Acute Abdomen Flashcards
Presentation of appendicitis?
Young 5-40 Acute onset Umbilical pain that moves central to RIF Staying still to avoid pain implies peritonitis
Signs for appendicitis?
Rovsings Copes -> pain on progressive flexion and internal rotation of the hip Psoas -> pain on hip extension (retrocaecal appendix) Rebound tenderness -> peritoneum involvement
Appendicitis Ix?
1st line = CT abdo, USS and bloods (leukocytosis and increased CRP) Use alvarado score for signs symptoms and lab values 1-4 = doscharge 5-6 observe and 7-10 = surgery
Management of appendicitis?
Cefotaxime and metronidazole as Abx Appendicectomy
A=
B = Paramedian (kidneys, adrenal, spleen)
C= Subcostal (GB, biliary tract, spleen)
D= chevron (gastrectomy, bilateral adrenealectomy)
E= loin (kidneys)
F = Mcburneys
G = Lanz (appendicectomy with better scar healing)
H = Pfannenstiel (caesarian, Lower GiT, Urinary tract
Complications of appendicitis?
Perforation (common on faecolith + kids)
Appendix mass (inflamed can be covered in omentum)
Appendix abscess
What classification is used for diverticular disease and stages?
Hinchey classification
1a: phlegmon
1b and 2: localised abscess
3: perforation with purulent peritonitis
4: faecal peritonitis
Presentation and aetiology of diverticular disease?
5o -70YO, asymptomatic life, LOW DIETARY FIBRE, smoker, NSAIDS
Bloody stool, fever, N+V, anorexia, urinary symptoms (fistulation to bladder = pneumaturia,faeculuria and recurrent UTIs)
LIF pain and bloating
Most common in sigmoid
Inspection and palpation of diverticular disease?
Tachycardia and low grade pyrexia. peritonits (lying still)
LIF tenderness and guarding, riity and rebound tenderness
Diverticular Ix?
Acute: CT abdo +- erect CXR for perforation
Chronic diverticulosis: barium enerma +- flexi/colonoscopy
Bloods (RBC,CRPclotting)
Dont do barium enema if perfration suspected
Diverticular management?
Mild Itis: PO Abx
Severe Itis: IV Abx + fluids + rest
Surgical = Hartmanns (gives end colostomy and anorectal stump)
Diverticolosis: soluble, high fibre diet and maybe primary anastomosis for surgery (may have a defunctioning loop ileostomy to allow anastamosis to heal). This can also be used for rectal carcinomas and distal large bowel cancers
Complications of diverticular disease?
Diverticulitis, faecal peritonitis, Fistulas and peri-colic abscess, colonic obstruction and perforation
Where do spigelian hernias occur?
On linea semilunaris of the abdomen
Hernia aetiology and presentation?
Age, obseity, constipation, chronic cough, heavy lifting (general increased intra-abdominal pressure)
Lump in groin
Groin pain
Vomiting
Scrotal swelling
Differences between femoral and inguinal hernias?
Femoral more common in femals and more commonly strangulated. Surgery recommended and in lder people
Inguinal more common overall, less commonyl strangulated, can be treated withut surgery and in younger people
Femoral canal borders?
Anterosuperiorly by inguinal ligament
Posterior : pectineal ligament lying anterior to sup. pubic ramus
Medial: lacuna ligamen
Lateral: femoral vein