Acute abdomen Flashcards
Give 4 eponymous/ specific signs for appendicitis.
What may cause appendicitis- like signs in children?
- Rovsing’s sign: pain greater in RIF than LIF when LIF is pressed.
- Cope’s sign: pain on passive flexion and internal hip rotation
- Psoas sign: pain on extending hip - only with retrocaecal appendix
- Rebound tenderness- if peritoneal involvement
- Meckel’s diverticulum
Give 2 blood results seen in appendicitis.
Give 2 other investigations for appendicitis
Which scoring system is used for appendicitis
What urinary test should be done in a female?
- Leukocytosis, raised CRP
- USS, CT
- Alvarado score
- Pregnancy test
What are the two incisions used for an appendicectomy?
For bonus fun, what are the following abdominal incisions used for?
- Right subcostal (Kocher’s)
- Mercedes-Benz incision
- Midline laparotomy incision
- J-shaped/ hockey stick incision
- Low transverse incision
- Inguinal incision
- Loin incision
- McBurney’s incision, angled incision, right inguinal region
- Lanz incsion- horizontal right inguinal region.
- Right subcostal: biliary surgery
- Merc B.- liver transplant
- Mid laparotomy: GI/ major abdominal surgery
- J-shaped: renal transplant
- Low transverse: gynaecological
- Inguinal: hernias, vascular access
- Loin: nephrectomy.
Give 2 antibiotics given for appendicectomy
Cefotaxime, Metronidazole
Give 3 complications of appendicitis.
- Perforation
- Appendix mass- inflamed appendix becomes covered in omentum and forms a mass
- Appendix abscess
What is diverticulosis?
What is diverticular disease?
What is diverticulitis?
Diverticulosis: diverticular outpouchings of colonic mucosa and submucosa throughout large bowel.
Diverticular disease: complications from diverticulosis
Diverticulitis: acute inflammation and infection of diverticulae.
What is the Hinchey classification used for?
What are the 4 stages?
Progression of diverticular disease I: phlegmon Ib/ II: localised abscesses III: perforation with prurulent peritonitis IV: faecal peritonitis
Give the aetiology of diverticular disease.
Where does it most commonly occur? What obstruction can occur?
- Low fibre diet
- High pressure required to expel stool
- Herniations through muscular weak points
Most common in sigmoid colon, can be obstructed with stool
- leads to bacterial overgrowth, injury and diverticulitis.
Give 4 symptoms of diverticular disease
- Bloody stool
- LIF pain
- Fever
- Urinary symptoms- diverticular fistulation into bladder- pneumaturia, faecalcuria, recurrent UTIs
In a patient with diverticulitis, where would pain be felt upon palpation?
Left iliac fossa
Give two blood tests to perform for diverticular disease.
When should a barium enema not be performed?
- FBC, clotting
Do not perform barium enema in acute diverticulitis, increased likelihood of perforation.
Give two treatment steps for acute diverticulitis.
Give 2 management steps for chronic diverticulitis
Give 2 surgical options for chronic diverticulitis.
Supine or erect AXR?
Acute (symptomatic)
- IV hydration, bowel rest,
Chronic (symptomatic):
- Soluble, high fibre diet, anti-inflammatories e.g. mesalazine.
- Hartmann’s: removal of diseased bowel and end-colostomy formation with anorectal stump. Followed by a primary anastomosis.
- Primary anastomosis: removal of affected bowel followed by joining of two remaining ends. To protect anastomosis/ allow healing, defunctioning (loop) ileostomy used to divert bowel contents away from primary anastomosis.
- erect AXR, to show air under diaphragm if perforation.
Give 6 complications of diverticular disease
- colonic obstruction
- diverticulitis
- peri-colic abscess
- perforation
- faecal peritonitis
- fistulas
Give 5 possible symptoms of a patient presenting with a hernia
- Lump in groin
- Scrotal swelling
- Groin pain
- Vomiting
- Constipation
Differentiate femoral and inguinal hernias in the following categories:
- Commonness and gender
- Strangulation prevalence
- Surgical necessity
- Age
Femoral
- more common in females
- more commonly strangulated
- Surgery recommended
- Older patients
Inguinal
- Most common type of hernia
- Less commonly strangulated
- Can be treated without surgery
- Younger
What is an incarcerated hernia?
What is a strangulated hernia?
- Incarcerated: hernia compressed by defect, causing it to be irreducible.
- Strangulated: compression around hernia prevents blood flow into hernial contents causing ischaemia and pain.
Describe femoral and inguinal hernia examination findings:
- Location
- Contents
- Swelling appearance and disappearance
- Strangulation signs (5)
- Lateral and inferior to pubic tubercle vs superior and medial to pubic tubercle
- Omentum vs bowel
- Appearance on coughing, disappearance on supination
- tender, red, colicky abdo pain, distention, vomiting
What is the first line investigation for a hernia?
Ultrasound
How does the first management step differ between inguinal and femoral hernia?
Inguinal: reassurance, then elective surgery.
Femoral: surgery 1st line, higher strangulation rate
Describe the test to differentiate indirect and direct inguinal hernias.
- Reduce hernia
- Place finger over deep inguinal ring (superior to mid inguinal point).
- Ask patient to cough.
If hernia reappears it is direct hernia as it is not coming through deep inguinal ring.
Give 4 features of pain from acute pancreatitis.
How is tissue damage caused in acute pancreatitis?
- Epigastric pain
- Pain relieved by sitting forward
- Pain radiates to the back
- Pain worst on movement
Activation of pancreatic enzymes results in tissue damage and inflammation.
What is the acronym for acute pancreatitis?
GET SMASHED
- Gallstones
- Ethanol
- Trauma
- Scorpion sting
- Mumps/ malignancy
- Autoimmune disease
- Steroid use
- Hyperlipidaemia, hypercalcaemia, hyperparathyroidism
- ERCP
- Drugs (e.g. thiazides, azathioprine)
Give 4 examination findings of acute pancreatitis
Give 2 skin changes found in acute pancreatitis.
- Epigastric tenderness
- Fever
- Shock, tachycardia, tachypnoea
- Reduced bowel sounds
- Cullen’s sign, Grey-Turner’s sign: both due to intra-abdominal bleeding from pancreatic inflammation.
Which blood test can differentiate between chronic pancreatitis and acute pancreatitis? What will the difference in result be?
Which other test differentiates acute and chronic?
What may be seen on USS?
What may be seen on a CXR/ erect AXR?
- Serum amylase is normal in chronic pancreatitis, but 3 times normal in acute pancreatitis.
NB: amylase is raised in any case of acute abdomen, e.g. perforation. - Faecal elastase is only high in chronic pancreatitis, but normal in acute pancreatitis.
- Gallstones on USS
- Pleural effusion on CXR
