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GI and Surgery > Abdominal Pain > Flashcards

Abdominal Pain Flashcards

1
Q

Which test is used to investigate acute pancreatitis for a late presentation (>24 hours)?

A

Serum lipase

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2
Q

Describe Boerhaave’s syndrome

A

Retrosternal chest pain, subcutaneous emphysema on background of alcoholism. Spontaneous rupture of oesophagus due to recurrent episodes of vomiting.

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3
Q

Is pancreatitis more common in men or women?

A

Men

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4
Q

How do gallstones cause acute pancreatitis?

A

Gallstone obstructs ampulla of Vater blocking the flow of bile and pancreatic enzymes into the duodenum. This refluxes back to pancreas causing inflammation.

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5
Q

How does alcohol cause acute pancreatitis?

A

Alcohol is directly toxic to pancreatic cells, resulting in inflammation.

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6
Q

What causes a fluid deficit in acute pancreatitis?

A

Fluid exits the vascular space into the tissues due to inflammation. Dry mucous membranes and reduced urinary output.

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7
Q

What is a diagnostic amylase level in acute pancreatitis?

A

Elevated 3 times above reference range.

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8
Q

Should you offer prophylactic antibiotics in acute pancreatitis?

A

No, only if infection is present.

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9
Q

Define acute pancreatitis

A

Rapid onset inflammation of pancreas.

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10
Q

True or false: normal functioning of the pancreas usually does not return in acute pancreatitis

A

False - it usually does return.

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11
Q

What are the main causes of acute pancreatitis?

A

Alcohol, gallstones and post-ERCP.

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12
Q

What is the pathophysiology of acute pancreatitis?

A

Abnormal release and activation of enzymes causing auto digestion of pancreatic tissue. Leading to recruitment of inflammatory cells and release of inflammatory mediators.

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13
Q

Describe the symptoms of acute pancreatitis

A

Severe epigastric pain radiating to the back and vomiting.

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14
Q

What clinical signs might you observe in a patient presenting with acute pancreatitis?

A

Abdominal tenderness, tachycardia and fever.
Rare: Cullen’s and Grey Turner’s sign.

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15
Q

What are Cullen’s and Grey Turner’s signs?

A

Cullen’s: periumbilical bruising.
Grey Turner’s: flank bruising.

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16
Q

What is the main diagnostic test for acute pancreatitis?

A

Serum amylase.

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17
Q

What is the Glasgow score?

A

Assesses severity of pancreatitis.
0-1: mild.
2: moderate.
3+: severe.

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18
Q

What components are measured in the Glasgow score?

A

PaO2, age, WBC, calcium, urea, LDH or AST, albumin and glucose.

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19
Q

What are the main management principles for acute pancreatitis?

A

Initial resuscitation, IV fluids, analgesia and nutritional support (mild = low fat diet; severe = enteral feeding).

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20
Q

List some complications of acute pancreatitis

A

Pancreatic necrosis, infection of necrotic area, abscess, pseudocysts, chronic pancreatitis.

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21
Q

Define chronic pancreatitis

A

Chronic inflammation of the pancreas causing fibrosis and permanent decline in pancreatic function.

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22
Q

What is the most common cause of chronic pancreatitis?

A

Alcohol

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23
Q

What structural changes are seen in chronic pancreatitis?

A

Atrophy, calcification and strictures.

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24
Q

Describe the clinical features of chronic pancreatitis

A

Abdominal pain, N+V, loss of appetite, steatorrhoea, bloating, weight loss.

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25
Q

What imaging techniques would you use to investigate chronic pancreatitis?

A

CT or MRI/MRCP (late stage).
Endoscopic ultrasound +/- biopsy (early stage).

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26
Q

What stool test is used to assess for pancreatic exocrine insufficiency?

A

Faecal elastase.

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27
Q

What is the management plan for a patient with chronic pancreatitis?

A

Alcohol and smoking cessation.
Creon.
Insulin.
Analgesia.
ERCP with stenting.
Surgery - removing inflamed tissues and draining ducts.

