ACUTE ABDOMEN Flashcards
What are the differential diagnoses for right upper hypochondrium pain?
Cholecystitis Ascending Cholangitis Biliary Colic Hepatitis Duodenal ulcer Basal pneumonia Choledocholithiasis
What are the four main causes of hepatitis?
NASH
Alcohol
Viral
Toxins (eg Paracetamol)
What is the triad associated with ascending cholangitis?
Charcot:
Spiking fever
Rigors
Jaundice
What is biliary colic?
Biliary colic is the term used to describe a type of pain related to the gallbladder that occurs when a gallstone transiently obstructs the cystic duct and the gallbladder contracts.
How might you differentiate cholecystitis in an acute abdomen from something like ascending cholangitis or choledocholithiasis?
Murphy’s sign - get patient to breath out. Place hand under rib cage in mid-clavicular line and then get patient to breath in. A positive sign is if the patient ‘catches’ with pain as they breath out. A positive sign is associated with cholecystitis.
What is ascending cholangitis?
An infection of the bile duct (cholangitis), usually caused by bacteria ascending from its junction with the duodenum (first part of the small intestine). It tends to occur if the bile duct is already partially obstructed by gallstones.
What will blood tests in someone with ascending cholangitis show?
Raised ALP
Raised bilirubin
How is someone with ascending cholangitis treated?
Fluids
Broad spectrum antibiotics and those that can target gram negative bacteria - cephalosporins, metranidazole, aminoglycosides (gentamicin)
ERCP
Cholecystectomy
What is choledocholithiasis?
A gall stone anywhere between the exit of the gall bladder and the ampullae (the biliary tree).
What might precipitate biliary colic?
Eating fatty foods
How long does a classic bout of biliary colic last?
Can be 5-10 minutes but often lasts more than 30 mins.
Where does biliary colic pain radiate?
Radiates to the back and shoulder and across the epigastrium.
What is cholelithiasis?
Gallstones in the gall bladder
Is fever associated with biliary colic?
No.
What do blood tests in someone with biliary colic show?
Normal ranges for LFTs.
What is the treatment for biliary colic?
Often only symptomatic relief unless there is evidence of underlying liver damage.
What is cholecystitis?
Inflammation of the gallbladder most often caused by cholelithiasis.
What are the common symptoms of cholecystitis?
Persistent sharp pain Sudden onset Radiating to shoulder Worse on inspiration Fever Nausea/vomiting Loss of appetite
How is cholecystitis treated?
Broad spectrum antibiotics if infection is suspected
Fluid
Cholecystectomy to prevent recurrence and complications
What are the risk factors for cholecystitis and gallstones?
Female Old age Pregnancy Oral contraceptives Obesity Diabetes mellitus Ethnicity (Native North American) Rapid weight loss
What are the possible complications associated with cholecystitis?
Gangrene Gallbladder rupture Empyema Fistula formation Gallstone ileus Rokitansky-Aschoff sinuses Too much calcium in the gallbladder will increase the risk of cancer
What will blood tests of someone with cholecystitis show?
Raised CRP
Normal or very mildly raised bilirubin (if too high an additional or alternative diagnosis should be sought)
Raised WCC
Mildly abnormal liver tests
What investigations would you do in someone suspected of having cholecystitis?
Blood tests
Ultrasound
Other imaging includes: X-ray, MRI or CT
What are most gallstones made of?
Cholesterol
What are black gallstones?
Bile pigment
Which gallstones show up on x-ray?
Black gallstones
What are the differential diagnoses for right iliac fossa pain?
Ovaries: Ruptured ovarian cyst Ruptured ectopic pregnancy Torsion in ovary Polycystic ovary syndrome (PCOS) Retrograde menstruation (into peritoneum)
Intestine: Appendicitis Diverticular disease Crohns Hernia Meckel's diverticulum Terminal ileitis
Renal:
Pyelonephritis
Renal calculi
