Acute Abdomen Flashcards
How does Appendicitis typically present?
Acute Umbilical pain that radiates to the RIF
What is Rovsing’s Sign?
Pain is greater in the RIF when the LIF is pressed
What is Cope’s Sign?
Pain on passive flexion and internal rotation of the hip
What is the Psoas Sign?
Pain on extension of the hip
How should you investigate a possible case of Appendicitis?
Bloods - Leukocytosis, Raised CRP
USS
CT
Alvarado Score
How should you manage a case of Appendicitis?
Appendicectomy
Metronidazole, Cefotaxime
Which complications can occur as a result of Appendicits?
Perforation
Appendix Mass
Appendix Abscess
What do:
Diverticulosis
Diverticular Disease
Diverticulitis
mean?
Diverticulosis - The presence of Diverticulae
Diverticular Disease - The complications from Diverticulosis
Diverticulitis - Acute infection and inflammation of diverticulae
How does Diverticulitis typically present?
Bloody Diarrhoea
LIF Pain
Fever
Urinary Symptoms
Mainly >60yo
How would you investigate a suspected case of Diverticular Disease?
Bloods - FBC, Clotting
Barium Enema (Only in chronic)
Flex Sig/Colonscopy
CT (Acute)
Erect AXR
How should you manage an Acute case of Diverticulitis?
IV Hydration
Bowel Rest
Surgery may be indicated (Hartmann’s, Primary Anastomosis)
How should you treat Chronic Diverticular Disease?
Soluble, high-fibre diet
Anti-Inflammatories (mesalazine)
Surgery may be indicated (Hartmann’s, Primary Anastomosis)
What is Hartmann’s Procedure?
Removal of the diseased bowel and an end-colostomy formation with an anorectal stump.
Used when Primary Anastomosis is not possible.
What are the main complications of Diverticular Disease?
Diverticulitis
Faecal Peritonitis
Fistula
Peri-Colic Abscess
Colonic Obstruction
Perforation
Define ‘Hernia’.
Protrusion of part of an organ through the wall of the cavity in which it is contained.
How do Inguinal and Femoral hernias typically present?
Lump in the groin
Groin Pain
Vomiting
Scrotal Swelling
What are the signs of a strangulated hernia?
Tender, red, colicky Abdo pain, distension, vomiting
How do you determine whether an Inguinal hernia is Direct or Indirect?
Reduce the Hernia
Place a finger over the deep-inguinal ring, just above the midpoint of the inguinal ligament
Ask the patient to cough, if it re-appers, it must be direct.
How would you investigate a hernia?
Usually a clinical diagnosis
USS
Why are Femoral Hernias more commonly operated on than Inguinal Hernias?
Higher risk of strangulation
How does Acute Pancreatitis typically present?
Epigastric Pain
Pain relieved when sitting forward
Radiation to the back
Worse on movement
Hx of gallstones & alcohol
What are the main causes of Pancreatitis?
GET SMASHED
Gallstones
Ethanol
Trauma
Steroids
Mumps, Malignancy
Autoimmune
Scorpion Venom
Hypercalcaemia, Hyperlipidaemia, HyperPTH
ERCP
Drugs
What signs might you see on examination of a patient with Pancreatitis?
Cullen’s
Grey-Turner’s
Both due to retroperitoneal bleeding
How would you investigate Acute Pancreatitis?
Amylase
USS (Gallstones)
Erect CXR/AXR
CT
How do you assess the severity of Acute Pancreatitis?
Modified Glasgow Score
How do you manage a case of Acute/Chronic Pancreatitis?
Fluid Balance, Catheter & NG Tube, Analgesia
ERCP
Surgery if complications are severe
How does Chronic Pancreatitis typically present?
Recurrent Epigastric Pain
Relieved on Sitting Forward
WL, Bloating, Steattorhoea
How would you investigate Chronic Pancreatitis?
Faecal Elastase
AXR
ERCP/MRCP
How might Intestinal Obstruction present?
Diffuse Pain
Constipation
Vomiting
Abdominal Distension
What can cause Intestinal Obstruction?
Adhesions from surgery
Malignancy
Volvulus
Ileus
What might you observe on examination of a patient with Intestinal Obstruction?
Distension
Pyrexia
High-Pitched, tinkling bowel sounds
Absent bowel sounds
How do you investigate a suspected case of Intestinal Obstruction?
Bloods
Plain AXR
CT
Normal Bowel = 3/6/9 Small/Large/Caecum
How do you treat Bowel Obstruction?
Drip & NG Tube
Conservative if a causative Volvulus shows signs of decompression. Laparotomy if peritonitic
How does Acute Intestinal Ischaemia present?
Sudden onset diffuse Abdominal Pain
How would you investigate a suspected case of Intestinal Ischaemia?
AXR - Perforation, Megacolon
Angiography - Blockages
ECG - MI/AF
How might Chronic Intestinal Ischaemia present?
Intermitten gut claudication
Post-prandial pain (after eating)
PR Bleeding
WL
