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Acute abdomen Flashcards

1
Q

What is an acute abdomen?

A

Less than 10 days.
Progressive intra abdominal condition
Causing severe morbidity or threat to life

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2
Q

What are the common causes of an acute abdomen?

A 
NSAP (acute nonspecific abdominal pain)
Acute appendicitis
Intestinal obstruction.
Urological cause
Gallstones
Diverticular disease
Trauma
Malignancy
Perforated ulcer
Pancreatitis
IBS
Bacterial and viral infections 
Gynae things 
Odd things (back pain, Diabetic ketoacidosis
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3
Q

What are the rare causes of acute abdomen?

A

Ruptured AAA
IBD
Medical causes
Ischemic gut

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4
Q

Munchhausenen’s syndrome is a common cause of acute abdomen. WHat is this?

A

factitious disorder, a mental disorder in which a person repeatedly and deliberately acts as if he or she has a physical or mental illness when he or she is not really sick.
Drug seekers, manipulative, seem genuine.

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5
Q

What are the symptoms of acute abdomen?

A

Abdo pain (visceral, parietal, extra-abdominal)
Location
Radiation
Associated symptoms (Nausea and vomiting, burping, heart burn/indigestion, change in bowel habit, PR blood/mucus)

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6
Q

What do you want to ask about someone vomit?

A 
Colour
Green (Bile) or foodstuff?
Projectile?
Blood?
Coffee grounds(coagulated blood)?
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7
Q

What signs are you looking for on abdominal examination of acute abdomen?

A 
Pain
Localised puritanism
Generalised puritanism
Guarding
Rebound tenderness
Rosvig's sign (palpation of the left => pain on the right)
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8
Q

WHen are bowel sounds absent?

A

Ileus

Very obese

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9
Q

What auscletation sounds may be seen in bowel obstruction?

A

Tinkling bowel sounds

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10
Q

What is the initial management of acute abdomen?

A 
ABCDE
Observations
GIve oxygen
Fluids
Urinanalysis
Analgesia
Morphine/paracetamol IV with anti-emetic.
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11
Q

What is Cullen’s sign?

A

superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus.
Seen in acute severe pancreatitis and ectopic pregnancy.

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12
Q

What is Grey Turners sign?

A

bruising of the flanks, the part of the body between the last rib and the top of the hip.
Seen in pancreatitis, trauma and ruptured AAA

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13
Q

What is erythema ab igne?

A

skin reaction caused by chronic exposure to infrared radiation in the form of heat.

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14
Q

What are striae?

A

Stretch marks

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15
Q

What are the initial investigations for acute abdomen>

A 
Bloods (FBC, LFT, UE, CRP, Ca, Lactate, Coag)
Amylase!
AGs
Plain radiology (AXR and erect CXR)
Or CT
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16
Q

Why is a plain erect CXR important?

A 
Useful if abnormal 
Eclude pneumonia
Gas under diaphragm => rupture of bowel.
Preoperative investigation.
If too ill to stand consider lateral CXR
17
Q

When would you consider an AXR?

A

Obstruction, colitis and perforation.

Over used and lots of radiation

18
Q

What is the gold standard test for an acute abdomen?

A

CT

Early CT is associated with reduced mortality and decreased hospital stay.

19
Q

When is an USS most useful?

A

RUQ and RIF pain (liver and appendix)
Children
Women with pelvic pain (transvagianl USS)

20
Q

What is replacing contrast swallows/enemas?

A

CT scanning

21
Q

When would you use MRI?

A

Only really in pregnant appendicitis.

Takes too long for acute abdomen

22
Q

What are the life threatening conditions you must exclude with acute abdomen?

A

Acute pancreatits- amylase bloods

Symptomatic AAA- CT scan.

23
Q

What is the treatment for acute abdomen?

A

Related to cause.
Often surgery. Laparotomy vs Laparoscopy
OR
Do nothing and actively observe the patient

24
Q

What are the surgical emergencies which must go to theatre immediately?

A

Ruptured AAA
Faecal peritonitis
Ischemic gut

25
Q

What are the signs of perforated duodenal ulcer?

A

Board like rigidity.

Ususlaly no history of dyspepsia

26
Q

How is a perforated DU treated?

A 
Resuscitate
Antibiotics
Theartre or not?
Patch repair
Eradicate H pylori and give PPI
27
Q

What are the colonic emergencies?

A 
Obstruction
Volvulus
Acute diverticulitis
Toxic colitis
Perforations
28
Q

How is a sigmoid volvulus treated?

A

Decompress using a rigid sigmoidoscope

29
Q

How is a colonic maligant obstruction treated?

A

Stent or operate

30
Q

How is diverticulitis treated?

A

Depends on severity

Antibiotics up to Hartmann’s procedure (proctosigmoidoscopy)

31
Q

What is Typhilitis and how is it treated?

A

Inflammation of the caecum.

Antibiotics or operate

32
Q

How are bowel perforations managed?

A

Stercoral: contents of intestines in peritoneum => Remove colon
Leaks: theatre (assess and decide)

33
Q

What are the operations to consider for diverticulitis?

A

Wash out
Harmanns
Laproscopic or open

34
Q

The Hinchey Classification is the classification for diverticulitis. What are the 4 classes?

A 
1= paracolic abscess
2= pelvic abscess
3= purulent peritonitis
4= faecal peritonitis
35
Q

What is the hartmann’s procedure?

A

Remove sigmoid colon, leaving recum and bring out a colostomy.

GI (48 decks)

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