Acute Abdomen 2 Flashcards
Common diagnoses
Acute cholecystitis Perforated peptic ulcer Appendicitis Diverticulitis Pancreatitis Bowel obstruction Ischemia
Causes of bowel obstruction (small)
Adhesion Hernia Tumor Stricture (crohns) Luminal (food/gallstone)
Obstruction in the lumen
Tumor
Food bolus
Gallstone
Obstruction in the wall
Crohns stricture
TB
Obstruction outside the wall
Adhesion
Hernia
Signs of vomiting
Low K
Raised urea and creatinine
Adhesions
Fibrous tissue caused by previous surgery / inflammation
Treat adhesions
Drip and suck!!!
Nasogastric tube
IV fluid
Catheter
Surgery if strangulating or high WCC
Raised PR
Pain
Tenderness
Causes of bowel obstruction (large bowel)
Colorectal cancer
Diverticular stricture
Sigmoid volvulus
Causes within lumen (large)
Colorectal cancer
Causes within the wall (large
Diverticular stricture
Crohns stricture
Causes outside the wall (large)
Volvulus
How to investigate the gastric tract?
Gastrografin enema (contrast for X-ray)
Management for colorectal cancer, Diverticular disease and volvulus?
Colorectal - surgery (stent)
Diverticular - surgery
Volvulus - endoscopic decompression (surgery)
Surgery for each part of the colon?
Right/transverse colon - hemicolectomy
Left - hartmann’s procedure (stoma)
Subtotal colectomy and small bowel colonic anatomosis
Left hemicolectomy following bowel washout (on table lavage)
Sigmoid volvulus?
Twist of elongated sigmoid colon
Causing recurrent large bowel obstruction
Elderly frail
Sigmoid volvulus symptoms?
Abdominal distension
Painless, non-tender
Beware If pain - strangulation
Sigmoid volvulus management
Conservative - tube decompression via rigid sigmoidoscopy
- or flexible sigmoidoscopy and decompression
Surgery - if strangulating or recurrent
Pseudo obstruction
Seen in patients with other problems. E.g resp, renal, post orthopaedic surgery
No physical obstruction (ileus)
Pseudo obstructive management?
Exclude mechanical obstruction
Correct electrolytes
Decompress with colonoscopyrarely pro kinetic drugs e.g neostigmine
V rarely surgery if caecal Ischemia/perforation
Causes of Ischemia
Embolus (mi/af/valvular heart disease)
Thrombus
Mnomocclusive mesenteric Ischemia
Ischemia signs?
FBC - WCC raised
Amylase raised
Lactate raised
Arterial blood gases - metabolic acidosis, negative base excess
Thumb printing on colon wall
Lack of contrast in mesenteric vessels and bowel wall
Ischemia management
Resuscitation - fluid/oxygen/catheter
Mesenteric angiogram +/- anticoagulants)
Surgery - as soon as diagnosed, segment bowel resection, embolectomy
