Acute Abdomen

Question 1

Describe Rosvig’s sign?

Answer 1

Sign of appendicitis

Abdo palpation on the LLQ = tenderness on the RLQ

Question 2

What is Cullen’s sign?

Answer 2

Peri-umbilical bruising

Seen in acute pancreatitis/ectopic rupture/AAA rupture/aortic dissection

Question 3

What is Grey-Turner’s sign?

Answer 3

Loin and flank bruising
Poor prognosis
Same causes as Cullen’s

Question 4

Describe Murphy’s sign?

Answer 4

Cholecystitis - place a hand on the costal margin of the R hand side and ask the patient to take a deep breath in - if the patient catches then = (+ve)
Only positive if L side normal

Question 5

In a patient with suspected peritonititis - what two features would be seen O/E?

Answer 5

Tenderness with gaurding
Percussion tenderness
Testing for rebound tenderness is UNNECESSARY

Question 6

What clinical significance does the positioning behind a duodenal ulcer have?

Answer 6

In Post’ = can perforate into the grastroduodenal A and cause bleeding and peritonitis (non-infectious)
In Ant’ = can perforate into the peritoneum and cause peritonitis

Question 7

Describe diverticulosis?

Answer 7

Diverticulosis = out pouching within the colon- poor transit time and lack of fibre typically seen in older patients
Diverticulitis = inflammation and infection of the out pouches (particularly L) and leads to peritonitis. Associated with diarrhoea

Question 8

What size of obstuction in the large bowel before an increased risk of perforation?

Answer 8

> 80mm

Most commonly the ceacum (thinnest part)

Question 9

What are the four cardinal features of obstruction?

Answer 9

Pain
Constipation
Abdominal distension
Vomiting

Question 10

Where is a femoral hernia typically found and which groups of patients are at risk of developing them?

Answer 10

Below and lateral
Fat old women
Can cause small bowel obstruction

Question 11

Off ABX when would you diagnose a small bowel obstruction and a large bowel obstruction?

Answer 11

Diameter >3cm

Diameter >5cm (>8cm = increased risk of perforation)

Question 12

In a large bowel obstruction - if the small bowel is also dilated - what does this signify?

Answer 12

IN-competent iliocecal valve

if competent = increased risk of perforation

Question 13

Name seven features of ectopic pregnancy?

Answer 13

Shock
Abdominal pain
Vaginal bleeding (75%)
Amenorrhoea 
Referred pain (hip/shoulder/epi)
Tenderness on fornicies
Tenesmus