Acute Abdomen Flashcards
What is an acute abdomen?
1 - chronic pain in the abdomen
2 - acute onset of severe painful abdomen
3 - GIT blockage
4 - GIT cancer
2 - acute onset of severe painful abdomen
Gastrointestinal haemorrhage is also a common reason for acute surgical referral. Which of the following are NOT manifestations of Gastrointestinal haemorrhage?
1 - vomiting of blood (haematemesis)
2 - profuse rectal bleeding
3 - lack of bowel movements
4 - passage of melaena
3 - lack of bowel movements
When a patient presents with an acute abdomen, which is often the first goal?
1 - diagnose the patient
2 - come up with a list of differentials
3 - resuscitate with fluids and given analgesia
4 - run laboratory tests
3 - resuscitate with fluids and given analgesia
When examining radiography, match the colours with what they are associated with:
- fat
- gas
- metallic objects
- calcified structures
- most soft tissues
- White—
- Off white—
- Medium shades of grey
- Dark grey
- Black
- White = metallic objects
- Off white = calcified structures
- Medium shades of grey = most soft tissues
- Dark grey = fat
- Black = air
In a patient with an acute abdomen, do we need an X-ray of the chest?
- yes need to look for:
- hiatus hernia
- heart size
- lung fields
- pneumothorax
- diaphragms: relative height; gas under
- bony changes
- central venous pressure line position
What is a stricture in the GIT?
1 - area of dilation
2 - area of narrowing
3 - area containing a mass
4 - blocked area
2 - area of narrowing
Is the most acute presentation of the acute abdomen in the upper or lower GI?
- upper
- specifically a small bowel obstruction
The most acute presentation is upper small bowel obstruction, manifesting within hours of onset. This is caused by large volume of gastric and pancreaticobiliary secretions is prevented from progressing, and thus regurgitates into the stomach. What can this cause?
1 - vomiting
2 - gastric distension
3 - oesophageal obstruction
4 - pancreatitis
1 - vomiting
A bowel obstruction or strangulation is one of the clinical features that presents as an acute abdomen. How will a complete obstruction present?
1 - partial faecal incontinence
2 - diarrhoea
3 - absolute constipation (flatus or faeces)
4 - blood in urine
3 - absolute constipation (flatus or faeces)
Abdominal pain—usually colicky in character is one of the clinical features that presents as an acute abdomen. Is this more severe in strangulation or mild obstruction?
- strangulation
- lack of blood supply to part of the GIT
A bowel obstruction or strangulation is one of the clinical features that presents as an acute abdomen. Why can dehydration be one of the physical signs?
1 - abnormal bowel sounds
2 - due to vomiting and low fluid intake
3 - distension of bowels that fill with gas
4 - increased peristalsis
2 - due to vomiting and low fluid intake
A bowel obstruction or strangulation is one of the clinical features that presents as an acute abdomen. Which of the following is NOT a physical sign of a bowel obstruction?
1 - Dehydration
2 - Abdominal distension
3 - Visible peristalsis
4 - Blood in faeces
5 - Abdominal tenderness
6 - Central resonance
7 - Abnormal bowel sounds
4 - Blood in faeces
The characteristics of vomiting can tell you a lot about where the obstruction in the bowels are. If a patient is vomiting semi-digested food, where is the obstruction likely to be?
1 - gastric outlet obstruction
2 - upper small bowel obstruction
3 - distal obstruction
4 - oesophageal obstruction
1 - gastric outlet obstruction
The characteristics of vomiting can tell you a lot about where the obstruction in the bowels are. If a patient is vomiting a bile stained fluid, where is the obstruction likely to be?
1 - gastric outlet obstruction
2 - upper small bowel obstruction
3 - distal obstruction
4 - oesophageal obstruction
2 - upper small bowel obstruction
The characteristics of vomiting can tell you a lot about where the obstruction in the bowels are. If a patient is vomiting a thick foul smelling liquid, where is the obstruction likely to be?
1 - gastric outlet obstruction
2 - upper small bowel obstruction
3 - distal obstruction
4 - oesophageal obstruction
3 - distal obstruction
The ileocecal valve is a sphincter muscle situated at the junction of the ileum (last portion of your small intestine) and the colon. If the valve remains competent, what can happen to the large intestines?
1 - caecum walls distend and eventually rupture
2 - colon triggers valve to close when full
3 - triggers an appendicitis
4 - lower bowels distend with no symptoms
1 - caecum walls distend and eventually rupture
- large capacity of the large intestines is the reason why obstruction here is insidious in nature
The ileocecal valve is a sphincter muscle situated at the junction of the ileum (last portion of your small intestine) and the colon. If the ileocaecal valve becomes incompetent what can then happen?
1 - caecum walls distend and eventually rupture
2 - contents do not reach the colon or delay and cause small bowel distension
3 - triggers an appendicitis
4 - lower bowels distend with no symptoms
2 - contents do not reach the colon or delay and cause small bowel distension
What is incomplete bowel obstruction?
- partial blockage
- causes non distinct clinical features
- slowly growing colonic cancer is most common cause
In a patient with bowel obstruction, why must we examine the groin?
1 - look for hernias
2 - look for scrotum enlargement
3 - look for rectal cancer
4 - look for incontenance
1 - look for hernias
- if caused by femoral hernia, it will not respond to obstruction treatment
A bowel obstruction presenting as an acute abdomen may be due to a volvulus. What is this?
1 - bowel is perforated
2 - bowel is completely blocked
3 - valves in bowel are non competent
4 - intestines has twisted on-itself and the mesentery that supplies
4 - intestines has twisted on-itself and the mesentery that supplies
When investigating a suspected obstruction that would present as an acute abdomen, we can use a contrast enema. What is a contrast enema?
1 - detailed CT scan
2 - MRI using water-soluble contrast agent containing iodine or barium
3 - colonoscopy with dye inserted
4 - x-ray using water-soluble contrast agent containing iodine or barium
4 - x-ray using water-soluble contrast agent containing iodine or barium
- effective for showing the structure of the rectum, colon, and large intestine. Contrast enemas are commonly referred to as barium enemas
Which of the following is NOT a cause of bowel strangulation?
1 - external hernia
2 - volvulus
3 - bowel wall is trapped in abdominal cavity
4 - tumour
4 - tumour
