Abdominal Pain Flashcards
What is the presentation of ruptured AAA?
Severe ‘Ripping’ abdominal or back pain, syncope and shock. Tachycardic and hypotensive
Classic triad - flank pain, hypotension and a pulsatile abdominal mass
what is the classification of an AAA, where are they commonly found?
diameter of 3cm of more (normal diameter is 2 cm)
Found below the level of the renal arteries
Risk factors for AAA
Male, atherosclerosis, FH, smoking, age, HTN, COPD, inflammatory disease, connective tissue disease, infection
Investigations for suspected ruptured AAA
A-E approach
Obs - hypotensive, tachycardic
Bloods - FBC, Group and save, cross match, U&Es (baseline for surgery)
Imaging - Abdo XR or CT will confirm diagnosis
ECG - is chest pain presentation
Management fo ruptures AAA
A-E approach. Surgical emergency
15L O2
Large bore canula and rapid fluid resuscitation
Prep for surgery - if stable to CT w/ contrast.
if not stable to laparotomy.
Presentation of appendicitis
abdominal pain moving to RIF. Pain aggrevated by moving, localised tenderness, may have rovsings sign.
N/V, constipation, fever
Signs: Gaurding, rebound tenderness, tachycardia.
Most common cause of acute abdomen?
appendicitis. Most common in young people, can occur at any age.
Differentials of acute abdominal pain presentation
Appendicitis Bowel obstruction Pancreatitis Perforated ulcer Diverticulitis DKA Renal Colic Constipation Ectopic pregnancy Ovarian cyst Testicular torsion
Scoring system used to rate symptoms of suspected appendicitis?
Alvadro score - RIF pain, Anorexia, N/V, RIF tenderness, rebound tenderness, Fever, Leucocytosis, Neutropihils.
Investigations for suspected appendicitis?
Exclusion of differentials: Urine dip, Pregnancy test.
Bloods: FBC, CRP, U&E
Imaging: USS, CT is gold standard for diagnosing.
Management of acute appendicitis
A-E approach Fluids and analgesia Pre-operative antibiotics NBM Prepped and wait for surger - lapraroscopic appendectomy.
What is Charcots Tirad?
Fever, jaundice, RUQ pain
Triad indicating Cholangitis (inflammation and infection of biliary tree)
what causes cholangitis?
obstruction of the gall bladder by stones, tumour, stenosis, infections., prodecudres (eg ERCP)
Presentation of cholangitis
Fever, jaundice, RUQ pain, puritis, change in stool colour - clay coloured.
Investigations for suspected cholangitis
Bloods: FBC, CRP, LFTs, U&Es, amylase, Blood culture
Imaging: liver USS, Contrast CT of clinical suspicion of diagnostic uncertainty
What changes in LFTs would you see in cholangitis
obstructive jaundice
increased bilirubin, increase ALP and transaminase.
Management for cholangitis
Stabilise - may need fluids and analgesia
Give IV antibiotics once cultures have returned.
Will need aerobic and gram negative coverage metronidazole, ceftriaxoe or ciprofloxacin.
If no improvement, can do endocopic biliary drainage.
Monitor LFTs, U&Es, vitimain absorption.
Presentation of bowel obstruction
Colicky abdominal pain.
N/V. failure to mass bowel motion
abdominal distenstion, tympanic ‘tinkly’ bowel sounds.
Signs: tachycardic, hypotensive, dehydrated, pyrexia.
Causes of bowel obstruction
constipation, malignancy, strangulated hernias, IBD, CF, Volvulus., neurological damage causing paralytic ileus
What is a paralytic ileus and what causes it?
Obstruction due to no peristalsis, part of the bowel becomes paralysed.
Caused by: Stroke, MI, AKI, DKA, Chest infections, electrolyte disturbance, MS, Parkinson’s, neurological impairment are at risk.
What type of obstruction is more common, how does it present?
Small bowel obstruction: presenting with vomiting and abdominal pain.
if not passing faeces this is a late sign.
How to tell the difference between small and large bowel obstruction on XR
Look for dilated bowel loops
Small: Valvulae starch entire way across the bowel loop
Large: haustra stretch only part of the way across the bowel
Investigations and Management for suspected bowel obstruction
A-E approach
ensure Pt is stable. give O2 is needed.
ECG - if electrolyte abnormalities
Bloods: FBC, group and save, crossmatch, glucose, ABG ( look at lactate)
Fluid resuscitation and electrolyte replacement - monitor fluid balance, will need catheter.
Imaging - abdominal XR. May need non-contrast CT
Emergency surgery - can have decompression with stents endoscopically, or may need laparotomy.
Complications of bowel obstruction
perforation, ischaemia, electrolyte disturbance, AKI, shock.
What is diverticulitis?
Herniation of GI mucosa through colonic muscle in the sigmoid or descending colon (diverticula) which then become inflamed.
