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Year 3 - Met3a > Acute abdomen > Flashcards

Acute abdomen Flashcards

1
Q

What is the definition of an acute abdomen

A
  • Abdominal pain of non-traumatic origin with a maximum duration of 5 days
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2
Q

How do you classify the cause of the acute abdomen

A
  • think about it in terms of location and the anatomical causes that can be causing it
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3
Q

what could it be if you had pain in the right upper quadrant

A

hepatitis
billary colic
cholecystits

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4
Q

what could it be if you had pain in the left upper quadrant

A

Gastritis
gastric ulcers
spleen

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5
Q

What could it be if you thinking about the epigastric region

A
  • duodenal ulcer

- pancretitis

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6
Q

If there is pain in the right lower abdomen what could it be

A

appendicitis

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7
Q

if there is pain in the left lower abdomen what could it be

A
  • diverticulum
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8
Q

What is the most common urgent abdominal pain

A

appendicitis

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9
Q

What are the uregent causes of abdominal pain that can be fatal

A 
Bleeding 
• AAA
• Ulcer
• Ectopic
• (Trauma)
Perforation 
• Ulcer
• Obstruction 
• IBD
• Diverticulitis

Ischaemia
• Mesenteric
• Cardiac

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10
Q

how do you assess the patient

A

Airway
Breathing
Circulation

then

  • history
  • examination
  • investigation
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11
Q

How do you measure pain

A

SOCRATES

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12
Q

What does SOCRATES stand for

A 
S - site 
O - onset 
C - character 
R - radiation 
A - associated features 
T - timing 
E - exacerbating/relieving 
S - severity
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13
Q

What are associated features with pain

A
  • Bowel habit
  • nauesa and vomitting
  • bleeding
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14
Q

What should be considered in a history

A
  • Past medical history
  • Drug history (inc allergies)
  • Surgical history
  • Gynaecological history
  • Family history
  • Social history
  • Systems review
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15
Q

What should they look for on examination

A
  • Analgesia
  • Scars/stomas
  • Distention
  • Tenderness
  • Peritonism
  • Herniae
  • PR
  • Genitalia
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16
Q

what else should be examined

A
  • Appearance • Neck
  • CV
  • Chest
  • Extremities
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17
Q

What are the basic investigations that should be done

A
  • ECG
  • Urine dip
  • HCG
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18
Q

What type of blood investigations should you do

A
  • Blood gas
  • Hb
  • Glucose
  • pH, lactate, base excess
  • Creatinine
• FBC 
• U&E 
• LFT
- CRP 
- Amylase/lipase - particulary for looking at pancreatitis
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19
Q

What blood marker is used for pancreatitis

A

Amylase/lipase

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20
Q

what radiograpsh are used for the abdomen

A
  • erect chest

- suprine abdomen x rays

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21
Q

Why are erect chest x ray good and bad for looking at the abdomen

A

Bad

  • more useful for looking at primary chest pathology
  • little effect of CXR on diagnosis
  • poor senstivity for perforation (33%) - therefore if there is a perforation it could be missed

Good

  • look for a performation under the diaphragm
  • look for free air under the diaphargm which suggests perforation
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22
Q

What are the good and bad uses of abdomen x ray

A
  • can visulaise walls of the bowel
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23
Q

How do you know that you are looking at the small intestines

A

in the centre

24
Q

How do you know you are looking at the large intestine

A
  • Haustra
25
Q

what is now hte imaging of choice for actue abdominal presentations

A

CT

26
Q

What is the good and bad of using an abdominal CT

A

Good

  • accurate across a range of diagnoses
  • good sensitivity and specficity
  • influences outcome and management

Bad
- high risk of ionising radiation

27
Q

What are the good and bad of using an ultrasound

A

Bad

  • operator depednent
  • not suitable for surgical planning
  • less senstiive than CT for most pathologies
  • bad for diagnosing appendicitis

good

  • good for evaluating potential gynaecological causes
  • cost effective
  • harmless
  • readily avaliable
  • highly sensitive and 1st line for biliary pathology
28
Q

