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Yr 3 MedEd > Acute abdomen > Flashcards

Acute abdomen Flashcards

1
Q

Give 4 eponymous/ specific signs for appendicitis.

What may cause appendicitis- like signs in children?

A
  • 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
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2
Q

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?

A
  • Leukocytosis, raised CRP
  • USS, CT
  • Alvarado score
  • Pregnancy test
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3
Q

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
A
  • 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.
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4
Q

Give 2 antibiotics given for appendicectomy

A

Cefotaxime, Metronidazole

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5
Q

Give 3 complications of appendicitis.

A
  • Perforation
  • Appendix mass- inflamed appendix becomes covered in omentum and forms a mass
  • Appendix abscess
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6
Q

What is diverticulosis?
What is diverticular disease?
What is diverticulitis?

A

Diverticulosis: diverticular outpouchings of colonic mucosa and submucosa throughout large bowel.

Diverticular disease: complications from diverticulosis

Diverticulitis: acute inflammation and infection of diverticulae.

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7
Q

What is the Hinchey classification used for?

What are the 4 stages?

A 
Progression of diverticular disease
I: phlegmon
Ib/ II: localised abscesses
III: perforation with prurulent peritonitis
IV: faecal peritonitis
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8
Q

Give the aetiology of diverticular disease.

Where does it most commonly occur? What obstruction can occur?

A
  • 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.

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9
Q

Give 4 symptoms of diverticular disease

A
  • Bloody stool
  • LIF pain
  • Fever
  • Urinary symptoms- diverticular fistulation into bladder- pneumaturia, faecalcuria, recurrent UTIs
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10
Q

In a patient with diverticulitis, where would pain be felt upon palpation?

A

Left iliac fossa

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11
Q

Give two blood tests to perform for diverticular disease.

When should a barium enema not be performed?

A
  • FBC, clotting

Do not perform barium enema in acute diverticulitis, increased likelihood of perforation.

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12
Q

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?

A

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.
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13
Q

Give 6 complications of diverticular disease

A
  • colonic obstruction
  • diverticulitis
  • peri-colic abscess
  • perforation
  • faecal peritonitis
  • fistulas
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14
Q

Give 5 possible symptoms of a patient presenting with a hernia

A
  • Lump in groin
  • Scrotal swelling
  • Groin pain
  • Vomiting
  • Constipation
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15
Q

Differentiate femoral and inguinal hernias in the following categories:

  • Commonness and gender
  • Strangulation prevalence
  • Surgical necessity
  • Age
A

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
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16
Q

What is an incarcerated hernia?

What is a strangulated hernia?

A
  • Incarcerated: hernia compressed by defect, causing it to be irreducible.
  • Strangulated: compression around hernia prevents blood flow into hernial contents causing ischaemia and pain.
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17
Q

Describe femoral and inguinal hernia examination findings:

  • Location
  • Contents
  • Swelling appearance and disappearance
  • Strangulation signs (5)
A
  • 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
18
Q

What is the first line investigation for a hernia?

A

Ultrasound

19
Q

How does the first management step differ between inguinal and femoral hernia?

A

Inguinal: reassurance, then elective surgery.
Femoral: surgery 1st line, higher strangulation rate

20
Q

Describe the test to differentiate indirect and direct inguinal hernias.

A
  1. Reduce hernia
  2. Place finger over deep inguinal ring (superior to mid inguinal point).
  3. Ask patient to cough.

If hernia reappears it is direct hernia as it is not coming through deep inguinal ring.

21
Q

Give 4 features of pain from acute pancreatitis.

How is tissue damage caused in acute pancreatitis?

A
  • 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.

22
Q

What is the acronym for acute pancreatitis?

A

GET SMASHED

  • Gallstones
  • Ethanol
  • Trauma
  • Scorpion sting
  • Mumps/ malignancy
  • Autoimmune disease
  • Steroid use
  • Hyperlipidaemia, hypercalcaemia, hyperparathyroidism
  • ERCP
  • Drugs (e.g. thiazides, azathioprine)
23
Q

Give 4 examination findings of acute pancreatitis

Give 2 skin changes found in acute pancreatitis.

A
  • 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.
24
Q

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?

