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NMF: General Surgery > Acute abdomen > Flashcards

Acute abdomen Flashcards

1
Q

What colour is bile?

A

golden yellow

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2
Q

What does coffee ground vomit suggest?

A

bleeding from stomach

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3
Q

What does peritonitis feel like?

A

rigid abdomen

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4
Q

What does generalised peritonitis feel like?

A

board-like

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5
Q

What is Rovsig’s sign?

A

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

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6
Q

When are bowel sounds useful?

A

tinkling in obstruction

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7
Q

What signs of pancreatitis can be seen on examination?

A

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

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8
Q

What approach is used for most acute abdomen surgeries ?

A

midline laparotomy

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9
Q

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

A 
fbc
u+es
lft
calcium
CRP
lactate
AMYLASE
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10
Q

What two diagnoses must be excluded in acute abdomen?

A

pancreatitis

ruptured AAA

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11
Q

Why is amylase measured with acute abdomen?

A

to check for pancreatitis

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12
Q

What is the gold-standard investigation in acute abdomen?

A

CT

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13
Q

When is ultrasound useful in acute abdomen?

A

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

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14
Q

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

A

MRI

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15
Q

Which diagnoses require immediate surgical management?

A

ischaemic gut

faecal peritonitis

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16
Q

How does perforated duodenal ulcer present?

A

sharp sudden pain which is either general or epigastric

board-like rigidity, lying still

17
Q

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

A

colic is coming and going so patient wriggles/paces

peritonism is constant and patient lies still

18
Q

What is seen on imaging of perforation ?

A

free air under diaphragm

19
Q

What colour is blood from colonic bleeding?

A

bright or dark red

20
Q

Bleeding from which area results in malaena?

A

Upper GI bleed eg small intestine

21
Q

Why is fluid resuscitation necessary in bowel obstruction?

A

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

22
Q

What causes obstruction of small bowel?

A

adhesions

herniae

23
Q

What causes obstruction of large bowel?

A

malignancy
diverticulitis
volvulus

24
Q

What are signs of hypovolaemia?

A

tachycardia
hypotension
pale and clammy
cool to touch

25
Q

What causes peritonitis?

A

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

26
Q

How should haematemesis or melaena be investigated?

A

oesophagogastroduodenoscopy (OGD)

27
Q

What is melaena?

A

tarry black stools with offensive smell and hard to flush away

28
Q

What causes melaena?

A

peptic ulcer
variceal bleed
ulcerating malignancy

29
Q

What blood tests may indicate an upper GI bleed?

A

drop in haemoglobin

rise in the urea:creatinine ratio

30
Q

What is the most common cause of lower GI bleeding?

A

diverticulosis

31
Q

How should rectal bleeding be invesigated?

A

flexible sigmoidosopy or colonoscopy

32
Q

What is IV triple therapy?

A

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

33
Q

How does pancreatitis present?

A

sudden, severe upper abdominal pain radiating to the back

34
Q

What causes pancreatitis?

A

GET SMASHED
gallstones
ethanol
trauma

steroids
mumps
autoimmunr
scorpion
hypercalcaemia
ERCP
drugs
35
Q

How should pancreatitis be investigated?

A

clinical signs + amylase = clinical diagnosis

US to see if gallstones are the cause

CT if uncertain diagnosis or looking for necrosis, pseudocysts…

36
Q

How should mild pancreatitis be managed?

A

fluid resus
analgesia
monitor fluid output

37
Q

How should severe pancreatitis be managed?

A 
fluid resus
monitor pulmonary oedema and renal function (due to hypoperfusion)
correct electrolyte imbalance
rule out necrosis
proph antibiotics
TPN nutrition
38
Q

What mneumonic can be used to diagnose appendicitis in children?

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

NMF: General Surgery (8 decks)

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