Acute Abdomen Flashcards
Peptic ulcer def
defined as mucosal erosions equal to or greater than 0.5 cm •4x as many in duodenum then stomach
•Modified Johnson Classification of peptic ulcers mention (V)
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).
Complications of peptic ulcer(3)
1.Bleeding = most common 2• Perforation = anterior = peritonitis posterior = bleeding (GD artery) 3• Gastric outlet obstruction = severe vomitting without bile
Bowel volvulus types(8)
- 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
congenital intestinal malrotation predispose to
abnormal intestinal contents or adhesions predispose to
(Minor)redundant (excess, inadequately supported) intestinal tissue and constipation predispose to
- Midgut volvulus
- Segmental volvulus
- Volvulus of the cecum, transverse colon, or sigmoid colon
Diagnosis of Bowel volvulus
•Diagnozed by clinical and imaging
Intussusception
Intussusception occurs when a segment of bowel telescopes into a segment just distal to it.
the most common cause of intestinal (bowel) obstruction (blockage) between
3 months and 6 years of age.
the most common Intussusception
Ileocolic
C/F of Intussusception(6)
- severe colicky abdominal pain (sudden attacks)
- pain increases as time passes
- The wall of bowel may become gangrenous and may perforate (with constant severe pain)
- may pass bloody mucus through the rectum
- tender distended abdomen often with a mass 6.abdomen that represents the intussusception
•X-ray may show the intussusception as
an increase in density of the telescoped bowel
•Barium enema will show
the tip of the obstructed intussusception
Intussusception treatment(2)
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
Abdominal aortic aneurysm
•Localized dilatation of the abdominal aorta exceeding the normal diameter by more than 50 percent
•Complications of Abdominal aortic aneurysm(5)
Ø Rupture Ø peripheral embolization Ø acute aortic occlusion Ø Aortocaval fistulae Ø Aortoduodenal fistulae
Ruptured spleen (cause , diagnosis , treatment)
by trauma lead to shock
Diagnosed by US showing free fluid
Surgical resection according to injury scale III to IV
Ruptured spleen (Injury scale)(4)
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
Acute intestinal ischemia Causes(3)
- thromboembolism from the left side of the heart
- Nonocclusive ischemia, such as that seen in hypotension secondary to heart failure
- Primary mesenteric vein thromboses
C/F of Acute intestinal ischemia(6)
- diffuse abdominal pain
- bowel distention
- bloody diarrhea
- bowel sounds will be absent. (on examination)
- neutrophilic leukocytosis and increased serum amylase.(in lab test)
- Abdominal radiography will show many air-fluid levels, as well as widespread edema.
Acute intestinal ischemia treatment
Treatment involves removal of the region of the bowel that has undergone infarction, and subsequent anastomosis of the remaining healthy tissue.
Testicular torsion(def, cause , diagnosis)
- 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
Acute pancreatitis
Severe upper abdominal burning pain radiating to the back, nausea, and vomiting that is worsened with eating
Acute pancreatitis APACHE, Glasgow,Ranson PANCREAS
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
Acute pancreatitis APACHE, Glasgow,Ranson PANCREAS
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