A
  • 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
25
Q

Which scoring system is used to investigate severity of acute pancreatitis?

A 
Modified Glasgow score
PANCREAS: >3 = severe
- PaO2 (low)
- Age >55
- Neutrophils (high)
- Calcium (low)
- Renal function urea (high)
- Enzymes LDL/AST raised
- Albumin (low)
- Sugar >10mmol
26
Q

Give 3 medical management steps for acute/ chronic pancreatitis

What is surgical treatment for acute/chronic pancreatitis?

A
  • Fluid balance
  • Catheter and NG tube if vomiting
  • Analgesia and glucose control
  • ERCP
27
Q

Give 4 presenting complaints/ symptoms of chronic pancreatitis.

What is the main cause of chronic pancreatitis.

A
  • Recurrent epigastric pain
  • Pain relieved sitting forward
  • Weight loss, bloating, steatorrhoea
  • Pain worst on movement

Alcohol causes 70% of cases.

28
Q

Give 2 dermatological signs of chronic pancreatitis

A
  • Cullen’s sign

- Grey- Turner’s sign.

29
Q

What serum amylase result would you see in chronic pancreatitis?

What faecal test would conducted for chronic pancreatitis
What would be seen on AXR?
What would be seen on ERCP/ MRCP?

A

Normal amylase

  • Faecal elastase is raised in chronic pancreatitis.
  • AXR: pancreatic calcification
  • ERCP: early: duct dilatation. Late: duct strictures.
30
Q

Give 3 local complications of chronic pancreatitis.

Give 2 systemic complications of chronic pancreatitis.

A
  • local: pseudocyst, duodenal obstruction, pancreatic ascites
  • systemic: diabetes, steatorrhoea
31
Q

Give 4 presenting complaints/ symptoms of intestinal obstruction.

A
  • Abdominal distention.
  • Constipation
  • Vomiting
  • Diffuse pain
32
Q

Give 2 small bowel and 3 large bowel causes of intestinal obstruction.

A

Small:

  • adhesions from prior operations- most common cause in western world. Look for Hx of surgery/ scars on examination.
  • Malignancy

Large:

  • Colorectal malignancies
  • Sigmoid/ caecal volvulus
  • Paralytic ileus/ post operative ileus
33
Q

Give 2 general inspection and 2 auscultation findings of intestinal obstruction.

A
  • Abdominal distention
  • Pyrexia/ sweating- potential perforation or infarction
  • High-pitched tinkling sounds
  • Absent bowel sounds
34
Q

What is an eponymous sign of bowel perforation secondary to intestinal obstruction on AXR?

A

Rigler sign:

- Represents air seen on both sides of intestinal wall

35
Q

Give 1 medical and 1 surgical step in management of intestinal obstruction.
Give the prognosis of small bowel mortality following surgery <36 and >36 hrs.

A

Medical: IV fluid and NG tube- “drip and suck”- conservative management if volvulus decompresses.
Surgical: laparotomy, especially if peritonitic

Prognosis: small bowel mortality 8% if surgery <36 hours
25% mortality if >36 hours

36
Q

What is the presenting complaint/ symptom of acute intestinal ischaemia?

A

SUDDEN onset of DIFFUSE pain.

37
Q

Give the aetiology of intestinal ischaemia

A
  • Arterial thrombosis (e.g. due to atherosclerosis) or embolism (e.g. due to emboli from AF)
  • Venous thrombosis (in hyper coagulable state) and non-occlusive disease, e.g. hypotension.
38
Q

Give 4 risk factors for intestinal ischaemia

A
  • old age
  • Cardiovascular disease
  • AF
  • Hypotensive state- car accident
39
Q

Give 3 investigations for intestinal ischaemia

A
  • AXR: perforation, megacolon
  • Angiography- show blockages
  • ECG: look for MI or AF
40
Q

Give 4 presenting complaints/ symptoms of chronic intestinal ischaemia

A
  • Weight loss
  • Intermittent gut claudication
  • Post-prandial pain
  • PR bleeding
41
Q

What abdomen exam finding would you expect from chronic intestinal ischaemia?
What would you see in DRE?

A
  • Normal abdo exam

- Blood on DRE

Yr 3 MedEd (31 decks)

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