What are the most common compositions of renal stones?

A 
Calcium Oxalate
Phosphate
Struvite
Cystine
Uric acid
21
Q

What are the signs & symptoms of renal colic?

A

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

22
Q

How is renal colic investigated?

A

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

23
Q

How is renal colic managed?

A 
Often spontaneous <5mm
Analgesia: NSAIDs, Opioids
Stenting
Extra-corporeal shockwave lithotripsy
Nephrostomy
24
Q

How are peptic ulcers characterised?

A

Mucosal damage from pepsin & gastrin commonly found in the stomach & proximal duodenum

25
Q

What are the causes of PUD?

A

H.Pylori
NSAIDs
Other: Smoking, meds, Zollinger-Ellison syndrome, Meckels diverticulum

26
Q

How do NSAIDs cause mucosal damage?

A
  • Inhibition of prostaglandin synthesis by inhibiting COX1

- Reduces mucous & bicarb secretion

27
Q

What are the signs & symptoms of PUD?

A

-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

28
Q

How is PUD investigated?

A

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

29
Q

How is PUD managed?

A

H.Pylori: Triple therapy- Omeprazole & Amoxicillin & Clarithromycin
ALARM signs: Admission/urgent referral for further investigation

30
Q

What are the clinical signs of a perforated ulcer?

A

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

31
Q

How is a PUD perforation treated?

A

Resus
Broad spec IV Abx: Cephalosporin & metronidazole/Tazocin
Surgery: Laparotomy, mental patch & washout
Bleed: IM Adrenaline 1:10000, vessel clipping, heat application

32
Q

What are the uses of endoscopy in PUD?

A
  • Haemorrhage control in upper GI bleed
  • Confirm PUD in pts w/persistent dyspepsia
  • Biopsy for confirmation of H.Pylori/neoplasia
  • Reassess ongoing symptoms
33
Q

What are the local & systemic complications of pancreatitis?

A

L: Necrosis, pseudocyst
S: SIRS, multiorgan failure

34
Q

What are the signs & symptoms of acute pancreatitis?

A

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

35
Q

How is acute pancreatitis investigated?

A 
Urinalysis
Bloods: FBC, U&amp;E, LFT (Alk Phos+), Glucose+, CRP, Ca-, Amylase++, Lipase+++
ABG
ECG
CXR
36
Q

How is acute pancreatitis managed?

A 
High flow O2
IV access &amp; 1-2L normal saline
Analgesia
Anti-emetic
Nil by mouth
Catheter
IV broad spec Abx
Surgical: ERCP within 72hours- gallstones, cholecystectomy

ACC (21 decks)

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