Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GASTROENTEROLOGY > Acute Abdomen and Surgical Emergency **** > Flashcards

Acute Abdomen and Surgical Emergency **** Flashcards

1
Q

List some causes:

  • Inflammation - 7
  • Rupture/perforation - 8
A 
Appendicitis 
Diverticulitis 
Cholecystitis 
GE
Salpingitis (PID)
IBD
Pyelonephritis 
Spleen 
AAA
Peptic ulcer 
Appendix
Bowel 
Gallbladder
Ectopic pregnancy 
Ovarian cyst
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

List some causes:

  • Torsion and strangulation - 3
  • Chest - 2
  • Bowel - 1
  • Gynae - 1
  • After surgery - 1
A

Strangulated hernia
Ovarian cyst torsion
Testicular torsion

Lower lobe pneumonia
Inferior MI

Bowel obstruction and ischaemia

Endometriosis

Adhesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

S+S - Visceral (organ) pain:

Is it well or poorly localised?

What type of pain do you get with obstruction and why?

Where is the pain for foregut structures (oesophagus to the ampulla of Vater)?

Where is the pain for midgut structures (to transverse colon)?

Where is the pain for hindgut structures (to proximal rectum)?

A

Poorly localised pain

Colicky pain due to waves of peristalsis push against obstruction

Epigastric pain

Umbilical pain

Suprapubic pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

S+S - Parietal pain (peritonitis):

Is it well or poorly localised?

Why does the patient lie still?

What is guarding?

What is rigidity?

They can also get pain or tenderness that occurs upon sudden release of pressure on the abdomen. What is this called?

A

Well localised

Pain is made worse by movement

Involuntary contraction of abdo muscles when palpated

Contraction of abdo muscles at rest

Rebound tenderness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

S+S:

What do rigors suggest?

A

Cholangitis

Pyelonephritis

Intra-abdominal abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Investigations:

  • Bedside and why? - 2
  • Bloods and why? - 6
  • Imaging - 4
A

Urine dip - UTI
ABG - acid/alk

FBC and U&E - WBC for infection and dehydration
Coag and group and save - if surgery is needed
LFT - function
Beta hCG - ectopic
CRP - inflammation
Lactate - sepsis

USS
Erect CXR
AXR
CT abdo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Initial management:

Medications

What should be instructed to the patient?

What should be considered in young women?

A

Analgesia
Antibiotics
IV fluids

NMB - nil-by-mouth

Consider USS and/or exploratory laparoscopy before CT abdo, due to the radiation risk (including to foetus) and CT is less useful for many gynae problems.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Investigations - RIF pain:

Bedside and why - 1
Bloods and why - 3
Tests for females - 2

What should be done on their bedside and what should they be instructed to do if you suspect appendicitis?

A

Urine dip - UTI

FBC - WBC and coag
U&E - dehydration
CRP - inflammatory

Beta hCG and USS

IVT and NBM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Investigations - LIF pain:

Tests for females - 2

What should be suspected if they are older and how should they be managed?

A

Beta hCG and USS

Diverticulitis - ABs IV fluids and CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Investigations - RUQ pain:

Key history questions? - 2

Bloods and why? - 4

Why is an USS done? - 3

A

Previous gallstones or USS

FBC - WBC and coag
U&E - dehydration
LFTs - liver function
Amylase - pancreatitis or obstruction

Gallstones or common bile duct dilation
MRCP should be done if CBD dilated and LFTs are raised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Investigations - Epigastric pain:

Key history questions? - 4

Bloods and why? - 4

Imaging done? - 1

A

Previous OGD, peptic ulcers, gallstones or pancreatitis

FBC - WBC and coag
U&E - dehydration
LFTs - liver function
Amylase - pancreatitis or obstruction

Erect CXR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Investigations - Generalised pain:

Key history questions - 4

Bloods and why? - 6

Why should an ABG be done?

Imaging - 2

Bedside and why? - 1

How should this person be managed int he meantime?

