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Y3 MedEd > Acute Abdo > Flashcards

Acute Abdo Flashcards

1
Q

4 signs that suggest appendicitis

A

Rovsings
Copes
Psoas
Rebound tenderness

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2
Q

What is Rovsings sign

A

Pain is greater in RIF than LIF when LIF is pressed

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3
Q

What is Copes sign

A

Pain on passive flexion and internal rotation of the hip

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4
Q

What is Psoas sign

A

Pain on extending hip (only with retrocaecal appendix)

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5
Q

What sign is:

Pain on extending hip (only with retrocaecal appendix)

A

Psoas Sign

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6
Q

“What sign is:

Pain on passive flexion and internal rotation of the hip”

A

Cope’s Sign

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7
Q

What sign is:

Pain is greater in RIF than LIF when LIF is pressed

A

Rovsing’s Sign

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8
Q

Which Abx in the Mx of appendicitis

A

Cef and met

Cefotaxime and metronidazole

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9
Q

Appendicitis complications (3)

A

Perforation
Appendix mass
Appendix abscess

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10
Q

Define diverticular disease

A

the complications from diverticulosis

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11
Q

Define diverticulitis

A

acute inflammation and infection of diverticulae

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12
Q

Define diverticulosis

A

presence of diverticulae outpouchings of the colonic mucosa and submucosa throughout the large bowel

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13
Q

What are the Hinchley stages of Diverticular disease

A
  • Ia: phlegmon
  • Ib and II: localised abscesses
  • III: perforation with purulent peritonitis
  • IV: faecal peritonitis
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14
Q

Presenting complaints of diverticular disease (4)

A

Bloody stool
LIF pain
Fever
Urinary symptoms from fistulation

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15
Q

Ix for diverticular disease (4)

A

“Bloods – FBC, clotting

Barium enema (CHRONIC) * - never acute as could perforate

Flexible sigmoidoscopy ± colonoscopy

CT (ACUTE) and erect AXR (?perf)”

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16
Q

Mx of acute symptomatic diverticular disease

A

IV hydration
Bowel rest
Surgery - Hartmann’s / primary anastamosis

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17
Q

Mx of chronic diverticular disease

A

Soluble, high-fibre diet

Anti-inflammatories (e.g. Mesalazine)
Surgery (may be required with recurrent attacks or complications)

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18
Q

What is a Hartmanns procedure and what is the indication

A

“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)”

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19
Q

Diverticular disease complications (6)

A 
Diverticulitis 
Faecal peritonitis
Fistulas
Peri-colic abscess
Colonic obstruction
Perforation
20
Q

What is the position of a femoral hernia in relation to the pubic tubercle

A

Lateral & inferior to pubic tubercle

21
Q

What is the position of an inguinal hernia in relation to the pubic tubercle

A

Superior & medial to public tubercle

22
Q

What do femoral hernias often contain

A

Omentum

23
Q

What do inguinal hernias often contain

A

Bowel

24
Q

Which type of hernia is more commonly strangulated

A

Femoral

25
Q

How to determine whether the hernia is direct of indirect

A
  1. Reduce the hernia
  2. Place a finger over the deep inguinal ring (just above the midpoint of the inguinal ligament)
  3. Ask the patient to cough and if the hernia re-appears, it cannot be an indirect hernia (must be direct)
26
Q

What can cause pancreatitis (10)

A

GET SMASHED – Gall stones, Ethanol, Trauma, Scorpion Venom (Trinidad scorpion), Mumps/Malignancy, Autoimmune, Steroids, Hyperlipidaemia/Hypercalcaemia/Hyperparathyroidism, ERCP, Drugs (e.g. Thiazides)

27
Q

What are the domains of the Glagow score (8)

A 
PaO2
Age
Neutrophils
Ca
Renal function
Enzymes
Albumin
Sugar
28
Q

Medical and surgical Mx of acute pancreatitis

A

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)

29
Q

Which signs of bleeding in Pancreatitis is which

A

Cullens is periumbilical

Grey-Turners is on the sides

30
Q

Diagnostic test for acute pancreatitis

A

Amylase

31
Q

PC of chronic pancreatitis (4)

A

Recurrent epigastric pain
Pain relieved on sitting forward
WL, bloating, steatorrhoea
Pain worst on movement

32
Q

Key blood test for chronic pancreatitis

A

Faecal elastase

33
Q

Local complications of chronic pancreatitis (3)

A

pseudocysts, duodenal obstruction, pancreatic ascites

34
Q

Systemic complications of chronic pancreatitis (3)

A

diabetes, steatorrhea, reduced quality of life

35
Q

Mx of chronic pancreatitis

A

ERCP to remove gallstone if it is the problem

36
Q

PC of intestinal obstruction (4)

A

Diffuse pain
Constipation
Vomiting if higher obstruction
Abdominal distension

37
Q

Causes of small bowel obstruction (2)

A

Adhesions from prior operations (most common cause in western world)
Malignancy

38
Q

Causes of large bowel obstruction (3)

A

Colorectal malignancies
Sigmoid/caecal volvulus
Paralytic Ileus Postoperative ileus

39
Q

What is heard on auscultation of intestinal obstruction (2)

A

High-pitched, tinkling bowel sounds

Absent bowel sounds…

40
Q

Medical and surgical Mx of intestinal obstruction

A

Medical
“Drip & suck” (Drip + NG tube)
Conservative if volvulus decompresses

Surgical
Laparotomy (esp. if peritonitic)

41
Q

PC of acute intestinal ischaemia

A

Sudden onset diffuse pain

42
Q

RF of acute intestinal ischaemia (4)

A

Old age

Cardiovascular disease

AF

Hypotensive state
Car accidents

43
Q

What is seen on examination of acute intestinal ischaemia (3)

A

Diffuse abdominal pain
Shock signs
Normal exam

44
Q

Ix for acute intestinal ischaemia (3)

A

AXR – perforation, megacolon

Angiography – show blockages

ECG – look for MI or AF

45
Q

RF of chronic intestinal ischaemia (3)

A

Old age

Cardiovascular disease

Heart failure hx

46
Q

PC of chronic intestinal ischaemia (4)

A

Intermittent gut claudication
Post-prandial pain
PR bleeding
Weight loss

47
Q

Ix for intestinal ischaemia (3)

A

AXR

Angiography – show blockages

ECG – look for MI or AF

Y3 MedEd (34 decks)

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