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Year 4 diagnostics > Acute abdomen - generalised pain > Flashcards

Acute abdomen - generalised pain Flashcards

1
Q

What is abdominal and pelvic ultrasound useful for?

A

Especially useful for biliary, renal and gyaecological disease

  • Acute cholecystitis
  • Ovarian pathology - torsion, haemorrhagic cyst, ectoptic pregnancy
  • Acute appendicitis - to rule out gynae pathology, appendix is not always visualised
  • Renal calculi +/- hydronephrosis

Less helpful in large body habitus

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2
Q

Serious differential diagnoses to rule out if patient has generalised abdominal pain

A
  • Intra abdominal haemorrage
  • Viscus organ perforation
  • Mesenteric iscahemia
  • Bowel obstruction
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3
Q

Viscus organ perforation causes peritonitis, what is peritonitis?

A

Inflamation of the peritoneum

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4
Q

What are the two causes of perforation?

A
  • Perforated gastroduodenal ulcer - upper abdomen
  • Colonic diverticulitis - lower abdomen
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5
Q

Clinical signs of peritonitis

A
  • rigid abdomen
  • involuntary gaurding
  • patient lying completely still (to avoid exacerbating pain)
  • deranged observations, inflamatory markers and lactate
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6
Q

Management of bowel perforation

A

Usually requires prompt surgical repair and washout to prevent contents from spilling into the peritoneum and causing abdominal sepsis.

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7
Q

Imaging investigations for perforation

A
  • Erect chest X-rays
    • first line imaging test
    • sensitive to free intraperitoneal gas
    • patient must be erect/semi-erect for at least 10 minutes
  • Abdominal X-rays
    • less sensitive for free intra-peritoneal gas
  • CT abdomen and pelvis
    • to identify pathology
    • after X-ray has confirmed intraperitoneal gas
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8
Q

Describe bowel obstruction

A

Mechanical blockage of the bowel

  • Structural pathology physically blocks the passage of intestinal contents
  • Proximal bowel becomes prgressively dilated
  • Urgent! If not promptly relieved bowel will become ischaemic, necrotic and perforate
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9
Q

SIgns and symptoms of bowel obstruction

A
  • Absolute constipation (no gas or faeces)
  • Colicky general abdominal pain
  • Nausea and vomiting
  • Distended abdomen
  • Absent bowel sounds
  • Deranged observations, inflammatory markers and lactate
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10
Q

Imaging investigations for bowel obstruction

A
  • CT
    • test of choice
    • confirms diagnosis and identifies the cause
  • Abdominal X-ray
    • Limited utility - can be normal
    • Unlikely to diagnose cause of obstruction
      • Except cases of volvulus or ulcerative colitis with toxic megacolon
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11
Q

Characteristics of small bowel

A
  • Centrally distributed
  • Valvulae conivantes (mucosal folds that go across the full width of bowel
  • Maximal normal diameter is 3cm
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12
Q

Characteristics of large bowel

A
  • Transverse colon and sigmoid colon are intraperitoneal and will move about the abdomen
  • Haustra (incomplete marking - do not go the full way around)
  • Maximal normal diameter is 6cm, except the caecum which is 9cm
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13
Q

Causes of small bowel obstruction

A
  • Common causes
    • Adhesions
    • Hernia
  • Other causes
    • Strictures
    • Tumour (benign or malignant)
    • Intussuception
    • Volvulus
    • Foreign bodies
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14
Q

What is the likely cause of a small bowel obstuction if no obvious cause can be seen on CT?

A

Abdominal adhesion

Adhesions cannot be seen on CT and are a diagnosis of exclusion.

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15
Q

Causes of large bowel obstruction

A
  • Common causes
    • Tumour
    • Volvulus
  • Other cause
    • Diverticular disease
    • Hernia
    • Foreign body
    • Extensive faecal impaction
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16
Q

Signs and symptoms of abdominal aortic aneurysm

A
  • Generalised abdominal pain, back/loin pain (often mistaken for renal colic)
  • Collapse
  • Hypotensive
  • Pulsatile abdominal mass
  • Lower limb ischaemia
17
Q

Imaging investigation for suspected ruptured abdominal aortic aneurysm

A

CT abdomen and pelvis aterial phase (contrast in the arteries)

18
Q

Signs and symptoms of mesenteric ischaemia

A
  • Generalised abdominal pain out of proportion to examination
  • Abdominal examination often unremarkable
  • High lactate
19
Q

Risk factors for mesenteric ischaemia

A
  • Arteriopaths - angina, previous MI, peripheral vascular disease
  • AAA, AF, heart valve intervention, DVT, PE
20
Q

Outcome from mesenteric ischaemia is untreated

A

Bowel ischaemia, necrosis, perforation

21
Q

Causes of mesenteric ischaemia

A
  • Mesenteric artery thromboembolism
    • emboli thrown off from the heart (AF/ valve intervention) or AAA
    • chronic atherosclerotic thrombosis
  • Non-occlusive isachemia (related to hypotension)
  • Mesenteric venous thrombosis - rare
22
Q

Imaging investigations for mesenteric ischaemia

A

CT abdomen and pelvis (arterial and portal venous phases, AKA mesenteric angiogram)

Year 4 diagnostics (6 decks)

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