Acute Abdomen

Question 1

What is an acute abdomen?

1 - chronic pain in the abdomen
2 - acute onset of severe painful abdomen
3 - GIT blockage
4 - GIT cancer

Answer 1

2 - acute onset of severe painful abdomen

Question 2

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

Answer 2

3 - lack of bowel movements

Question 3

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

Answer 3

3 - resuscitate with fluids and given analgesia

Question 4

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

Answer 4

• White = metallic objects
• Off white = calcified structures
• Medium shades of grey = most soft tissues
• Dark grey = fat
• Black = air

Question 5

In a patient with an acute abdomen, do we need an X-ray of the chest?

Answer 5

• yes need to look for:
• hiatus hernia
• heart size
• lung fields
• pneumothorax
• diaphragms: relative height; gas under
• bony changes
• central venous pressure line position

Question 6

What is a stricture in the GIT?

1 - area of dilation
2 - area of narrowing
3 - area containing a mass
4 - blocked area

Answer 6

2 - area of narrowing

Question 7

Is the most acute presentation of the acute abdomen in the upper or lower GI?

Answer 7

• upper
• specifically a small bowel obstruction

Question 8

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

Answer 8

1 - vomiting

Question 9

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

Answer 9

3 - absolute constipation (flatus or faeces)

Question 10

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?

Answer 10

• strangulation
• lack of blood supply to part of the GIT

Question 11

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

Answer 11

2 - due to vomiting and low fluid intake

Question 12

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

Answer 12

4 - Blood in faeces

Question 13

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

Answer 13

1 - gastric outlet obstruction

Question 14

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

Answer 14

2 - upper small bowel obstruction

Question 15

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

Answer 15

3 - distal obstruction

Question 16

Pain due to an obstruction in an acute abdomen is often colicky in pain and in short bouts. Why does it occur in small bouts?

1 - new neurotransmitters need to be synthesised
2 - peristaltic contractions try to overcome blockage
3 - nervous system cuts off continuous pain

Answer 16

2 - peristaltic contractions try to overcome blockage

Question 17

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

Answer 17

1 - caecum walls distend and eventually rupture

• large capacity of the large intestines is the reason why obstruction here is insidious in nature

Question 18

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

Answer 18

2 - contents do not reach the colon or delay and cause small bowel distension

Question 19

What is incomplete bowel obstruction?

Answer 19

• partial blockage
• causes non distinct clinical features
• slowly growing colonic cancer is most common cause

Question 20

Which of the following is NOT a common sign of a physical sign of intestinal bowel obstruction?

1 - vomiting (low fluid intake and retained fluid in proximal to blockage)
2 - gas filled loops causing distension
3 - anaemia
4 - blood in stool
5 - lymphadenopathy

Answer 20

4 - blood in stool

Question 21

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

Answer 21

1 - look for hernias

• if caused by femoral hernia, it will not respond to obstruction treatment

Question 22

During an examination we percuss the abdomen. Why is the peripheries more dull than the centre?

Answer 22

• gas rises to the sides of the abdomen

Question 23

What is the most effective radiological investigation of a suspected bowel obstruction?

1 - chest X-ray
2 - plain supine abdominal x-ray
3 - standing abdominal X-ray
4 - supine CT scan

Answer 23

2 - plain supine abdominal x-ray

Question 24

If there is a large bowel obstruction, the large bowel due to its large capacity is able to dilate significantly. At what size dilation must immediate surgery be performed?

1 - 1cm
2 - 5cm
3 - >10cm
4 - >20cm

Answer 24

3 - >10cm

• imminent danger of rupture and an operation is needed urgently

Question 25

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

Answer 25

4 - intestines has twisted on-itself and the mesentery that supplies

Question 26

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

Answer 26

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

Question 27

A pseudo-bowel obstruction can cause an acute abdomen. Which of the following is NOT a common cause of a pseudo-bowel obstruction? 1 - neurological deficit 2 - retroperineal inflammation 3 - medication 4 - undigested food 5 - pregnancy

Answer 27

4 - undigested food

Question 28

Two thirds of uncomplicated causes of bowel obstruction are caused by what? 1 - adhesions 2 - cancer 3 - fistulas 4 - volvulus

Answer 28

1 - adhesions - usually resolve with conservative measures used for a maximum of 4 days

Question 29

If a bowel obstruction has been confirmed in a patient, what are the first 2 key principles of management? 1 - IV fluids and NG tube 2 - IV fluids and enema 3 - NG tube and enema 4 - colonoscopy and IV fluids

Answer 29

1 - IV fluids and NG tube - IV fluids for resuscitation - NG tube to aspirate gastric contents

Question 30

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

Answer 30

4 - tumour