Acute Abdomen

Question 1

what colour is fresh bile?

Answer 1

yellowish

not really green

Question 2

signs to check for in acute abdo?

Answer 2

pain
localised peritonism
generalised peritonitis (board like)
guarding
rebound tenderness
rosvigs sign

Question 3

when might bowel sounds be absent?

Answer 3

obese people

absent in ileus

Question 4

what does tinking bowel sounds indicate?

Answer 4

obstruction

Question 5

important part of rectal examination?

Answer 5

must document reason why it was done

only do when appropriate and during abdo exam

Question 6

analgesia in acute abdo?

Answer 6

IV morphine
IV paracetamol
(add anti-emetic if strong pain killer)

Question 7

initial management in acute abdo?

Answer 7

ABCDE
analgesia
observations
urinalysis
give oxygen
give fluids
treat nausea and pain
(think how youll resuscitate if needed)

Question 8

things to look at ina cute abdo patient from end of bed?

Answer 8

look unwell?
moving around or still?
hlding abdomen?
sick bowl/sick around them?
scars?
moribound?

Question 9

types of scars on abdomen?

Answer 9

//////

Question 10

cullens vs grey tueners sign?

Answer 10

cullens = around umbilicus
grey turners = on flanks
bruising which indicates pancreatitis

Question 11

what is erythema ab iigne?

Answer 11

mottling from heat

hot water bottle rash

Question 12

other possible sings on abdomen which may be less relevant in acute abdo?

Answer 12

caput medusae
jaundice
striae
masses

Question 13

initial blood investigations in acute abdo?

Answer 13

FBC
LFT
U&Es
CRP
Ca
Lactate
Coagulation screen (if needed)
AMYLASE
AMYLASE
AMYLASE

Question 14

other intials investigations?

Answer 14

ABGs
plain radiology
AXR
erect CXR if possible
may go straight to CT if acutely unwell

Question 15

why is erect CXR useful?

Answer 15

useful if abnormal
excludes basal pneumonia etc
free air under diaphragm could be relevant

Question 16

type of CXR if too ill to stand?

Answer 16

lateral decubitus

Question 17

use of plain AXR?

Answer 17

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

Question 18

use of CT in acute abdo?

Answer 18

gold standard

early CT associated with better outcome due to faster diagnosis

Question 19

use of US in acute abdo?

Answer 19

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

Question 20

when might MRI be used in acute abdo?

Answer 20

pregnant women
(dont want to use CT in pregancy due to radiation)
can show appendicitis etc in pregnant women

Question 21

what things must you look for and exclude to prevent quick death?

Answer 21

pancreatitis
AAA
ALWAYS LOOK AT SCANS AND RECORD RESULT

Question 22

main catagories of surgery in acute abdo?

Answer 22

laparotomy (open them up)

laparoscopy (key hole)

Question 23

when might you do nothing?

Answer 23

diverticulitis etc

but always actively observe

Question 24

who must go to theatre immediately?

Answer 24

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)

Question 25

presentation of perforated duodenal ulcer?

Answer 25

usually no history of dyspepsia
board like rigidity
70% have free air under diaphragm (FAUD)

Question 26

management of perforated duodenal ulcer?

Answer 26

resuscitate 
antibiotics
theatre usually (not always needed)
patch repair (cover with a piece of ommentum)
eradicate H pylori

Question 27

what is classed as colonic emergency?

Answer 27

obstruction
volvulus
acute diverticulitis
toxic colitis
perforations (stercora (constipation related), iatrogenic, anastomotic leaks)

Question 28

management of volvulus?

Answer 28

decompress with rigid sigmoidoscope

Question 29

management of malignant obstruciton?

Answer 29

stent or operate

Question 30

management of diverticulitis>

Answer 30

spectrum from antibiotics to hartmanns procedure

Question 31

management of typhitis?

Answer 31

antibiotics or surgery

Question 32

management of perforations?

Answer 32

stercoral = remove colon (subtotal may be needed)
leaks = theatre