Acute Abdomen: Obstruction, Perforation, Inflammation

Question 1

What happens when perforation occurs in the acute abdomen?

Answer 1

direct communication of organ with peritoneum

Question 2

What happens when here is peroration of the stomach/small intestine/large bowel? (3)

Answer 2

1. rapid bacterial and chemical spread
2. peritonitis
3. septicaemia

Question 3

What are the clinical signs of perforation? (3)

Answer 3

1. severe pain
2. lies still in bed
3. rigid board like abdomen

Question 4

What is seen on x-ray in a perforation?

Answer 4

air under the diaphragm

Question 5

How can peritonitis be treated? (2)

Answer 5

1. control of infection

2. sealing/removal of perforation

Question 6

What are the consequence of bowel obstruction?

Answer 6

1. ischaemia
2. necrosis
3. perforation
4. inflammation

Question 7

What is the presentation of intestinal obstruction? (3)

Answer 7

1. abdominal pain and disension
2. constipation/obstipation
3. vomiting

Question 8

What are the common causes of intestinal obstruction? (4)

Answer 8

1. hernia
2. adhesion
3. intussusception
4. Volvulus

Question 9

Where do hernias usually occur? (4)

Answer 9

1. inguinal
2. femoral
3. para umbilical
4. surgical scars

Question 10

What are the complications of hernias?

Answer 10

1. bacterial invasion
2. transmural infarction
3. visceral peritoneal inflammation

Question 11

What causes intussusception?

Answer 11

1. reactive lymphoid hyperplasia in paediatrics

2. tumours in adults

Question 12

What is stool like with an intussusception?

Answer 12

1. red current jelly stool

Question 13

How is intussusception treated?

Answer 13

enema

Question 14

What is a volvulus?

Answer 14

twisting of any mesentrized viscous around its mesenteric root

Question 15

What are the watershed areas of the intestine?

Answer 15

1. splenic flexure

2. sigmoid colon to rectum

Question 16

What are the characteristics of acute intestinal ischaemia? (5)

Answer 16

1. sudden onset left lower abdominal pain
2. urge to defacate
3. +/- blood
4. elevated LDH
5. greater mortality if right sided

Question 17

What are the characteristics of chronic intestinal ischaemia?

Answer 17

1. mesenteric angina

2. post-prandial pain

Question 18

What is the pathology of acute intestinal ischaemia? (4)

Answer 18

1. usually complete occlusion
2. transmural
3. coagulative necrosis
4. gangrene

Question 19

What is the pathology of chronic intestinal ischaemia?

Answer 19

1. progressive stenosis
2. often mucosal
3. ulceration, surface inflamation
4. mural - fibrosis and stricture

Question 20

What are the complications of appendicitis? (7)

Answer 20

1. perforation
2. fistula
3. abscess
4. empyema
5. intussusception
6. pyophlebitis
7. liver abscess

Question 21

What mimics appendicitis? (4)

Answer 21

1. mesenteric lmphadenitis
2. merkel’s diverticulitis
3. salpingitis
4. ectopic pregnancy

Question 22

What is the typical clinical presentation of acute appenticitis? (4)

Answer 22

1. nausea/vomitting
2. low grade fever
3. periumbilical pain moving to the right iliac fossa
4. mild/moderate tenderness on examination at McBurney’s point

Question 23

What is the aetiology of acute appendicitis? (5)

Answer 23

1. inflammation secondary to obstruction
2. worms
3. faecolith
4. foreign bodies
5. lymphoid hyperplasia

Question 24

What is the pathogenesis of appendicitis? (6)

Answer 24

1. arterial pressure > tissue pressure > venous pressure
2. venous engorgement, stasis, venous infarction
3. blockage increased lumen pressure
4. bacterial invasion
   transmural infarction
5. visceral peritoneal inflammation
6. obstruction

Question 25

What is diverticular disease?

Answer 25

normal mucosa in abnormal place

Question 26

What is the pathogenesis of diverticular disease? (2)

Answer 26

1. weakness at the site of perforating arteries | 2. intraluminal pressure

Question 27

What is the clinical presentation of diverticular disease? (5)

Answer 27

1. most asymptomatic 2. lower abdominal discomfort/pain 3. variation in bowel habit 4. blood 5. +/ mass/tenerness

Question 28

What are the complications of diverticular disease? (5)

Answer 28

1. obstruction 2. diverticulitis 3. diverticular abscess 4. rupture and peritonitis 5. haemorrhage