Acute Abdomen Flashcards
A nervous 16-year-old college student attends the local A&E department with her boyfriend, complaining of an episode of sudden onset right-sided pain in her abdomen. Physical examination of the patient is unremarkable except from a small scar in the right lower quadrant.
What is the most appropriate first line investigation in this case?
A) USS of the abdomen B) 𝞫-hCG test C) Full blood count D) CT scan of the abdomen E) No investigations, immediate surgery
B) 𝞫-hCG test
- 16 y/o college student with a boyfriend
- sudden onset RIF pain + McBurney’s incision (appendicectomy)
I believe this comes together to drive concern of ectopic pregnancy
A 26-year-old professional rugby player presents to the A&E department with abdominal pain in the umbilical area. On initial inspection, the gentleman is feverish with a temperature of 38C and a BP of 115/90. The admitting doctor suspects a diagnosis of appendicitis from the history and performs an abdominal physical examination and passively extends the gentleman’s right hip which elicits pain.
Which eponymous sign of appendicitis is being demonstrated here and what does it represent?
A) Cope’s sign, and a retrocaecal appendix
B) Psoas sign, and a retrocaecal appendix
C) Psoas sign, and an appendix located next to obturator externus
D) Rovsing’s sign, and a retrocaecal appendix
E) Rovsing’s sign, and an appendix located next to obturator externus
B) Psoas sign, and a retrocaecal appendix
A feverish 56-year-old woman attends her GP complaining of a sudden appearance of bloody stools. She adds that she has experienced a few episodes of bloody stools before but did not seek medical attention and apart from a fever, she has had no other constitutional symptoms. The GP notes that the patient’s diet is particularly low in fibre and on physical examination, tenderness is found on pressure to the LIF. A DRE shows fresh blood upon removal of a gloved finger.
What is the most likely diagnosis?
A) Angiodysplasia B) Diverticulosis C) Diverticulitis D) Mallory-Weiss tear E) Gastroenteritis
C) Diverticulitis
- fever, bloody stool, LIF tenderness = diverticulitis (may lie still indicating peritonitis)
- can have other FLAWSV signs
A feverish 65-year-old is brought to the local A&E department by her daughter. She complains about nausea, LIF pain and vomiting. The attending doctor takes a full history and performs an abdominal examination and subsequently makes a diagnosis of acute diverticulitis with some associated signs of peritonism. A erect AXR is taken which shows some air under the diaphragm.
What is the most appropriate surgical procedure?
A) Hartmann’s procedure B) Primary anastomosis C) Colectomy and end-ileostomy formation D) Delorme’s procedure E) Whipple’s procedure
A) Hartmann’s procedure
- peritonism + air under diaphragm indicates inflammation and acute presentation, making primary anastomosis not possible right away as bowel needs to be given rest before anastomosis
- Hartmann’s procedure removes diseased bowel and forms stoma, followed by primary anastomosis afterwards
diverticulitis = Hartmann’s (due to inflammation)
A 26-year-old bodybuilder attends the local day-surgical clinic upon referral from his GP due to a groin lump. The general surgical registrar suspects a hernia and so performs a simple test to ascertain the type of hernia to determine the most appropriate management. The doctor reduces the hernia and then places their finger over the deep inguinal ring. The patient is asked to cough and the hernia does not reappear.
What is the most likely type of hernia?
A) Femoral hernia B) Direct inguinal hernia C) Indirect inguinal hernia D) Spigelian hernia E) Hiatus hernia
C) Indirect inguinal hernia
- does not reappear on compression of deep inguinal ring
- direct would reappear
- femoral would be downwards of inguinal ligament
Which of the following may be raised in chronic pancreatitis?
A) Amylase B) Calcium C) Faecal elastase D) Albumin E) Haematocrit
C) Faecal elastase
Which of the following is not a cause of acute pancreatitis?
A) Mumps B) Hypocalcaemia C) Thiazide drugs D) Trinidad scorpion bite E) Steroids
B) Hypocalcaemia
- GETSMASHED mnemonic
- hyPERcalcaemia actually causes it (all 3 H’s are hyper’s)
An overweight 65-year-old woman visits her general practitioner with discomfort in her right groin. On examination, the suggestion of a reducible groin lump is noted. She is routinely referred to the surgical outpatient clinic with a possible diagnosis of inguinal hernia. However, two weeks later and before her surgical appointment, she again visits her general practitioner, this time with vomiting, diarrhoea, and colicky abdominal pain.
What is the next most appropriate management step?
A) Administer antibiotics B) Give IV fluids C) Insert an NG tube D) Give IV fluids and insert an NG tube E) Administer an enema
D) Give IV fluids and insert an NG tube
Mx of bowel obstruction
- ‘drip and suck’ first-line supportive (IV fluids + NG tube)
- conservative if volvulus decompresses
- laparotomy (especially if patient is peritonitic)
A 70-year-old gentleman presents to the A&E department with sudden-onset severe diffuse abdominal pain. Observations are taken in the ambulance which show an irregularly irregular pulse rate of 130 and a blood pressure of 76/60mmHg. An abdominal X-ray is performed as soon as possible which shows the Rigler sign and the physician diagnoses an acute form of mesenteric ischaemia with perforation.
What is the most likely cause for the acute onset of the mesenteric ischaemia?
A) Atherosclerotic disease B) Embolism C) Thrombosis D) Polycythaemia vera E) Idiopathic
B) Embolism
- irregularly irregular pulse (AF) is a RF for thromboembolism
