Acute Abdo Tutorial - Sai

Question 1

Where does pain from the foregut, midgut and hind gut refer to?

Answer 1

Foregut - epigastric pain
Midgut - periumbilical pain
Hindgut - suprapubic

Question 2

Inflammatory vs obstructive pain - describe

Answer 2

Obstructive pain - colicky, maybe associated with constipation and nausea

Inflammatory pain - fever, systemic symptoms, constant

Question 3

Boundaries of foregut

Answer 3

Mouth to second part of duodenum

Question 4

Boundaries of the midgut

Answer 4

Second part of duodenum to 2/3 along transverse colon

Question 5

What might you see on an X-ray for someone with perforated appendicitis?

Answer 5

Pneumoperitoneum

Question 6

Most common cause of small bowel obstructions

Answer 6

Adhesions resulting from surgery incl. caesareans

Question 7

What is a gallstone ileus?

Answer 7

When a gallstone goes and lodges through biliary-ileus fistula

Question 8

Which type of hernia is a most common cause of small bowel obstruction?

Answer 8

Inguinal hernia

Question 9

Which hernia is most likely to present with obstruction?

Answer 9

Femoral hernia due to strangulation

Question 10

Valvulae vs haustra

Answer 10

Valvulae - go all the way across the diameter of the bowel, present in small bowel

Haustra - along the peripheries of the large bowel

Question 11

What is the rule for identifying parts of the abdo X-ray?

Answer 11

3 - small bowel less than 3cm
6 - large bowel less than 6cm
9 - caecum less than 9cm

Question 12

Alcohol history with upper abdo pain and vomiting

Answer 12

Acute pancreatitis

Note: could also be acute cholecystitis, though commonly RUQ
Could also be upper GI bleed but requires haematemesis

Question 13

Alcohol history with upper abdo pain and vomiting and malena

Answer 13

GI bleed

Question 14

How would acute cholecystitis present?

Answer 14

Inflammation of the gall bladder, therefore the pain will be CONSTANT in RUQ with fevers

Question 15

How would someone present with acute cholangitis?

Answer 15

Fever/rigoros
RUQ pain
Jaundice

= Charcot’s triad

Question 16

Cholangitis va cholecystitis

Answer 16

Cholangitis - inflammation of common bile duct

Cholecystitis - inflammation of gall bladder

Question 17

Initial management of cholecystitis / cholangitis

Answer 17

Treat the sepsis ! Sepsis 6

Question 18

Severe left sided loin pain on a background of non adherence to antihypertensives - what must you exclude?

Answer 18

Abdominal aortic aneurysm

Question 19

Pyelonephritis symptoms

Answer 19

Fever
Dysuria
Constant loin pain

Question 20

Most common cause of pyelonephritis in the elderly

Answer 20

E. coli

Question 21

Hey things to rule out with epigastric pain

Answer 21

Peptic ulcer perforation
STEMI
Lower lobe pneumonia

Question 22

What is ogilvie’s syndrome?

Answer 22

Pseudo bowel dilation without an actual cause

Question 23

Two most common causes of large bowel obstruction

Answer 23

Bowel cancer

Diverticular disease

Question 24

Diverticulitis- where is the pain

Answer 24

General, then localises to left iliac fossa due to being in sigmoid or rectum ?

Question 25

Where is the pain in cystitis?

Answer 25

Bladder / suprapubic

Question 26

Renal colic pain

Answer 26

Loin to groin

Question 27

AAA where is the pain

Answer 27

Central abdominal OR loin