Acute Abdo Flashcards
4 signs that suggest appendicitis
Rovsings
Copes
Psoas
Rebound tenderness
What is Rovsings sign
Pain is greater in RIF than LIF when LIF is pressed
What is Copes sign
Pain on passive flexion and internal rotation of the hip
What is Psoas sign
Pain on extending hip (only with retrocaecal appendix)
What sign is:
Pain on extending hip (only with retrocaecal appendix)
Psoas Sign
“What sign is:
Pain on passive flexion and internal rotation of the hip”
Cope’s Sign
What sign is:
Pain is greater in RIF than LIF when LIF is pressed
Rovsing’s Sign
Which Abx in the Mx of appendicitis
Cef and met
Cefotaxime and metronidazole
Appendicitis complications (3)
Perforation
Appendix mass
Appendix abscess
Define diverticular disease
the complications from diverticulosis
Define diverticulitis
acute inflammation and infection of diverticulae
Define diverticulosis
presence of diverticulae outpouchings of the colonic mucosa and submucosa throughout the large bowel
What are the Hinchley stages of Diverticular disease
- Ia: phlegmon
- Ib and II: localised abscesses
- III: perforation with purulent peritonitis
- IV: faecal peritonitis
Presenting complaints of diverticular disease (4)
Bloody stool
LIF pain
Fever
Urinary symptoms from fistulation
Ix for diverticular disease (4)
“Bloods – FBC, clotting
Barium enema (CHRONIC) * - never acute as could perforate
Flexible sigmoidoscopy ± colonoscopy
CT (ACUTE) and erect AXR (?perf)”
Mx of acute symptomatic diverticular disease
IV hydration
Bowel rest
Surgery - Hartmann’s / primary anastamosis
Mx of chronic diverticular disease
Soluble, high-fibre diet
Anti-inflammatories (e.g. Mesalazine)
Surgery (may be required with recurrent attacks or complications)
What is a Hartmanns procedure and what is the indication
“Removal of the diseased bowel and an end-colostomy formation with an anorectal stump
This is used when a primary anastomosis (immediate joining) is not possible (e.g. inflammation)”
Diverticular disease complications (6)
Diverticulitis Faecal peritonitis Fistulas Peri-colic abscess Colonic obstruction Perforation
What is the position of a femoral hernia in relation to the pubic tubercle
Lateral & inferior to pubic tubercle
What is the position of an inguinal hernia in relation to the pubic tubercle
Superior & medial to public tubercle
What do femoral hernias often contain
Omentum
What do inguinal hernias often contain
Bowel
Which type of hernia is more commonly strangulated
Femoral
How to determine whether the hernia is direct of indirect
- Reduce the hernia
- Place a finger over the deep inguinal ring (just above the midpoint of the inguinal ligament)
- Ask the patient to cough and if the hernia re-appears, it cannot be an indirect hernia (must be direct)
What can cause pancreatitis (10)
GET SMASHED – Gall stones, Ethanol, Trauma, Scorpion Venom (Trinidad scorpion), Mumps/Malignancy, Autoimmune, Steroids, Hyperlipidaemia/Hypercalcaemia/Hyperparathyroidism, ERCP, Drugs (e.g. Thiazides)
What are the domains of the Glagow score (8)
PaO2 Age Neutrophils Ca Renal function Enzymes Albumin Sugar
Medical and surgical Mx of acute pancreatitis
Medical:
Fluid balance, catheter and NG tube if vomiting, analgesia, glucose control
Surgical
ERCP
Further surgery if complications are serious (most management for pancreatitis is passive or medical though)
Which signs of bleeding in Pancreatitis is which
Cullens is periumbilical
Grey-Turners is on the sides
Diagnostic test for acute pancreatitis
Amylase
PC of chronic pancreatitis (4)
Recurrent epigastric pain
Pain relieved on sitting forward
WL, bloating, steatorrhoea
Pain worst on movement
Key blood test for chronic pancreatitis
Faecal elastase
Local complications of chronic pancreatitis (3)
pseudocysts, duodenal obstruction, pancreatic ascites
Systemic complications of chronic pancreatitis (3)
diabetes, steatorrhea, reduced quality of life
Mx of chronic pancreatitis
ERCP to remove gallstone if it is the problem
PC of intestinal obstruction (4)
Diffuse pain
Constipation
Vomiting if higher obstruction
Abdominal distension
Causes of small bowel obstruction (2)
Adhesions from prior operations (most common cause in western world)
Malignancy
Causes of large bowel obstruction (3)
Colorectal malignancies
Sigmoid/caecal volvulus
Paralytic Ileus Postoperative ileus
What is heard on auscultation of intestinal obstruction (2)
High-pitched, tinkling bowel sounds
Absent bowel sounds…
Medical and surgical Mx of intestinal obstruction
Medical
“Drip & suck” (Drip + NG tube)
Conservative if volvulus decompresses
Surgical
Laparotomy (esp. if peritonitic)
PC of acute intestinal ischaemia
Sudden onset diffuse pain
RF of acute intestinal ischaemia (4)
Old age
Cardiovascular disease
AF
Hypotensive state
Car accidents
What is seen on examination of acute intestinal ischaemia (3)
Diffuse abdominal pain
Shock signs
Normal exam
Ix for acute intestinal ischaemia (3)
AXR – perforation, megacolon
Angiography – show blockages
ECG – look for MI or AF
RF of chronic intestinal ischaemia (3)
Old age
Cardiovascular disease
Heart failure hx
PC of chronic intestinal ischaemia (4)
Intermittent gut claudication
Post-prandial pain
PR bleeding
Weight loss
Ix for intestinal ischaemia (3)
AXR
Angiography – show blockages
ECG – look for MI or AF
