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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
Why is urine dipstick done for Acute Abdomen?
For signs of infection / haematuria
26
Why is ABG done for Acute Abdomen?
Useful for bleeding / septic patients Check pH, pO2, pCO2, lactate for tissue hypoperfusion signs + rapid Hb level
27
What routine bloods should be done for Acute Abdomen? (6 things)
1. FBC 2. U&Es 3. LFTs 4. CRP 5. Amylase 6. Group & save (G&S) if patient likely to need surgery soon
28
Why is Blood culture done for Acute Abdomen?
If infection is considered as potential diagnosis
29
What is the amylase level diagnostic of Pancreatitis?
3x greater than the upper limit Raised level but below 3x could be: Perforated bowel Ectopic pregnancy DKA
30
What imaging should be done for Acute Abdomen? (3 things)
1. CXR 2. US 3. CT
31
Why should a CXR be done for Acute Abdomen? (2 things)
To check for: 1. Abdominal air (pneumoperitonuem aka air under diaphram = Peritonitis) 2. Lower lobe lung pathology (consolidation = Pneumonia)
32
Why should a US of kidneys, ureters, and bladder (‘KUB’) be done for Acute Abdomen? (2 things)
To check for: 1. Hydronephrosis (kidney swelling) 2. Cortico-medullary differentiation (= nephropathy)
33
Why should a US of Biliary tree and liver be done for Acute Abdomen? (3 things)
To check for: 1. Gallstones 2. Gallbladder thickening 3. Duct dilatation
34
Why should a Transvaginal US be done for Acute Abdomen? (1 thing)
To check for: 1. Suspected tubo-ovarian pathology
35
In an emergency setting, what scan should a patient with Acute Abdomen also have?
ECG to exclude cardiac pathology as referred pain
36
What is the initial management for Acute Abdomen regardless of the cause?
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
What is the main cause of medical (non surgical) Acute Abdomen?
Irritable Bowel Syndrome (IBS)
38
What should you ask about to diagnose a patient with IBS? (4 things)
1. Loose stools 2. Bloating 3. Urgency 4. Pain relieved by defecation
39
What does air in the abdomen seen in a CXR indicate?
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
What test is vital to rule out ectopic pregnancy in Acute Abdomen?
Urine + serum hCG

#Phase 2.1: Peri Op (24 decks)

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