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Gastroenterology > Acute Abdomen > Flashcards

Acute Abdomen Flashcards

1
Q

What are the differentials for pain in the right hypochondriac region?

A
  1. Pancreatitis
  2. Ulcer (gastric)
  3. Gallstones
  4. Biliary Colic
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2
Q

What are the differentials for pain in the Epigastric region?

A
  1. Heartburn
  2. Pancreatitis
  3. Epigastric hernia
  4. Gallstones
  5. Ulcer (gastric)
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3
Q

What are the differentials for pain in the left hypochondriac region?

A
  1. Pancreatitis

2. Ulcer (gastric or duodenal)

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4
Q

What are the differentials for pain in the left lumbar region?

A
  1. kidney stones
  2. urinary tract infection
  3. constipation
  4. IBD
  5. Diverticular disease
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5
Q

What are the differentials for pain in the umbilical region?

A
  1. Gastric ulcer
  2. Early stages of appendicitis
  3. Aortic aneurysm
  4. Ruptured aortic aneurysm
  5. Pancreatitis
  6. IBD.
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6
Q

What are the differentials for pain in the left iliac region?

A
  1. Diverticular disease
  2. IBD
  3. Ectopic pregnancy
  4. Ovarian Torsion
  5. Inguinal or femoral hernias
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7
Q

What are the differentials for pain in the hypogastric region?

A
  1. UTI
  2. Appendicitis
  3. IBD
  4. Diverticular disease
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8
Q

What are the differentials for pain in the right iliac region?

A
  1. Appendicitis
  2. Ectopic pregnancy
  3. Ovarian torsion
  4. Inguinal or femoral hernias
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9
Q

What are the differentials for pain in the right lumbar region?

A
  1. Kidney stones
  2. UTI
  3. Constipation
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10
Q

What would make a patient need immediate abdomen in acute abdomen?

A
  1. Bleeding
  2. Perforation
  3. Ischaemia
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11
Q

Bleeding Presentation

A

Ruptured AAA

Other causes

  • Gastric ulcer
  • Ectopic pregnancy

Signs:

  • Tachycardia
  • Hypotension
  • Pale and clammy
  • Thready pulse
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12
Q

Perforation Presentation

A

Peptic ulceration
Bowel obstruction
Diverticular disease
IBD

Signs:

  • Peritonitis - laying completely still
  • Rigid abdomen with tenderness
  • Involuntary guarding
  • Reduced or absent bowel sounds
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13
Q

Bowel Ischaemia presentation

A

Arterial and venous causes
Can be thrombotic or embolic
Most commonly embolic
Think about AF

Signs:

  • Severe pain out of proportion is ischaemic bowel until proven otherwise.
  • Raised lactate
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14
Q

Involuntary guarding

A

Tensing even if you ask them to relax they can’t stop guarding.

Ddx anxiety, try asking them to relax if they are anxious they will be able to

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15
Q

True rupture AAA

A

Where all layers rupture

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16
Q

False rupture

A

Not all layers rupture - outside doesn’t

17
Q

Who gets AAA?

A

Old, fat, white men with Marfan’s who smoke

18
Q

Whos AAA rupture?

A

old, fat, white women who smoke.

19
Q

Triple AAA triad + signs

A
  • Abdominal/back pain, pulsatile mass + hypotension

Back pain, then collapse then hypotension.

20
Q

Triple A triad + signs

A
  • Abdominal/back pain, pulsatile mass + hypotension

Back pain, then collapse then hypotension.

21
Q

Investigations AAA

A

ABCDE

  1. US abdomen - FAST scan, quick and easy
  2. CT angiography
22
Q

Treatment of AAA

A

Stabilise: FBC, U&E, cross match (if giving blood right now)

Urgent surgical repair - EVAR preferred even in rupture.

23
Q

Right upper quadrant pain

A

Predominantly HPB causes
Intermittent = biliary colic secondary to gallstones
constant with fever = cholecystitis
constant with fever + jaundice = ascending cholangitis
palpable liver + jaundice = hepatitis

None of the above - consider pneumonia or pylonephritis

24
Q

Epigastric

A

Upper GI problems
Bleeding - gastric ulcer
pain better by leaning forward - pancreatitis
N+V, diarrhoea and light coloured stools? Pancreatitis
ERCP = pancreatitis
gallstones or abuse alcohol = pancreatitis

25
Q

LUQ

A

Bleeding - Gastric ulcer
Urinary symptoms - pyelonephritis
Colic = Ureteric colic (never crosses the midline - renal related)
Rest signs - pneumonia

26
Q

Peri-umbilical

A

AAA and bowel

Vomit first and profuse = small bowel
Constipation then vomit = Large bowel

Electrolyte imbalances can be present in both (due to obstruction and oedema, which sucks in water and electrolytes)

First line investigation AXR and upright CXR (perforation)

27
Q

LLQ

A

Bowel: Diverticulitis, IBD, Hernia, Cancer
Renal: Ureteric colic or UTI
Genitourinary: Torsion or ectopic

28
Q

RLQ

A

Bowel: Appendix, IBD, Hernia or cancer
Renal: Ureteric colic or UTI
Genitourinary: torsion or ectopic

29
Q

Appendicitis

A

Umbilical pain then RLQ (laproscopic) then ruptures you get peritonitis (laparotomy at that point)

30
Q

Investigations of acute abdomen

A

History
Examination: Abdo + PR
Bedside: Urine dip (+pregnancy test) + ECG
ABG: Lactate + Hb info
Bloods: FBC, U&E, LFT, CRP and amylase (pancreatitis - lipase is now being used more)

IMAGING:
Biliary or ovary - US
Calculi - CT KUB
Bowel - AXR + erect CXR

If they are going to have an operation, they get a CT

31
Q

Abdo Xray - small bowel

A

Partial SBO: Gas throughout abdomen and into rectum

Complete SBO: No distal gas, staggered air-fluid levels

Complicated SBO: free air under diaphragm OR thumb printing

Rigler’s sign - air either side of the bowel. Changes

32
Q

pneumoperitonism

A

Pneumoperitoneum is pneumatosis (abnormal presence of air or other gas) in the peritoneal cavity, a potential space within the abdominal cavity.

33
Q

369 rule

A

> 3 - small bowel
6 - large bowel
9 - caecum or sigmoid

obstruction, high risk of perforation.

34
Q

Toxic megacolon

A

Complication of UC, distended bowl and swollen, risk of perforation.

35
Q

Caecum volvulus

A

Can move in any direction (looks a bit like a question mark)
More common in young people
Operation

36
Q

Sigmoid volvulus

A

Can only move upwards and goes to the RUQ (coffee bean sign)
More common in older people
Drip and suck

37
Q

Drip and Suck

A

Fluids and NG tube

38
Q

Management

A

Acute:

  • IV access
  • NBM
  • Analgesia +/- antiemetics
  • VTE prophylaxis (TED stockings, express sleeves and anticoag - LMWH unless renal problems then give UFH)
  • Catheter (and fluid balance)

Definitie:

  • operation
  • Drip and suck (sigmoid)
  • Abx and fluids (diverticulitis)
  • Palliation
39
Q

Types of scar

A 
Lanz scar = old appendix 
Grid iron scar = Kidney transplant 
Kocher scar = old gallbladder approach 
Rooftop scar = Thoracic surgery 
Mercedes-Benz = Liver Tx or Whipple 
Midline = Laparotomy 
Ports = Laparoscopy (various) 
Pfannelnsteil = C-section

Gastroenterology (9 decks)

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