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MET3a > Acute abdomen > Flashcards

Acute abdomen Flashcards

1
Q

Define an acute abdomen

A

Abdominal pain of non-traumatic origin with a maximum duration of 5 days

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2
Q

Causes for pain in upper abdomen

A 
Acute pancreatitis
Herpes Zoster
Pneumonia
Interrupted blood flow to heart - MI
Inflammation of spinal nerve root
Peptic ulcer
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3
Q

Causes of pain in upper left abdomen

A

Gastritis
Gastric Ulcer
Abscess in spleen
Ruptured spleen

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4
Q

Causes of pain in upper right abdomen

A 
Inflammation of gallbladder
Enlargement of liver
Hepatitis
Abscess in liver
Perforated duodenal ulcer
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5
Q

Causes of pain in the lower left abdomen

A

Diverticulitis

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6
Q

Causes of pain in the lower right abdomen

A 
Appendicitis
Diverticulitis
Meckel diverticulitis
Enlarged lymph nodes in abdomen
Crohns
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7
Q

Causes of pain in the lower abdomen

A 
Abscess
Kidney stone
Ruptured AAA
Ectopic pregnancy
Torsion of ovarian cyst/testis
Haematoma
Cystitis
Endometriosis
Trapped/strangulated hernia
IBD
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8
Q

Causes of widespread abdominal pain

A 
Acute pancreatitis
DKA
Early appendicitis
Gastroenteritis
Intestinal obstruction
Ischaemia
Peritonitis
Sickle cell crisis
Typhoid fever
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9
Q

What causes of abdominal pain should you never miss?

A 
Perforation
Aneurysms
Ectopics
MI
Torsion of ovaries/testes
Pancreatitis
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10
Q

Urgent causes of abdominal pain

A 
Bleeding = AAA, ulcer, ectopic, trauma
Perforation = ulcer, obstruction, IBD, diverticulitis
Ischaemia = mesenteric, cardia
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11
Q

Abdominal pain associated symptoms

A

Bowel habit changes
Nausea/vomiting
Bleeding

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12
Q

What to look for on examination

A 
Analgesia on side/IV
Scars/stomas
Distention
Tenderness
Perionism
Herniae
PR
Genitalia
General appearance
Neck
CV?
Chest
Extremities
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13
Q

Basic Ix

A

ECG
Urine Dip
HCG
Bloods = ABG, Hb, glucose, pH, lactate, base excess, creatinine, FBC, U&E, LFT, CRP, amylase/lipase

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14
Q

Imaging

A

CT!
Sometimes CXR but not great for abdo diagnoses
US
Laparoscopy = for women of child bearing age, if imaging inconclusive, suspicion of urgent cause high

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15
Q

What is US good and bad for?

A

Good for biliary pathologies, gynaeocological

Bad for appendicitis

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16
Q

What imaging to use in pregnancy

A

US and MRI

CT if necessary

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17
Q

Alvarado Score

Air Score

A

Score for likelihood of appendicitis

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18
Q

Acute appendicitis

A

Peaks around 30 years
More males slightly
Can become inflamed, gangrenous, perforated
Caused by mechanical blockage, infection, hygiene changes in flora

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19
Q

Clinical features of acute appendicitis

A 
Central migrating to RIF
Anorexia
Nausea
Tachycardia
Low grade fever
20
Q

Position of appendix significance

A

Retrocaecal - RIF more masked as less irritation to peritoneum

21
Q

Management of acute appendicitis

A

Surgical = open or laparoscopic keyhole

Non surgical

22
Q

Open incision scar for appendectomy

A

grid iron incision at Mcburnery’s point, oblique

2-5 cm above AIIS to 1/3 of the way between AIIS and umbilicus (McBurney’s point)

23
Q

Complications of appendicitis

A

Perforation
Appendix mass
Appendix abscess
Appendicular tumours

24
Q

Rosving’s sign

A

Palpation of LLQ initiates pain in RLQ

25
Q

Causes of acute pancreatitis

A

Gallstones
Alcohol
Hyperlipidaemia

26
Q

Imaging for pancreatitis

A

US - gall stones?

27
Q

Management of acute pancreatitis

A

Conservative - main = analgesia, anti-emetics, fluids
Further imaging
Treat cause = gall stones?
Treat complications

28
Q

Perforations of GI tract

A

Multiple sites
Multiple causes
Most common cause is peptic ulcer in foregut = H pylori, smoking, NSAIDs, alcohol, steroids

29
Q

management of perforation

A

Operation
Non surgical
H Pylori eradication if they have it
Nutrition as GI tract out of action for a while

30
Q

Ruptured AAA

A

Degeneration of the aorta
Vascular RF
Rupture is bad
Rupture RF - diameter, volume, wall stress

31
Q

Management of AAA

A

Treat shock

Operative = open/endovascular

32
Q

Peptic ulcers 2 types

A
  • duodenal ulcers = epigastric pain relieved by eating
  • gastric ulcers = epigastric pain worsened by eating
  • features of GI haemorrhage = haematemesis, maelena
33
Q

Symptoms of acute pancreatitis

A 
Severe epigastric pain
Vomiting
Tenderness
Low grade fever
Cullen's and Grey Turner's sign rare
34
Q

Cullen’s sign

A

Periumbilical discolouration

35
Q

Grey Turner’s sign

A

Flank discolouration

36
Q

Biliary Colic features

A

RUQ pain
Radiates to the back and interscapular region
After a fatty meal
Can persist for hours
Obstructive jaundice = pale stools and dark urine

37
Q

Who gets biliary colic?

A 
4 F's
female
fat
forties
fair
38
Q

Acute cholecystitis

A

Gallstone symptoms
Continuous RUQ pain
Fever, raised inflammatory markers
Positive Murphy’s sign

39
Q

Diverticulitis

A

Colicky pain in LLQ

Fever, raised inflammatory markers and WCC

40
Q

Symptoms of AAA

A

Severe central abdominal pain radiating to back
Catastrophic presentation = sudden collapse
Or sub-acute = persistent severe central abdominal pain with shock
History of CV disease?

41
Q

Intestinal obstruction

A

Malignancy/previous operation history
Vomiting
Not opened bowels
Tinkling bowel sounds

42
Q

GI causes of clubbing

A

IBD
GI Lymphoma
Coeliac
Hepatic Cirrhosis

43
Q

5 F’s causing distension

A 
Fat (obesity)
Faeces (constipation)
Fetus (pregnancy)
Flatus (GI)
Fluid (ascites)
44
Q

What is the purpose of light/superficial palpation?

A

Check for guarding/rebound tenderness

45
Q

What to do if there is ascites?

A

Shifting dullness

Fluid thrill

46
Q

How to do a fluid thrill test?

A

Have patient push hands down on midline of abdomen

Tap one flank and feel for thrill in other

47
Q

Macroscopic blood types

A
  • bright red
  • dark
  • clots
  • melaena

MET3a (38 decks)

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