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Clinical > Acute Abdomen > Flashcards

Acute Abdomen Flashcards

1
Q

Definition of acute abdomen?

A

Severe abdominal pain, lasting less than 10 days, usually requiring emergency surgery; it is caused by acute disease of/injury to the internal organs

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2
Q

4 common causes of RUQ (hypochondrium) pain?

A

Gall bladder - biliary colic, cholecystitis, cholangitis
Basal pneumonia
Musculoskeletal
Liver abscess/hepatitis

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3
Q

Presentation of gallstones?

A

Most common cause of RUQ pain and their presentation is with complications

Usually, they have a temperature and jaundice

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4
Q 
How does biliary colic pain present:
Site
Radiation
Duration of pain
Temperature
Jaundice?
A

Pain in the RUQ with radiation to the right shoulder blade; the pain is intermittent
There is no assoc. jaundice or temperature

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5
Q 
How does cholecystitis pain present:
Site
Radiation
Duration of pain
Temperature
Jaundice?
A

Pain in the RUQ with radiation to the right shoulder blade; the pain is constant

There is an assoc. temperature but no jaundice

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6
Q 
How does choledocholithiasis pain present:
Site
Radiation
Duration of pain
Temperature
Jaundice?
A

Presence of gallstones in the common bile duct presents with pain in the RUQ and no radiation; the pain is constant

There is no assoc. temperature but there is JAUNDICE

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7
Q 
How does cholangitis pain present:
Site
Radiation
Duration of pain
Temperature
Jaundice?
A

RUQ pain with no radiation; the pain is constant

There are assoc. symptoms of both a TEMPERATURE AND JAUNDICE

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8
Q 
How does pancreatitis pain present:
Site
Radiation
Duration of pain
Temperature
Jaundice?
A

Epigastric pain with radiation to the back; the pain is constant

There CAN BE assoc. symptoms of a TEMPERATURE AND JAUNDICE

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9
Q

5 common causes of pain in the epigastrium?

A 
Pancreatitis
Perforated duodenal ulcer
AAA
Gastritis/reflux
Oesophagitis
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10
Q

History and examination of tenderness with pancreatitis pain?

A

Usually, there is a Hx of alcohol intake; there may have been occult injury to the pancreas, e.g: with trauma

These people are often very sore and “peritonitic” (lie still)

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11
Q

Ix for pancreatitis?

A

Amylase (>3 times the upper limit of normal is usually diagnostic)
Scoring
Ultrasound
CT scan (to look for peri-pancreatic fluid, etc)

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12
Q

History and examination of tenderness with a perforated duodenal ulcer?

A

Often assoc. with excess alcohol intake and NSAID use; the epigastric pain is sudden onset

Examination reveals peritonitic pain and a rigid abdomen

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13
Q

Ix for a perforated duodenal ulcer?

A

Erect CXR to look for free air under the diaphragm

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14
Q

History and examination of AAA?

A

Sudden onset epigastric pain which RADIATES TO THE BACK (mimics pancreatitis); there is usually a Hx of collapse and shock (low BP, tachycardia, etc)

Sometimes, there is a palpable tender aneurysm (usually felt in thin people)

Usually occurs in elderly males, with a cardiac history

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15
Q

Ix for AAA?

A

CT angiogram

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16
Q

History of gastritis/GORD/oesophagitis?

A

A tender epigastrium and there is usually a history of alcohol or reflux disease

17
Q

Ix for gastritis/GORD/oesophagitis?

A

Oesophago-gastro-duodenoscopy (OGD)

18
Q

3 common causes of LUQ pain?

A

Splenic (with injury, rupture or infarct)
Basal pneumonia
Musculoskeletal

19
Q

Presentation of spleen injury, rupture, infarct, etc?

A

Normally, have a Hx of trauma or splenomegaly; most will present with shock

20
Q

3 common causes of right AND left flank pain?

A

Pyelonephritis
Renal colic (this can sometimes lead to pyelonephritis)
Musculoskeletal

21
Q

What is renal colic? Hx and examination findings?

A

Pain is in the flank and often radiates to the back (sometimes, mimics an AAA); these people are unable to get comfortable (move around a lot)

Assoc. symptoms are temperature and, sometimes, renal angle tenderness

22
Q

Ix for pyelonephritis?

A

Urinalysis is +ve
Blood, nitrates, leukocytes
CTKUB (CT of kidney, ureter and bladder)

23
Q

4 common causes of umbilical pain?

A

Obstruction
Early appendicitis
AAA
Meckel’s diverticulum (can also present in the LIF)

24
Q

Hx and examination of obstruction?

A

Pain tends to be very general; assoc. symptoms of a distended abdomen, vomiting and constipation

25
Q

Common causes of bowel obstruction?

A

Hernia
Tumour (often, in the caecum)
Previous surgery (adhesions)

26
Q

4 common causes of suprapubic pain?

A

UTIs
Ovarian
Appendicitis with a long appendix
Diverticulitis

27
Q

5 common causes of LIF pain?

A 
Diverticulitis 
Ectopic pregnancy
Torsion of an ovarian cyst
Hernia 
Gastroenteritis
28
Q

Hx and examination of diverticulitis?

A

There is usually tenderness and guarding assoc. with a temperature; they may be peritonitic

These people tend to be older

Diverticular perforation can occur (life-threatening)

29
Q

Hx and examination of ectopic pregnancy?

A

Life-threatening; consider in all women who are child-bearing age and do a pregnancy test

Often present with sepsis and shock

30
Q

Ix for ectopic pregnancy?

A

BHCG (beta-HCG) test - not diagnostic

31
Q

Hx and examination of torsion of an ovarian cyst?

A

Occurs in woman, who are often mid-cycle, and presents with sudden onset pelvic pain (may be located further to one side)

32
Q

Hx and examination of hernias?

A

Check for a mass and cough impulse (direct or indirect); they can be inguinal, femoral or incisional (check scares)

There are 2 complications of hernias:
Irreducible
Strangulated - life-threatening

33
Q

8 common causes of RIF pain?

A 
Appendicitis (tip can vary in location)
Ectopic pregnancy
Torsion of an ovarian cyst
Hernia
Diverticulitis
Crohn's disease (often affect the terminal ileum)
Meckel's diverticulum
Perforated caecal cancer
34
Q

Hx, examination and Ix of a perforated caecal cancer?

A

Consider age and assoc. symptoms of altered bowel habit, PR blood, weight loss, etc; Ix is CT scan

Clinical (54 decks)

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