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
Signs of abscess formation in appendicitis
Pyrexia
Palpable abdo mass
Signs of peritonitis
Vomiting, high fever, severe pain, absent bowel sounds
Risk factors for appendicitis
Age 10-20
Male
Frequent abx
Smoking
Two bedside tests in appendicitis to rule out differentials
Pregnancy test
Urinalysis
ABCDE for appendicitis
IV access
IV opioid + anti-emetic
Pre-op abx: cefuroxime + metronidazole
Define the following:
Cholecystitis
Biliary colic
Cholangitis
Cholecystitis: gallstone impaction + acute inflammation of the GB
Biliary colic: ‘gallstone attack’, gallstone temporarily blocks the cystic duct
Cholangitis: inflammation of the biliary tract
Most common GS problems
Biliary colic (56%) Cholecystitis (36%)
Features of biliary colic
Short-lived, recurrent episodes of epigastric/ right hypochondrial pain
RADIATES TO THE BACK
Features of cholecystitis
Hypochondrial pain radiating to the RUQ Vomiting Fever Murphy's sign Palpable mass?
What is murphy’s sign?
local peritonism, particularly on inspiration
Features of chonalngitis (charcot’s triad)
Abdo pain
Jaundice
Fever
5 F’s (RFs for gallstones)
Female, fair, fat, female + forty
Other RFs for gallstones
Sudden weight loss
Loss of bile salts (e.g. ileal resection)
OCP
Poor diabetes control
RFs specific for cholangitis
Pregnancy
Hyperlipidaemia
Which imaging is the best way of detecting gallstones?
What may it show?
USS
Stones, thickened GB wall, pericholecystic fluid
Why isn’t ERCP 1st line?
More invasive + v expensive!
Management of biliary colic
NBM
Analgesia
IV fluids
Elective removal
Management of acute cholecystitis
NBM
IV analgesia + anti-emetic
IV abx
Laparascopic cholecystectomy
What abx are given in acute cholecystitis?
IV cefuroxime (1.5g/ 8 hours)
Management of cholangitis
Abx (cefuroxime + metronidazole)
Prompt treatment - may become septic!!
Definitive: endoscopic biliary decompression
ERCP to clear any obstruction
What is diverticulitis?
Inflamed + infected diverticula (protrusions of mucosa through muscular wall of the colon)
What are uncomplicated and complicated diverticulitis
Uncomplicated: localised inflammation, does not extend to peritoneum
Complicated: abscess, peritonitis, fistula, obstruction or perforation
Risk factors for diverticulitis
Lack of dietary fibre (low stool bulk, slow transit time. high intraluminal pressure)
Smoking, obesity, genetics
If diverticulitis is uncomplicated/ mild, how can it be managed?
Can be managed in primary care
Co-amoxiclav + metronidazole
Analgesia
In emergency diverticulitis, what is the management?
Analgesia
IV fluids
Refer to surgeon (NBM)
Broad spec abx (cefuroxime + metronidazole)
Emergency diverticulitis: what should you advise re the urge to pass stools
Avoid if possible, as may cause another bleed