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28
Q

List some complications of chronic pancreatitis

A

Pancreatic exocrine insufficiency.
Diabetes.
Biliary obstruction.
Pseudocysts and abscesses.
Pancreatic cancer.

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29
Q

Which imaging modality would best confirm a bowel perforation?

A

Effect chest X-ray.

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30
Q

What is the preferred diagnostic test for chronic pancreatitis?

A

CT pancreas to look for calcification.

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31
Q

List the drugs that can cause acute pancreatitis

A

Azathioprine, mesalazine, didanosine, bendroflumethiazide, furosemide, pentamidine, steroids, sodium valproate.

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32
Q

Are wide neck hernias at higher or lower risk of complications?

A

Lower

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33
Q

Are men or women more likely to be affected by inguinal hernias?

A

Men

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34
Q

What are the 2 most important factors for development of a hernia?

A

Inherent or acquired weakness and raised intra-abdominal pressure (constipation, chronic cough, pregnancy).

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35
Q

Inguinal canal in males vs. females

A

Males: spermatic cord and it’s contents travel from inside peritoneal cavity, through abdominal wall and into scrotum via inguinal canal.
Females: round ligament attaches to uterus and passes through deep inguinal ring, inguinal canal and then attaches to labia majora.

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36
Q

A patent processus vaginalis predisposes patients to which two conditions?

A

Indirect inguinal hernia and hydroceles.

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37
Q

Irreducible, painful lump inferolateral to pubic tubercle

A

Strangulated femoral hernia

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38
Q

Location of inguinal hernia?

A

Superomedial to pubic tubercle.

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39
Q

Do inguinal hernias resolve spontaneously?

A

No

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40
Q

Management for an asymptomatic inguinal hernia?

A

Routine referral for surgical repair.

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41
Q

What is the most common cause of small bowel obstruction?

A

Adhesions

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42
Q

What are adhesions?

A

Scar tissue usually from inflammation or manipulation of abdominal contents during surgery.

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43
Q

Symptoms of bowel obstruction?

A

Abdominal pain, distension and constipation.

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44
Q

What is the differentiating factor between small and large bowel obstructions?

A

Onset of nausea and vomiting - early stage of small bowel obstruction.

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45
Q

What is the most common cause of large bowel obstructions?

A

Colorectal cancer.

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46
Q

Should you attempt to manually reduce a strangulated hernia?

A

No because you would push necrotic bowel back into abdomen which can make the patient deteriorate more rapidly.

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47
Q

Are incarcerated hernias painless?

A

Yes

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48
Q

Brad is a 48-year-old builder who calls you on a Monday morning complaining of severe epigastric pain, which started over the weekend and worsens by lying down. The pain radiates into his back. He has vomited several times over the last few days. He has no known medical history and takes no regular medication. He reports that the pain started following a takeaway meal on Friday night.

A

Pancreatitis

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49
Q

Gloria is a 28-year-old city worker who attends your surgery complaining of a 7-month history of intermittent abdominal pain and diarrhoea. She has a busy job and her constant need for the toilet is starting to affect her. She describes the symptoms as more constant over the last 3 months, occurring almost daily. She denies any bleeding and is otherwise well in herself. She denies any weight loss. Her father suffers from Crohn’s disease and she is concerned this is the case.

A

IBS

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50
Q

A mother brings her 6-year-old son to the surgery as he has been complaining of abdominal pain for the last few days. He points to the left lower quadrant when questioned on the location of the pain. This has been constant. There is no history of any recent infections. His mother denies any fevers and reports he has been drinking well but reports he has had a reduced appetite over the last few days. He last opened his bowels three days ago. On examination, his abdomen is soft with mild tenderness in the left iliac fossa. His observations are within the normal range.

A

Constipation

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51
Q

What is mesenteric adenitis?

A

Inflamed mesenteric lymph nodes. Fairly common cause of abdominal pain in children. Symptoms often start following a sore throat/cold: central abdominal pain, fever, nausea and diarrhoea.

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52
Q

Irreducible hernias may not have a cough impulse - true or false?

A

True

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53
Q

What are the risk factors for femoral hernia?

A

Female and pregnancy.

