Acute Abdomen Flashcards
what colour is fresh bile?
yellowish
not really green
signs to check for in acute abdo?
pain localised peritonism generalised peritonitis (board like) guarding rebound tenderness rosvigs sign
when might bowel sounds be absent?
obese people
absent in ileus
what does tinking bowel sounds indicate?
obstruction
important part of rectal examination?
must document reason why it was done
only do when appropriate and during abdo exam
analgesia in acute abdo?
IV morphine
IV paracetamol
(add anti-emetic if strong pain killer)
initial management in acute abdo?
ABCDE analgesia observations urinalysis give oxygen give fluids treat nausea and pain (think how youll resuscitate if needed)
things to look at ina cute abdo patient from end of bed?
look unwell? moving around or still? hlding abdomen? sick bowl/sick around them? scars? moribound?
types of scars on abdomen?
//////
cullens vs grey tueners sign?
cullens = around umbilicus
grey turners = on flanks
bruising which indicates pancreatitis
what is erythema ab iigne?
mottling from heat
hot water bottle rash
other possible sings on abdomen which may be less relevant in acute abdo?
caput medusae
jaundice
striae
masses
initial blood investigations in acute abdo?
FBC LFT U&Es CRP Ca Lactate Coagulation screen (if needed) AMYLASE AMYLASE AMYLASE
other intials investigations?
ABGs plain radiology AXR erect CXR if possible may go straight to CT if acutely unwell
why is erect CXR useful?
useful if abnormal
excludes basal pneumonia etc
free air under diaphragm could be relevant
type of CXR if too ill to stand?
lateral decubitus
use of plain AXR?
overused generally and gives a lot of radiation so dont use if not neccessary
useful to diagnose obstruction, acute colitis, perforation
erect and supine views can be useful to view fluid levels etc
use of CT in acute abdo?
gold standard
early CT associated with better outcome due to faster diagnosis
use of US in acute abdo?
useful in women and children to avoid radiation
gold standard for RUQ and RIF pain
can view gallstones well
useful in women with pelvic pain (trans vaginal US) as it gives good view and prevents radiation damage to ovaries etc
when might MRI be used in acute abdo?
pregnant women
(dont want to use CT in pregancy due to radiation)
can show appendicitis etc in pregnant women
what things must you look for and exclude to prevent quick death?
pancreatitis
AAA
ALWAYS LOOK AT SCANS AND RECORD RESULT
main catagories of surgery in acute abdo?
laparotomy (open them up)
laparoscopy (key hole)
when might you do nothing?
diverticulitis etc
but always actively observe
who must go to theatre immediately?
faecal peritonitis
ischaemic gut
nobody with pancreatitis (unless gallstones and cholecystitis involved)
nobody with DKA
make sure they are resucitated and stable first (not including faecal peritonitis and ischaemic gut)
presentation of perforated duodenal ulcer?
usually no history of dyspepsia
board like rigidity
70% have free air under diaphragm (FAUD)
management of perforated duodenal ulcer?
resuscitate antibiotics theatre usually (not always needed) patch repair (cover with a piece of ommentum) eradicate H pylori
what is classed as colonic emergency?
obstruction volvulus acute diverticulitis toxic colitis perforations (stercora (constipation related), iatrogenic, anastomotic leaks)
management of volvulus?
decompress with rigid sigmoidoscope
management of malignant obstruciton?
stent or operate
management of diverticulitis>
spectrum from antibiotics to hartmanns procedure
management of typhitis?
antibiotics or surgery
management of perforations?
stercoral = remove colon (subtotal may be needed) leaks = theatre