What is ultrasound used in for 1st line choice

A

in bilary pathology ultrasound is the 1st choice

29
Q

what is the role of laproscopy

A
  • less use now as imaging becomes more effective and widespread
  • should be considered when imaging inconclusive adn suspicion of urgent cause is high
  • most useful in women of childbearing age
30
Q

when you are pregnant where does appedicitis present

A
  • everything is pushed up so it could go to the right upper quadrant
31
Q

Why should you consider someones age when imaging

A
  • physioloigcal differences
  • medications
  • exisiting medical problems
  • frailty
  • cognitive bias
  • low threshold for CT
32
Q

analgesia does not mask …

A

clinical signs in assesment of the acute abdomen and should not be withhled

33
Q

How can you quantify the risk of someone having appendicitis

A

Alvarado score and AIR score

34
Q

what is the peak around appendicitis

A
  • peaks around 30 years
35
Q

Who is appendicits more common in

A
  • more common in males although appendicectomy slighly more common in females
36
Q

what are the stages of appendcitis

A
  • suppurative stage
  • gangrenous stage
  • perforated stage
37
Q

what are the clinical features of appendicitis

A
  • central pain migrating to RIF
  • anorexia
  • nausea
  • tachycardia
  • low grade fever
38
Q

What is the most common position of the appendix

A
  • retrocecal
39
Q

How do you manage appendicitis

A
  • surgical removal of the appendix - either by open or laparoscopic
40
Q

what can cause complicated appendicitis

A
  • perforation
  • appendix mass
  • appendix abscess
  • appendicular tumours
41
Q

What can cause acute pancreatitis

A
  • gallstones
  • alcohol
  • hyperlipidaemia
42
Q

What criteria is used for acute pancreatitis

A

SERS criteria

43
Q

What imaging is used for actue pancreatits

A

Ultrasound

44
Q

How do you treat acute pancreatits

A
  • conservative management
  • further imaging
  • treat cause
  • treat complications
45
Q

what are the signs of abdominal aortic aneurysm

A
  • back pain
46
Q

What are rupture risk factors for an AAA

A
  • diameter
  • volume
  • wall stress
47
Q

What can sudden onset of pain be due to

A
  • perforation
  • rupture
  • torsion (e.g. Ovarian cyst)
  • acute pancreatitis
  • infarction
48
Q

What causes a gradual onset of pain

A
  • inflammatory conditions (e.g. appendicitis)
49
Q

What causes back pain

A
  • pancreatitis
  • rupture of aortic aneurysm
  • renal tract disease
50
Q

When is a laparotomy required

A
  • rupture of an organ e.g. spleen, aorta, ectopic pregnancy

- peritonitis

51
Q

What are the symptoms of a rupture of the organ

A
  • Shock leading sign; assess blood loss
  • abdominal swelling

Any history of trauma

  • blunt trauma - spleen (may be delayed by weeks)
  • Penetrating trauma - liver
  • peritoneum - may be mild
52
Q

What can cause peritonitis

A
  • perforation of peptic ulcer/duodenal ulcer
  • diverticular
  • appendix
  • bowel
  • gallbladder
53
Q

What are the signs of peritonitis

A
  • prostration
  • shock
  • lying still
  • positive cough test
  • tenderness (+- rebound/percussion pain)
  • board-like abdominal rigidity
  • guarding
  • No bowel sounds
  • Erect CXR may show gas under the diaphragm
54
Q

When is a laparotomy not required

A
  • Local peritonitis

- colic

55
Q

What can cause local peritonitis

A
  • diverticulitis
  • cholecystitis
  • salpingitis
  • appendicitis
56
Q

What should you do instead of a laparotomy for local peritonitis

A
  • if abscess formation suspected (swelling, swinging fever, increased WCC) do an US or CT
  • ## drainage can be percutaneous (US or CT guided) or by laparotomy
57
Q

What does colic feel like

A
  • regularly waxing and waning pain
  • caused by muscular spasm in a hollow viscus (e.g. gut, ureter, bile duct, gallbladder)
  • Gallbladder in the latter pain is often dull and constant
  • causes restlessness and the patient may be pacing around

Year 3 - Met3a (43 decks)

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