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54
Q

Describe diastasis recti/rectus diastasis/recti divarication

A

Weakening and widening of linea alba (but no defect). It is not technically a hernia. Gap becomes most prominent when patient lies on their back and lifts their head. It can be congenital or due to weakness in the connective tissue, e.g. following pregnancy or obesity. No treatment required in most cases.

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55
Q

Define littre’s hernia

A

Very rare - herniation of Meckel’s diverticulum. Most commonly occurs in inguinal canal and becomes strangulates.

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56
Q

Define lumbar hernia

A

Rare posterior hernia that occur spontaneously or iatrogenically following surgery (e.g. open renal surgery). Present as a posterior mass associated with back pain.

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57
Q

Does hypothermia or hyperthermia cause acute pancreatitis?

A

Hypothermia

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58
Q

What is the investigation for suspected Boerhaave’s syndrome?

A

CT contrast swallow.

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59
Q

What is the most sensitive blood test for diagnosis of acute pancreatitis?

A

Lipase

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60
Q

What is the most common type of hiatus hernia?

A

Sliding

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61
Q

What mechanical complications are associated with rolling hiatus hernia?

A

Gastric volvulus, leading to dysphagia, post-prandial pain and distension.
Strangulation.
Perforation.
Gastric outlet obstruction.

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62
Q

Define hernia

A

When a body organ penetrates through weakness in cavity wall.

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63
Q

What does a reducible hernia mean?

A

It can be pushed back into normal place.

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64
Q

When might hernias protrude out?

A

On coughing or standing.

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65
Q

What are the 3 complications of hernias?

A

Incarceration - hernia is irreducible.
Obstruction.
Strangulation - blood supply cut off, surgical emergency.

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66
Q

What is the management for abdominal wall hernias?

A

Placing mesh over defect (tension-free repair).

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67
Q

Define Richter’s hernia

A

Partial herniation of bowel.

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68
Q

What is the name of a hernia where 2 loops of bowel are contained within the hernia?

A

Maydl’s hernia

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69
Q

What are the boundaries of the inguinal canal?

A

Anterior wall - aponeurosis of external oblique.
Posterior wall - transversalis fascia.
Roof - internal oblique and transversus abdominis.
Floor - inguinal ligament.

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70
Q

What is the most common type of inguinal hernia?

A

Indirect

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71
Q

What is an indirect inguinal hernia?

A

Hernia that protrudes through deep inguinal ring and into inguinal canal.

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72
Q

Describe the pathophysiology for indirect inguinal hernias

A

When processus vaginalis is patent bowel can herniate through the inguinal canal.

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73
Q

Why are indirect inguinal hernias at greater risk of strangulation?

A

Due to narrow deep inguinal ring.

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74
Q

Define direct inguinal hernia

A

Hernia that protrudes through posterior wall of inguinal canal due to weakness in abdominal wall at Hesselbach’s triangle.

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75
Q

What are the boundaries of Hesselbach’s triangle?

A

Rectus abdominis (medial).
Inferior epigastric vessels (superior/lateral).
Inguinal ligament (inferior).

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76
Q

Define femoral hernia

A

Herniation of abdominal contents through femoral canal.

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77
Q

What are the boundaries of the femoral canal?

A

Femoral vein (laterally).
Lacunar ligament (medially).
Inguinal ligament (anteriorly).
Pectineal ligament (posteriorly).

78
Q

What are the boundaries of the femoral canal?

A

Sartorius (laterally).
Adductor longus (medially).
Inguinal ligament (superiorly).

79
Q

What are the contents of the femoral triangle?

A

Femoral nerve, femoral artery, femoral vein, femoral canal.

80
Q

What are incisional hernias?

A

Occur at site of incision from previous abdominal surgery.

81
Q

Umbilical vs paraumbilical hernias

A

Umbilical occur around umbilicus.
Paraumbilical herniate through linea alba around umbilical region.

82
Q

What are epigastric hernias?

A

Hernia in epigastric area through linea alba, due to chronic increase in intra-abdominal pressure.

83
Q

What is the name of the hernias that occur between lateral border of rectus abdominis and linea semilunaris?

A

Spigelian hernia

84
Q

Where do obturator hernias herniate through?

A

Obturator foramen.

85
Q

Why do obturator hernias occur?

A

Due to defect in pelvic floor.

86
Q

Why are obturator hernias more common in women?

A

Due to multiple pregnancies, vaginal deliveries and wider pelvis.

87
Q

How might patients with an obturator hernia present?

A

Irritation of obturator nerve causing pain in groin/medial thigh.
Mass in upper medial thigh and features of small bowel obstruction.

88
Q

What is the Howship-Romberg sign?

A

Pain extending from inner thigh to knee when hip is internally rotated due to compression of obturator nerve.

89
Q

Define hiatus hernia

A

Herniation of stomach through diaphragm due to a wider opening.

90
Q

What are the 4 types of hiatus hernia?

A

Type 1: sliding (stomach slides up through diaphragm, displacing GOJ above diaphragm).
Type 2: rolling (fundus herniates through diaphragm and GOJ is unchanged).
Type 3: combination of sliding and rolling (fundus and GOJ lie above diaphragm).
Type 4: large hernia allowing other intra-abdominal organs to enter thorax.

91
Q

What are the risk factors for hiatus hernia?

A

Increasing age, obesity and pregnancy.

92
Q

Describe the symptoms of hiatus hernia

A

May be asymptomatic or may have dyspepsia symptoms (heartburn, acid reflux, regurgitation, burping, bloating, halitosis).

93
Q

How can a hiatus hernia be investigated?

A

Endoscopy.

94
Q

Describe the management plan for a hiatus hernia

A

PPIs or surgery (laparoscopic fundoplication or cruroplasty).

95
Q

What are the clinical features associated with Peutz-Jeghers syndrome?

A

Hamartomatous polyps in small bowel, small bowel obstruction, GI bleeding, pigmented lesions on lips, oral mucosa, face, palms and soles.

96
Q

Management of baby with umbilical hernia?

A

Reassure parents that hernia should resolve by age of 4-5.

97
Q

Name the differentials for appendicitis

A

Ectopic pregnancy, ovarian cysts/rupture/torsion, Meckel’s diverticulum, mesenteric adenitis.

98
Q

What is Meckel’s diverticulum?

A

Malformation of distal ileum, which can bleed, become inflamed, rupture or cause volvulus or intussusception.

99
Q

A female patient of child-bearing age presents to A&E with abdominal pain, what test should do?

A

Serum HCG.

100
Q

What is an appendix mass?

A

When the omentum surrounds and sticks to the inflamed appendix, forming a mass in the RIF.

101
Q

What is the preferred diagnostic test for chronic pancreatitis?

A

CT pancreas - looking for pancreatic calcification.

102
Q

Define diverticula

A

Pouches/pockets in bowel wall.

103
Q

Define diverticulosis

A

Presence of diverticula without inflammation or infection.

104
Q

Define diverticulitis

A

Inflammation and infection of diverticula.

105
Q

How do diverticula form?

A

Raised intra-luminal pressure causing mucosa to herniate through muscle layer.

106
Q

Can diverticula form in rectum?

A

No due to outer longitudinal muscle layer.

107
Q

Which part of the bowel does diverticulosis most commonly affect?

A

Sigmoid colon.

108
Q

List some risk factors for Diverticular disease

A

Older age, diet low in fibre, obesity, FHx, smoking.

109
Q

Which drugs are associated with an increased risk of diverticular perforation?

A

NSAIDs and steroids.

110
Q

How might diverticulosis present?

A

Asymptomatic or cause lower left abdominal pain, constipation or rectal bleeding.

111
Q

What type of laxative is used in the treatment of diverticulosis?

A

Bulk forming laxative e.g. ispaghula husk.

112
Q

Describe the clinical features of acute diverticulitis

A

Pain in LIF, fever, diarrhoea, N+V, rectal bleeding, raised inflammatory markers.

113
Q

How would you investigate suspected acute diverticulosis?

A

CT abdomen/pelvis.

114
Q

What is the management of uncomplicated diverticulitis?

A

Oral co-amoxiclav and analgesia.

115
Q

What is the management of complicated diverticulitis?

