Acute abdomen

Question 1

Bowel size

Answer 1

3, 6, 9

Small bowel= 2/3cm
Large bowel= 6cm

Caecum= 9cm

Question 2

Causes of mechanical bowel obstruction

Answer 2

Volvulus
- Twisting of intestines

Adhesions

Hernias

Cancer

Foreign matter

Gallstone ileus

Bowel inflammation/ swelling

Intussusception

Impacted faeces

Question 3

Differentials for acute abdominal pain

Answer 3

RIF

• Appendicitis
• Ureteric colic
• Ectopic pregnancy
• IBD
• UTI

Epigastric

• Pancreatitis
• Gastric ulcer
• MI
• Cholecystitis

LIF

• IBD
• UTI
• Diverticulitis

Question 4

Causes of perforated bowel

Answer 4

Peptic ulcer

Diverticulitis

Obstruction

IBD

Perforated gallbladder

Infection:

Question 5

Cullen’s sign

Answer 5

Superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus
- Sign of retroperitoneal bleed

Causes

• acute pancreatitis
• blunt abdominal trauma
• aortic rupture
• bleeding from ruptured ectopic pregnancy

Question 6

Staging of pancreatitis

Answer 6

PANCREAS

Within the first 24 hrs:

P- PO2 <8
A- Age >55
N- Neutrophils, WCC >15
C- Calcium <2
R- Renal function, urear >16
E- Enzyme (LDH >600(
A- Albumin <32
S- Sugar >10