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#Phase 2.1: Peri Op > Acute Abdomen > Flashcards

Acute Abdomen Flashcards

1
Q

What is the definition of Acute Abdomen?

A

Sudden onset of severe abdominal pain

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2
Q

What are the Acute Abdomen syndromes that require laparotomy? (2 things)

A
  1. Organ rupture
  2. Peritonitis
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3
Q

What are the Acute Abdomen syndromes that DO NOT require laparotomy? (2 things)

A
  1. Local peritonitis
  2. Colic
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4
Q

What are the organs that rupture in Acute Abdomen that will require laparotomy? (3 things)

A
  1. Spleen
  2. Aorta
  3. Ectopic pregnancy
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5
Q

What is the leading signs of organ rupture in Acute Abdomen? (2 things)

A
  1. Hypovol Shock (Main) (present with tachycardia, hypotension, pale)
  2. Abdominal swelling (sometimes)
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6
Q

What are the causes of Peritonitis?

A

Perforation of

  1. Peptic ulcer / duodenal ulcer
  2. Diverticulum
  3. Appendix
  4. Bowel
  5. Gall bladder
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7
Q

What are the signs of Peritonitis? (5 things)

A
  1. Rigidity (invol persistent tensing of abd wall muscles)
  2. Guarding (invol tensing of abd wall musc @ palpation)
  3. Percussion tenderness
  4. Rebound tenderness (rapid releasing pressure of abd –> worse pain)
  5. +ve Cough test (cough = abd pain)
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8
Q

What may a CXR of Peritonitis show?

A

Gas under diaphragm

(aka Pneumoperitonuem)

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9
Q

How do you differentiate between Peritonitis and Acute Pancreatitis?

A

Both show same signs
BUT
Acute Pancreatitis DOES NOT require laparotomy
+ Serum Amylase in Pancreatitis will be HIGH

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10
Q

What are the causes of Local Peritonitis? (4 things)

A
  1. Diverticulitis
  2. Cholecystitis
  3. Salpingitis (fallopian tube inflamm)
  4. Appendicitis (WILL NEED SURGERY)
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11
Q

When should a CT / US be done for Local Peritonitis?

A

When abscess formation suspected (swelling / swinging fever and high WBC)

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12
Q

What is a swinging fever?

A

Fever every few hours

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13
Q

How do you drain the abscess from Local Peritonitis?

A
  1. Percutaneous drainage (US / CT guided)
  2. Laparotomy
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14
Q

What can Peritonitis cause in the bowel?

A

Ileus (loss of peristalsis in bowel aka bowel asleep)

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15
Q

What is Colic?

A

Pain that comes and goes

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16
Q

What is colic pain caused by?

A

Muscular spasm in a hollow viscus (gut / ureter / salpinx / uterus / bile duct / gall bladder)

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17
Q

What is the pain like in gall bladder colic?

A

Dull and constant

18
Q

How does colic present different to peritonitis in patients?

A

Colic causes restlessness –> patient can be pacing around

19
Q

How do you differentiate a diagnosis for Acute Abdomen?

A

Divide abdomen into 4 quadrants

20
Q

What are the differentials of Acute Abdomen in the RUQ? (5 things)

A
  1. Cholecystitis
  2. Hepatitis
  3. Pyelonephritis
  4. Ureteric colic
  5. Pneumonia
21
Q

What are the differentials of Acute Abdomen in the LUQ? (4 things)

A
  1. Gastric Ulcer
  2. Pyelonephritis
  3. Ureteric colic
  4. Pneumonia
22
Q

What are the differentials of Acute Abdomen in the RLQ? (7 things)

A
  1. Ureteric colic
  2. Appendicitis
  3. IBD
  4. Inguinal hernia
  5. UTI
  6. Gynaecological
  7. Testicular torsion
23
Q

What are the differentials of Acute Abdomen in the LLQ? (7 things)

A
  1. Ureteric colic
  2. Diverticulitis
  3. IBD
  4. Inguinal hernia
  5. UTI
  6. Gynaecological
  7. Testicular torsion
24
Q

What are the LAB investigations for Acute Abdomen? (4 things)

A
  1. Urine dipstick
  2. ABG
  3. Bloods
  4. Blood cultures
25
Q

Why is urine dipstick done for Acute Abdomen?

A

For signs of infection / haematuria

26
Q

Why is ABG done for Acute Abdomen?

A

Useful for bleeding / septic patients

Check pH, pO2, pCO2, lactate for tissue hypoperfusion signs + rapid Hb level

27
Q

What routine bloods should be done for Acute Abdomen? (6 things)

A
  1. FBC
  2. U&Es
  3. LFTs
  4. CRP
  5. Amylase
  6. Group & save (G&S) if patient likely to need surgery soon
28
Q

Why is Blood culture done for Acute Abdomen?

A

If infection is considered as potential diagnosis

29
Q

What is the amylase level diagnostic of Pancreatitis?

A

3x greater than the upper limit

Raised level but below 3x could be:
Perforated bowel
Ectopic pregnancy
DKA

30
Q

What imaging should be done for Acute Abdomen? (3 things)

A
  1. CXR
  2. US
  3. CT
31
Q

Why should a CXR be done for Acute Abdomen? (2 things)

A

To check for:

  1. Abdominal air (pneumoperitonuem aka air under diaphram = Peritonitis)
  2. Lower lobe lung pathology (consolidation = Pneumonia)
32
Q

Why should a US of kidneys, ureters, and bladder (‘KUB’) be done for Acute Abdomen? (2 things)

A

To check for:

  1. Hydronephrosis (kidney swelling)
  2. Cortico-medullary differentiation (= nephropathy)
33
Q

Why should a US of Biliary tree and liver be done for Acute Abdomen? (3 things)

A

To check for:

  1. Gallstones
  2. Gallbladder thickening
  3. Duct dilatation
34
Q

Why should a Transvaginal US be done for Acute Abdomen? (1 thing)

A

To check for:
1. Suspected tubo-ovarian pathology

35
Q

In an emergency setting, what scan should a patient with Acute Abdomen also have?

A

ECG to exclude cardiac pathology as referred pain

36
Q

What is the initial management for Acute Abdomen regardless of the cause?

A
  1. IV fluids
  2. Nil-by-mouth (NBM)
  3. Analgesia
  4. Antiemitics
  5. Initial imaging
  6. VTE prophylaxis
  7. Urine dip
  8. Bloods
  9. NG tube / catheter if necessary
37
Q

What is the main cause of medical (non surgical) Acute Abdomen?

A

Irritable Bowel Syndrome (IBS)

38
Q

What should you ask about to diagnose a patient with IBS? (4 things)

A
  1. Loose stools
  2. Bloating
  3. Urgency
  4. Pain relieved by defecation
39
Q

What does air in the abdomen seen in a CXR indicate?

A
  1. Bowel perforation
  2. Gas-forming infection (C. perfringens)
  3. Iatrogenic (laproscopic surgery, air detectable in CXR for upto 10 days)
  4. Per vaginam (sexual activity)
40
Q

What test is vital to rule out ectopic pregnancy in Acute Abdomen?

A

Urine + serum hCG

#Phase 2.1: Peri Op (24 decks)

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