A

NBM/clear fluids, IV co-amoxiclav, IV fluids, analgesia, surgery for complications.

116
Q

Describe the complications of diverticulitis

A

Perforation, peritonitis, peridiverticular abscess, haemorrhage, fistula, ileus, obstruction, stricture.

117
Q

Where does the appendix attach to?

A

Caecum.

118
Q

What is the peak incidence of appendicitis?

A

10-20 years old.

119
Q

What causes appendicitis?

A

Appendiceal obstruction (e.g. by hard collections of stool) cause bacterial overgrowth, leading to infection and inflammation.

120
Q

Rupture of appendix can lead to…

A

Peritonitis.

121
Q

Describe the symptoms of appendicitis

A

Central abdominal pain that spread to RIF.
Tenderness at McBurney’s point.
Loss of appetite.
N+V.
Low-grade fever.

122
Q

What clinical signs would you see with appendicitis?

A

Rovsing’s sign - palpation of LIF causes pain in RIF.
Guarding on palpation.

123
Q

What clinical signs would suggest peritonitis and ruptured appendix?

A

Rebound tenderness in RIF and percussion tenderness.

124
Q

How is a diagnosis of appendicitis made?

A

On clinical presentation and in the presence if raised CRP/WCC. CT can confirm diagnosis.

125
Q

What is the treatment for appendicitis?

A

Laparoscopic appendicectomy.

126
Q

What are the potential complications of a bowel obstruction?

A

Bowel ischaemia or perforation.

127
Q

True or false - a large bowel obstruction is more common than a small bowel obstruction

A

False - a small bowel obstruction is more common.

128
Q

Because of the bowel obstruction, fluid can’t reach and be reabsorbed by the colon, so fluid is lost from the intravascular space into the GI causing hypovolaemic shock. This is called…

A

Third-spacing.

129
Q

What are the big 3 causes of bowel obstruction?

A

Adhesions, hernias and malignancy.

130
Q

Describe the other causes of bowel obstruction

A

Diverticular disease, volvulus, structures (secondary to Crohn’s), intussusception (children), gallstone ileus, foreign bodies, faecal impaction, Meckel’s diverticulum, lymphoma.

131
Q

2 points of obstruction along a bowel is called?

A

Closed-loop obstruction.

132
Q

What are the clinical features of bowel obstruction?

A

Vomiting (green bilious), abdominal distension, colicky/crampy diffuse abdominal pain and absolute constipation.

133
Q

What blood test are important when investigating a bowel obstruction and why?

A

U&Es (renal function and electrolytes due to third-spacing).
VBG - lactate (bowel ischaemia), metabolic derangement/alkalosis (vomiting).
Group and saves (transfusion).

134
Q

How would you test for a bowel perforation?

A

Erect CXR - subdiaphragmatic gas to detect pneumoperitoneum.

135
Q

What imaging modalities would you use to detect a bowel obstruction?

A

Abdominal X-ray (distended bowel loops).
CT abdomen with contrast (to confirm diagnosis).

136
Q

At what level is abnormal dilation for small bowel, large bowel and caecum?

A

Small bowel: > 3cm
Large bowel: > 6cm
Caecum > 9cm

137
Q

Describe the conservative management for stable patient with a bowel obstruction

A

Drip and suck: NBM, IV fluids, NG tube with free drainage (decompress stomach and prevent aspiration).
Analgesia, anti-emetics and urinary catheter (fluid balance).

138
Q

Why are IV fluids administered to a patient with a bowel obstruction?

A

To hydrate the patient and to correct any electrolyte imbalances.

139
Q

What is the definitive management for bowel obstruction?

A

Surgery

140
Q

What types of surgery can you do for bowel obstruction?

A

Exploratory, adhesiolysis, hernia repair, tumour resection, endoscopic stents.

141
Q

How might a Richter’s hernia present?

A

Presence of strangulation without obstruction symptoms.

142
Q

Describe the clinical signs indicative of peritonitis

A

Guarding, rigidity, rebound tenderness, pain on coughing and percussion tenderness.

