Acute Abdo Flashcards
What should always be suspected in unexplained abdo pain + hypotension
AAA
What are the signs of a ruptured AAA?
Sweating, inc HR, absent femoral pulses, mottled skin in lower body, tender pulsative mass, sudden collapse
Abdo signs of ruptured AAA
Abdominal bruir
Grey turner’s sign
What is the pathophysiology of AAA?
degradation of the elastic lamellae + smooth muscle loss
What is the most common site of AAA?
Where is blood most likely to haemorrhage?
Below the renal arteries
Blood into the retroperitoneum
In an unruptured AAA, when would surgery be considered?
Aneurysm >5.5cm diameter or expansible of >1cm
How is unruptured AAA monitored?
Regular USS (if <4.4cm then every 2 years, if >4.5 then every 3 months) + BP control
ABCDE management of suspected AAA rupture
- Oxygen
- venous access
- bloods: including coagulation screen + crossmatch
- IV analgesia (morphine)
IV anti-emetic (cyclizine) - IV fluids
- IMMEDIATE BEDSIDE USS
- urinary catheter, radial arterial line, ECG
IV fluids in AAA rupture
Treat major hypovolaemia until systolic >90 (if passing urine then minimal fluid needed before theatre)
What is the emergency surgical management of AAA?
How can this be done?
Stenting!!
Endovascular (through femoral)
Open (expose aorta, clamp + repair)
Describe the classic pattern of appendicitis pain
Pain in the epigastric region, worsens in first 24 hours, then migrates to RIF (becomes constant + sharp)
What can make pain in appendicitis worse?
think adults + children
Movement (e.g. cough)
Hopping
Abdo exam in appendicitis
Tenderness
Guarding at RIF
Rebound tenderness
Where is McBurney’s point?
2/3 from umbilicus to ASIS
Presentation of appendicitis
Pain!!
Anorexia, N+V, facial flushing, fever, inc HR
What is rovsing’s sign in appendicitis?
Palpation of LLQ increases pain over RQ
Signs of perforation in appendicitis
Inc HR
Sudden relief of pain