Acute abdomen

Question 1

What colour is bile?

Answer 1

golden yellow

Question 2

What does coffee ground vomit suggest?

Answer 2

bleeding from stomach

Question 3

What does peritonitis feel like?

Answer 3

rigid abdomen

Question 4

What does generalised peritonitis feel like?

Answer 4

board-like

Question 5

What is Rovsig’s sign?

Answer 5

when you press left side of abdomen pain is felt in the right which indicates appendicitis

Question 6

When are bowel sounds useful?

Answer 6

tinkling in obstruction

Question 7

What signs of pancreatitis can be seen on examination?

Answer 7

cullens sign (periumbilical bruising) and grey turner sign (flank bruising)

Question 8

What approach is used for most acute abdomen surgeries ?

Answer 8

midline laparotomy

Question 9

What blood tests should be performed on all acute abdomen admissions?

Answer 9

fbc
u+es
lft
calcium
CRP
lactate
AMYLASE

Question 10

What two diagnoses must be excluded in acute abdomen?

Answer 10

pancreatitis

ruptured AAA

Question 11

Why is amylase measured with acute abdomen?

Answer 11

to check for pancreatitis

Question 12

What is the gold-standard investigation in acute abdomen?

Answer 12

CT

Question 13

When is ultrasound useful in acute abdomen?

Answer 13

RUQ pain to check for gallstones
RIF/pelvic pain in women
children

Question 14

What imaging is best in a pregnant woman with acute abdomen?

Answer 14

MRI

Question 15

Which diagnoses require immediate surgical management?

Answer 15

ischaemic gut

faecal peritonitis

Question 16

How does perforated duodenal ulcer present?

Answer 16

sharp sudden pain which is either general or epigastric

board-like rigidity, lying still

Question 17

How does a patient with colic pain differ to a patient with peritonism?

Answer 17

colic is coming and going so patient wriggles/paces

peritonism is constant and patient lies still

Question 18

What is seen on imaging of perforation ?

Answer 18

free air under diaphragm

Question 19

What colour is blood from colonic bleeding?

Answer 19

bright or dark red

Question 20

Bleeding from which area results in malaena?

Answer 20

Upper GI bleed eg small intestine

Question 21

Why is fluid resuscitation necessary in bowel obstruction?

Answer 21

proximal limb of bowel dilates and peristalsis increases which leads to secretion of large volumes of electrolyte rich fluid

Question 22

What causes obstruction of small bowel?

Answer 22

adhesions

herniae

Question 23

What causes obstruction of large bowel?

Answer 23

malignancy
diverticulitis
volvulus

Question 24

What are signs of hypovolaemia?

Answer 24

tachycardia
hypotension
pale and clammy
cool to touch

Question 25

What causes peritonitis?

Answer 25

perforated viscous organ eg due to peptic ulcer, diverticular disease, obstruction or IBD

Question 26

How should haematemesis or melaena be investigated?

Answer 26

oesophagogastroduodenoscopy (OGD)

Question 27

What is melaena?

Answer 27

tarry black stools with offensive smell and hard to flush away

Question 28

What causes melaena?

Answer 28

peptic ulcer variceal bleed ulcerating malignancy

Question 29

What blood tests may indicate an upper GI bleed?

Answer 29

drop in haemoglobin | rise in the urea:creatinine ratio

Question 30

What is the most common cause of lower GI bleeding?

Answer 30

diverticulosis

Question 31

How should rectal bleeding be invesigated?

Answer 31

flexible sigmoidosopy or colonoscopy

Question 32

What is IV triple therapy?

Answer 32

amoxicillin, clarithromycin, and a proton pump inhibitor such as omeprazole

Question 33

How does pancreatitis present?

Answer 33

sudden, severe upper abdominal pain radiating to the back

Question 34

What causes pancreatitis?

Answer 34

GET SMASHED gallstones ethanol trauma ``` steroids mumps autoimmunr scorpion hypercalcaemia ERCP drugs ```

Question 35

How should pancreatitis be investigated?

Answer 35

clinical signs + amylase = clinical diagnosis US to see if gallstones are the cause CT if uncertain diagnosis or looking for necrosis, pseudocysts...

Question 36

How should mild pancreatitis be managed?

Answer 36

fluid resus analgesia monitor fluid output

Question 37

How should severe pancreatitis be managed?

Answer 37

``` fluid resus monitor pulmonary oedema and renal function (due to hypoperfusion) correct electrolyte imbalance rule out necrosis proph antibiotics TPN nutrition ```

Question 38

What mneumonic can be used to diagnose appendicitis in children?

Answer 38

``` MANTRELS migration of pain from umbilicus to RIF anorexia N+V temperature rebound tenderness elevated leukocytes ```