143
Q

Define abdominal guarding

A

Involuntary tensing of abdominal wall muscles on palpation to protect inflamed organs.

144
Q

Define rebound tenderness

A

Pain upon removal of pressing on abdomen, rather than application of pressure.

145
Q

What are the 3 types of peritonitis?

A

Localised, generalised and spontaneous bacterial peritonitis.

146
Q

Peritonitis caused by underlying organ inflammation such as appendicitis or cholecystitis

A

Localised peritonitis

147
Q

Peritonitis caused by perforation of an abdominal organ, such as perforated ulcer, bowel or ruptured appendix, releasing contents into peritoneal cavity.

A

Generalised peritonitis

148
Q

Spontaneous bacterial peritonitis is associated with spontaneous infection of ascitic fluid secondary to what?

A

Liver disease

149
Q

What are the symptoms of peritonitis?

A

Acute, severe abdominal pain.
Fever.
N+V.

150
Q

What is the role of surgery in treating peritonitis?

A

Remove source of contamination, wash-outs and repair any defects.

151
Q

What are the clinical features of colonic ischaemia?

A

Abdominal pain and bloody diarrhoea.

152
Q

Ischaemic colitis most likely affects which area?

A

Splenic flexure

153
Q

Define mesenteric ischaemia

A

Insufficient blood flow to intestines leading to ischaemia.

154
Q

What causes chronic mesenteric ischaemia?

A

Narrowing of mesenteric vessels due to atherosclerosis.

155
Q

Describe the clinical features of chronic mesenteric ischaemia

A

Central colicky abdominal pain after eating.
Weight loss (due to food avoidance).
Abdominal bruit.

156
Q

List the risk factors associated with chronic mesenteric ischaemia

A

Increased age, FHx, smoking, obesity, diabetes, hypertension, raised cholesterol.

157
Q

How would you diagnose chronic mesenteric ischaemia?

A

CT angiography

158
Q

Describe the management plan for chronic mesenteric ischaemia

A

Reduce modifiable risk factors.
Secondary prevention - statins, anti-platelets.
Revascularisation - percutaneous mesenteric artery stenting, bypass grafting, endarterectomy.

159
Q

What causes acute mesenteric ischaemia?

A

Rapid blockage of blood flow through superior mesenteric artery by a thrombus or embolism.

160
Q

What are the risk factors for a thrombus or embolism in acute mesenteric ischaemia?

A

Thrombus - AF.
Embolism - atherosclerosis.

161
Q

What are the clinical features of acute mesenteric ischaemia?

A

Acute, non-specific abdominal pain associated with N+V.
Abdominal pain is disproportionate to examination findings.

162
Q

What are the complications of acute mesenteric ischaemia?

A

Necrosis, perforation, mortality (>50%).

163
Q

What findings would you see on a blood test for acute mesenteric ischaemia?

A

Metabolic acidosis, raised lactate, raised WCC/CRP, raised D-dimer.

164
Q

Which imaging modality would you use to investigate acute mesenteric ischaemia?

A

Contrast CT abdomen/pelvis.

165
Q

Describe the management plan for acute mesenteric ischaemia

A

Medical: IV fluids, broad-spectrum antibiotics, anticoagulants (unfractionated heparin).
Surgery: resection or revascularisation.

166
Q

A 64-year-old man presents to the GP with a new lump he has noticed on his abdomen. On examination, there is a single visible protrusion 5cm above the umbilicus in the midline. It appears pink and is painless with no signs of necrosis. There are bowel sounds present.

A

Epigastric hernia

167
Q

Describe the location of a para-umbilical hernia

A

Asymmetrical bulge directly above or below the umbilicus.

168
Q

Describe the location of epigastric hernia

A

Lump in the midline between umbilicus and the xiphisternum.

169
Q

What is the annual risk of strangulation for direct inguinal hernias?

A

3%

170
Q

Is strangulation more common in indirect or direct inguinal hernias?

A

Indirect

171
Q

A 21-year-old female presents to the emergency department with lower abdominal pain. The pain started centrally and is now localised on the right side. She states the severity of the pain is 8 out of 10 on the pain scale. She is sexually active and states that she is not on any form of contraception but uses condoms. On examination she has pain in the right iliac fossa with rebound tenderness. What initial investigation should be completed during admission to rule out a potential diagnosis?

