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acute abdomen Flashcards

1
Q

define acute abdomen

A

rapid onset of
severe symptoms that may indicate potentially
life-threatening intra-abdominal pathology that may require
urgent surgical intervention.

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2
Q

sx of acute abdomen

A

Abdominal pain

Vomiting

Rigid abdomen

Meteorism

Collapse

Shock

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3
Q

classifications of pain

A

organic pain: has specific I.Dable cause

functional pain:
w/o clearly I.Dable cause
increased by psychosocial factors

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4
Q

types of gyne pain

A

acute
chronic
reccurent
cyclical episodic pain

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5
Q

examples of cyclic episodic pain

A

mittelschmerz

dysmenorrhea

endometriosis

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6
Q

approach of acute abdomen in pregnant women

A

pregnancy related

non pregnancy related

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7
Q

approach to acute abdomen in non pregnant women

A

gyneacological

non gynealogical

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8
Q

most common gynae causes of acute abdomen

A

1) PID
2) Ovarian cyst
3) Endometrosis
4) Fibroid

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9
Q

causes of acute abdomen

A

intra-abdominal bleeding

acute decrease or stop of blood supply of internal
genital organs

inflammatory diseases of internal genitalia

internal genital organ perforation (uterus)

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10
Q

class of gynea acute abdomen in reproductive age women

A
  1. Pregnancy related
    - ectopic,
    - septic abortion
    - endometritis
  2. infection
    - PID
    - Tubulo Ovarian Abscess
  3. complicated ovarian cyst
    - torsion
    - rupture
    - hemorrhage
    - ovarian hyperstimulation syndrome
  4. complicated fibroid
    - degeneration
    - torsion
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11
Q

Causes of acute abdomen in adolescents

A

main causes:
imperforate hymen
transvaginal septum

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12
Q

causes of acute abdomen in PMP women

A

main cause: ovarian torsion

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13
Q

gynae examples of intra-abdominal bleeding in acute abdomen

A

ectopic pregnancy

  • most common
  • d/2 tubal rupture/ abortion

ovarian hemorrhage from corpus luteum

ruptured ovarian cyst
-chocolate/endometriotic is most common type

haemoperitioneum d/2 uterine rupture

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14
Q

gynae examples of Acute decrease or stop of blood

supply of internal genital organs

A

ovarian torsion.

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15
Q

what is an ovarian torsion

A

partial or complete twisting of an ovary
around its ligamental support

leads to an occlusion of
its blood supply

associated with the sudden onset of abdominal pain
if untreated, causes ovarian necrosis.

affects females of all ages

challenging dg d/2 non specific sx but MUST NOT BE MISSED

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17
Q

what pathology is often assoc w/ ovarian torsion

A

ovarion tumor/ cyst

  • act as lead point
  • larger mass have higher risk
18
Q

pathogenesis of ovarian torsion

A

1) at first only venous outflow is obstructed
- increases intraovarian P
- d/2 torsion below 360 degrees

2) Additional twisting (over 360)
- arterial inflow obstruction

3) ischeamic ovary

19
Q

sx of ovarian torsion

A

Acute Pelvic Pain

Adenexal Mass

Nausea/Vomiting

Low grade fevers

Orthostasis or Light-headedness if hemorrhaging

20
Q

what is an adnexal torsion

A

when the falopian tube twists alongside the overies.

20
Q

how does torsion of pedunculated subserous myoma present

A

sx are d/2 myoma complications

  • degenration
  • necrosis
  • infec
  • expulsion of submucus pedunculated myoma
  • torsion
21
Q

si & sx of adnexal torsion

A

pain: sudden onset in lateral lower quads
peritonism: symptoms of peritonitis but without the inflammation of the peritoneum

no flow during DOPPLER US

22
Q

examples of inflammatory diseases of internal genitalie

A

gonococcal

  • salpingitis
  • salpingooophoritis/
  • tubo ovarian abscess

pelvioperitonitis

parametritis

23
Q

acute gonococcal

  • salpingitis
  • salpingooophoritis/
  • tubo ovarian abscess

presentation

A

the rupture of the abscess can cause septic shock

sx

pain
fever
severe peritoneal sighs
palpable tender adnexal mass

24
Q

what is Pelvioperitonitis -

A

inflammation of the pelvic peritoneum. d/2 MO’s migrating from

1) fallopian tubes
2) Blood
3) Lymph

25
Q

what is parametritis

A

inflammation of connective tissue adjacent to the

uterus.

26
Q

what is uterine perforation

A

potential complication of all
intrauterine procedure.

assoc damage to surrounding blood vessles and vicera (bowel and bladder)

27
Q

what are the worst complications of urerine perforation

A

hemorrhage and SEPSIS

28
Q

rf of uterine perforation

A

factors making the endometrial cavity less accesible- CERVICAL STENOSIS

factors changing the the strength of the myometrium -PREG
-MENOPAUSE

29
Q

history suggesting acute abdomen

A

age

time of onset:

relation to menstrual cycle

freq of pain

loc of pain

assoc sx

past medical history

  • history of precipitating illness (previous cysts)
  • previous incidence of acute abdomin d/2 gynae causes

past surgical history

sexual history: PID
- STI’S, etc
contraceptive history
IUD can cause PID

30
Q

pelvic exam in acute abdomen

A

inspection of external genitals

speculum examination

bimanual examination

pelvic exam

31
Q

lab tests in acute abdomen

A

CBC, ESR,

Urinalysis & culture

Urine pregnancy test!!!!

vaginal wet mount
-wbc’s suggest PID

ultrasonography

serum pregnancy test

other imaging tests (eg, CT, MRI)

Culdocentesis (procedure in which peritoneal fluid is obtained from the cul de sac of a female patient)

If the cause of severe or persistent pain remains unidentified, laparoscopy or laparotomy is done.

32
Q

what is culdocentesis

A

(procedure in which peritoneal fluid is obtained from the cul de sac of a female patient)

33
Q

DX of Acute abdomen

A

Acute apappendicitis

Acute peptic ulcer and its complications

Acute cholecystitis

Acute pancreatitis

Acute intestinal ischemia

Acute diverticulitis

Acute peritonitis (including hollow viscus perforation)

Acute ureteric colic

Bowel volvulus

Acute pyelonephritis

Adrenal crisis

Biliary colic

Abdominal aortic aneurysm

Ruptured spleen

Kidney stone

34
Q

rx of acute abomen

A

LAPAROSCOPY

LAPAROTOMY

O&G (43 decks)

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