A

Bowel habit
Features of obstructions
Perforation
Ischaemia

FBC - WBC and coag
U&E - dehydration 
LFTs - liver function 
Amylase - pancreatitis or obstruction
CRP - inflammation
Lactate - sepsis

Lactic acidosis

CXR and AXR

Urinalysis - UTI

Analgesia
NBM
IV fluids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Lower Gi Bleed:

List some causes

A 
Diverticular disease 
Colorectal carcinoma or polyps 
Vascular - haemorrhoids, angiodysplasia 
Anal fissure 
IBD usually UC 
Ischaemic colitis 
GE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Lower GI bleed:

What is haematochezia?

What symptom could you have in IBD or GE?

What symptom could you have with cancer?

A

Fresh red blood PR

Fever

Weight loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Lower GI bleed - investigations:

What should be done initially if it is acute?

Bloods and why? - 2
Imaging? - 2

A

ABCDE + fluids

FBC - Raised WBC - infection
Coag and cross match

CT abdo-pelvis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Lower GI bleed - investigations:

Colonoscopy is used to localise the source. How can the bleeding be stopped if it is acute and the patient is unstable? - 3

What can be done?

A

Haemostasis using adrenaline, thermal coagulation and/or clipping

Mesenteric angiography and embolisation - visualisation of mesentery using contrast

17
Q

Nasogastric tube placement:

Indications - 3

Contraindications

A

Nasogastric decompression (e.g. due to bowel obstruction - drip and suck)
Feeding
Giving drugs

Basal skull fracture
Severe facial or nasal trauma
Varices or stricture, coagulopathy

18
Q

Nasogastric tube placement:

NEX is used to determine what length of tube to put in. What does this stand for?

How can the passage be made easier?

A

Nose to ear to the xiphoid

Wetting tube - NO LUBRICANT

19
Q

Nasogastric tube placement:

What if first-line to check placement?

CXR is next line. What would you look for that indicates it has entered the stomach? - 3

A

pH paper (should be <5.5) with the aspiration of gastric contents

Bisects the carina
Crosses diaphragm in the midline (as oesophagus enters the abdomen with the aorta and IVC)
Tip visible beneath the diaphragm

20
Q

Nasogastric tube placement:

Complications - 5

A 
Local trauma (nosebleed)
Tube into lungs and aspiration pneumonitis 
Oesophagitis 
Perforation 
Vocal cord paralysis
21
Q

Complications of abdominal surgery - Immediate (<24 hrs):

Intubation complication - 1
Anaesthetic complication - 1

Complications in the surgery itself?

A

Mouth or teeth trauma

Anaphylaxis

Infection
Primary haemorrhage during operation (vessel trauma)
Reactionary haemorrhage occurs within 24 hours of operation
Most cases of reactive haemorrhage are from a ligature that slips or a missed vessel. These vessels are often missed intraoperatively due to intraoperative hypotension and vasoconstriction, meaning only once the blood pressure normalises post-operatively will this bleeding occur

Damage to surrounding structures

22
Q

Complications of abdominal surgery - Early (<1 wk):

Fever - what are the 7C’s for causes?

A 
Cut (wound)
Chest
Catheter
Cannuka 
Central line 
Collection 
Calves (DVT)
23
Q

Complications of abdominal surgery - Early (<1 wk):

What is atelectasis?

What is the cause?

What may it lead to?

What else could occur due to immobility to the lungs and legs?

A

The collapse or closure of a lung resulting in reduced or absent gas exchange.

Shallow breathing due to pain

Pneumonia

PE and DVT

24
Q

Complications of abdominal surgery - Early (<1 wk):

What can happen to the GI tract?

GU - you can also get reduced urine output. What may cause it?

A

Paralysis of GI tract causing obstruction

Retention
Blocked catheter
AKI 
Pain (post-hernia)
BPH 
Drugs (opioids, anticholinergics)
25
Q

Complications of abdominal surgery - Early (<1 wk):

The wound could reopen. What is this called?

A

Wound dehiscence

26
Q

Approach to post-op sick patient MNEUMONIC:

SIMPLE

A 
Sepsis 
Ileus 
MI
Pneumonia 
Anastomotic (L)eak 
Embolus - PE/DVT

GASTROENTEROLOGY (54 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions