Acute Abdomen

Question 1

Peptic ulcer def

Answer 1

defined as mucosal erosions equal to or greater than 0.5 cm •4x as many in duodenum then stomach

Question 2

•Modified Johnson Classification of peptic ulcers mention (V)

Answer 2

Type I: Ulcer along the body of the stomach, most often along the lesser curve at incisura angularis along the locus minoris resistantiae

Type II: Ulcer in the body in combination with duodenal ulcers. Associated with acid oversecretion

Type III: In the pyloric channel within 3 cm of pylorus. Associated with acid oversecretion.

Type IV: Proximal gastroesophageal ulcer

Type V: Can occur throughout the stomach. Associated with chronic NSAID use (such as aspirin).

Question 3

Complications of peptic ulcer(3)

Answer 3

1.Bleeding = most common 
2• Perforation
 = anterior = peritonitis 
posterior = bleeding (GD artery) 
3• Gastric outlet obstruction = severe vomitting without bile

Question 4

Bowel volvulus types(8)

Answer 4

• volvulus neonatorum
• volvulus of the small intestine
• volvulus of the caecum
• sigmoid colon volvulus
• volvulus of the transverse colon
• volvulus of the splenic flexure, the rarest
• gastric volvulus
• ileosigmoid knotting

Question 5

congenital intestinal malrotation predispose to
abnormal intestinal contents or adhesions predispose to
(Minor)redundant (excess, inadequately supported) intestinal tissue and constipation predispose to

Answer 5

• Midgut volvulus
• Segmental volvulus
• Volvulus of the cecum, transverse colon, or sigmoid colon

Question 6

Diagnosis of Bowel volvulus

Answer 6

•Diagnozed by clinical and imaging

Question 7

Intussusception

Answer 7

Intussusception occurs when a segment of bowel telescopes into a segment just distal to it.

Question 8

the most common cause of intestinal (bowel) obstruction (blockage) between

Answer 8

3 months and 6 years of age.

Question 9

the most common Intussusception

Answer 9

Ileocolic

Question 10

C/F of Intussusception(6)

Answer 10

1. severe colicky abdominal pain (sudden attacks)
2. pain increases as time passes
3. The wall of bowel may become gangrenous and may perforate (with constant severe pain)
4. may pass bloody mucus through the rectum
5. tender distended abdomen often with a mass 6.abdomen that represents the intussusception

Question 11

•X-ray may show the intussusception as

Answer 11

an increase in density of the telescoped bowel

Question 12

•Barium enema will show

Answer 12

the tip of the obstructed intussusception

Question 13

Intussusception treatment(2)

Answer 13

Non-operative

reduction accomplished under fluoroscopy utilizing a thin barium mixture or air alone with careful pressure control of the enema technique. The recurrence rate with this technique is about 10%

operative reduction

carried out whenever non-operative reduction is unsuccessful or signs there are signs of peritoneal irritation

Question 14

Abdominal aortic aneurysm

Answer 14

•Localized dilatation of the abdominal aorta exceeding the normal diameter by more than 50 percent

Question 15

•Complications of Abdominal aortic aneurysm(5)

Answer 15

Ø Rupture
 Ø peripheral embolization 
Ø acute aortic occlusion 
Ø Aortocaval fistulae
 Ø Aortoduodenal fistulae

Question 16

Ruptured spleen (cause , diagnosis , treatment)

Answer 16

by trauma lead to shock
Diagnosed by US showing free fluid
Surgical resection according to injury scale III to IV

Question 17

Ruptured spleen (Injury scale)(4)

Answer 17

Grade I - Hematoma: subcapsular, <10 percent of surface area. Laceration: capsular tear <1 cm in depth into the parenchyma.

Grade II -
Hematoma: subcapsular, 10 to 50 percent of surface area. Laceration: capsular tear, 1 to 3 cm in depth, but not involving a trabecular vessel.

Grade III -
Hematoma: subcapsular, >50 percent of surface area OR expanding, ruptured subcapsular or parenchymal hematoma OR intraparenchymal hematoma >5 cm or expanding. Laceration: >3 cm in depth or involving a trabecular vessel.

Grade IV -
Laceration involving segmental or hilar vessels with major devascularization (ie, >25 percent of spleen). Grade V - Hematoma: shattered spleen. Laceration: hilar vascular injury which devascularizes spleen

Question 18

Acute intestinal ischemia Causes(3)

Answer 18

1. thromboembolism from the left side of the heart
2. Nonocclusive ischemia, such as that seen in hypotension secondary to heart failure
3. Primary mesenteric vein thromboses

Question 19

C/F of Acute intestinal ischemia(6)

Answer 19

1. diffuse abdominal pain
2. bowel distention
3. bloody diarrhea
4. bowel sounds will be absent. (on examination)
5. neutrophilic leukocytosis and increased serum amylase.(in lab test)
6. Abdominal radiography will show many air-fluid levels, as well as widespread edema.

Question 20

Acute intestinal ischemia treatment

Answer 20

Treatment involves removal of the region of the bowel that has undergone infarction, and subsequent anastomosis of the remaining healthy tissue.

Question 21

Testicular torsion(def, cause , diagnosis)

Answer 21

• Testicular torsion occurs when the spermatic cord twists
• Most common underlying cause is a congenital malformation known as a “bell-clapper deformity

•Diagnosis can be made clinically but an urgent ultrasound is helpful in evaluation

Question 22

Acute pancreatitis

Answer 22

Severe upper abdominal burning pain radiating to the back, nausea, and vomiting that is worsened with eating

Question 23

Acute pancreatitis APACHE, Glasgow,Ranson PANCREAS

Answer 23

P  02 Oxygen < 60mmHg or 7.9kPa • 
A  ge > 55 • 
N  eutrophilia White blood cells > 15 •
C  alcium < 2 mmol/L • 
R  enal Urea > 16 mmol/L • 
E nzymes Lactate dehydrogenase (LDH) >600iu   Aspartate transaminase (AST) > 200iu L 
A  lbumin < 32g/L • 
S  ugar Glucose > 10 mmol/L

Question 23

Acute pancreatitis APACHE, Glasgow,Ranson PANCREAS

Answer 23

P  02 Oxygen < 60mmHg or 7.9kPa • 
A  ge > 55 • 
N  eutrophilia White blood cells > 15 •
C  alcium < 2 mmol/L • 
R  enal Urea > 16 mmol/L • 
E nzymes Lactate dehydrogenase (LDH) >600iu   Aspartate transaminase (AST) > 200iu L 
A  lbumin < 32g/L • 
S  ugar Glucose > 10 mmol/L

Question 24

Acute cholecystitis

Answer 24

Presents as a pain in the right upper quadrant or epigastric region internittent but becomes constant

Question 25

Acute peritonitis

Answer 25

Inflammation of the peritoneum
Chemical or bacterial
on physical examination as rebound tenderness
Most specific physical finding is rigidity.