A

Urine hCG

172
Q

A 17-year-old male is admitted with lower abdominal discomfort. He has been suffering from intermittent right iliac fossa pain for the past few months. His past medical history includes a negative colonoscopy and gastroscopy for iron deficiency anaemia. The pain is worse after meals. Inflammatory markers are normal.

A

Meckels diverticulum (may contain ectopic gastric mucosa which may secrete acid with subsequent bleeding and ulceration).

173
Q

A 14-year-old female is admitted with sudden onset right iliac fossa pain. She is otherwise well and on examination has some right iliac fossa tenderness but no guarding. She is afebrile. Urinary dipstick is normal. Her previous menstrual period two weeks ago was normal and pregnancy test is negative.

A

Mittelschmerz

174
Q

A 21-year-old male is admitted with a 3 month history of intermittent right iliac fossa pain. He suffers from episodic diarrhoea and has lost 2 kilos in weight. On examination he has some right iliac fossa tenderness and is febrile.

A

Crohns disease

175
Q

A 43-year-old man who has a long term history of alcohol misuse is admitted with a history of an attack of vomiting after an episode of binge drinking. After vomiting he developed sudden onset left sided chest pain, which is pleuritic in nature. On examination he is profoundly septic and drowsy with severe epigastric tenderness and left sided chest pain.

A

Boerhaaves syndrome

176
Q

Define ileus

A

Condition affecting the small bowel, where the normal peristalsis temporarily stops - paralytic ileus or adynamic ileus.

177
Q

What is a common cause of ileus?

A

After abdominal surgery - usually resolves with supportive care within a few days.

178
Q

Describe the clinical features of ileus

A

Vomiting (green bilious), abdominal distention, diffuse abdominal pain, absolute constipation and absent bowel sounds (as opposed to the “tinkling” bowel sounds of mechanical obstruction).

179
Q

Describe the management for ileus

A

Supportive care:
- NBM/limited sips of water.
- NG tube if vomiting.
- IV fluids (prevent dehydration and correct electrolyte imbalances).
- Mobilisation (stimulate peristalsis).
- Total parenteral nutrition (TPN) may be required whilst waiting for the bowel to regain function.

180
Q

Define volvulus

A

The bowel twists around itself and the mesentery, leading to a closed-loop bowel obstruction. This could cause ischaemia, necrosis and perforation.

181
Q

Describe the 2 types of volvulus

A

Sigmoid volvulus - more common, affects older patients due to chronic constipation where sigmoid colon becomes overloaded with faeces causing it to sink and twist.
Caecal volvulus - less common, affects younger patients.

182
Q

What sign on abdominal X-ray would indicate a sigmoid volvulus?

A

Coffee bean sign.

183
Q

Describe the management for a sigmoid volvulus

A

Endoscopic decompression or surgery (Hartmann’s procedure).

184
Q

What is the initial management for pancreatic pseudocysts?

A

Conservative management if no signs of infection, deranged LFTs or pseudocysts >12 weeks.

185
Q

How would you drain a pancreatic pseudocyst?

A

Radiological fine-needle aspiration.

186
Q

Which test can be used to assess the pancreases exocrine function in chronic pancreatitis?

A

Faecal elastase.

187
Q

When would laparoscopic hernia repair be indicated over open repair?

A

Laparoscopic - bilateral hernias.
Open - unilateral hernia.

188
Q

Name the contraindications to laparoscopic surgery

A
  • Acute intestinal obstruction with dilated bowel loops.
  • Significantly raised ICP.
189
Q

What imaging would you use to determine aetiology in acute pancreatitis?

A

US abdomen

190
Q

What electrolyte abnormality can acute pancreatitis cause?

A

Hypocalcaemia - due to calcium precipitation within pancreatic tissue, impaired release of PTH, and binding of calcium to fatty acids released during lipolysis.

(Hypercalcaemia can rarely cause pancreatitis, but hypocalcaemia is a complication).

GI and Surgery (14 decks)

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