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Surgery block > Acute abdomen SDL > Flashcards

Acute abdomen SDL Flashcards

1
Q

What is an acute abdomen problem?

A

Often sudden onset severe abdominal pain

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2
Q

What presentations of acute abdomen problems need urgent attention?

A

Acute bleeding
Perforated viscus
Ischemic bowel

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3
Q

What are the different types of intra-abdominal bleeding?

A

Intra-luminal - Into GIT
Extra-luminal - into abdominal cavity

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4
Q

What are some common causes of intra-abdominal bleeding?

A

Ruptured ectopic pregnancy
Bleeding peptic ulcer
Traumatic injury

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5
Q

How may untreated acute bleeding of the abdomen present?

A

Hypovolemic shock
Clinical features - tachycardia, pale/clammy, hypotension
At this stage may or may not present with abdominal pain

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6
Q

What are the key features of treatment for acute intra-abdominal bleeding?

A

Blood products available - major haemorrhage protocol
Resuscitation
Early investigations and interventions

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7
Q

What are some common causes of gastrointestinal perforation?

A

Peptic ulcer disease
Untreated bowl obstruction
Diverticular disease
Inflammatory bowel disease

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8
Q

How do patients with located gastrointestinal perforation tend to present?

A

Localised pain and peritonitis
Tachycardia
Pyrexia
(May not look unwell)

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9
Q

How do patients with generalised peritonitis typically present?

A

Tachycardia +/- hypotension
Pyrexia
Rigid abdomen
(Look unwell)

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10
Q

What is the typical management plan for patients with suspected perforated viscus?

A

Urgent resuscitation
Cross sectional imagaing prior to final management decision

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11
Q

What is the key clinical symptoms of ischemic bowel?

A

Severe pain out of proportion to the clinical signs
Often severe and constant pain, otherwise unremarkable examination

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12
Q

What investigations can indicate a bowel obstruction?

A

Raised WCC and CRP
Raised lactate and acidosis
Definitive diagnosis via CT with intravenous contrasts

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13
Q

What is colic?

A

Abdominal pain the crescendos to very severe and then goes away completely.

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14
Q

What are the different types of colic?

A

Biliary colic
Uteric colic
Bowel obstruction
NOTE - hollow viscus pathology
Differentiate based on triggers, tomining, routine blood tests and imaging

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15
Q

What is peritonism?

A

Locaised inflammation of the peritoneum, often due to inflammation of the viscus that then irritates peritoneum

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16
Q

What is the typical pattern of pain in peritonism?

A

Pain starts in one place (Irritation of visceral peritoneum), then locaised to one area (irritation of parietal peritoneum) or becoming generalised
For example acute appendicitis.

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17
Q

What is the pattern of pain presentation in acute appendicitis?

A

When pain often migrates from the umbilical region (visceral peritoneum of the midgut) to the right iliac fossa (irritation of parietal peritoneum)

18
Q

What conditions can result in pain in the RUQ of the abdomen?

A

Cholecystitis
Pyelonephritis
Uteric colic
Hepatitis
Pneumonia

19
Q

What are the common causes of pain in the LUQ?

A

Gastric ulcer
Pyelonephrtitis
Ureteric colic
Pneumonia

20
Q

What are the common causes of pain in the RLQ of the abdomen?

A

Appendicitis
Utertic colic
Inguinal hernia
IBD
UTI
Gynaecological
Testicular torsion

21
Q

What are some common causes of pain in the LLQ of the abdomen?

A

Diverticulitis
Ureteric colic
Inguinal hernia
IBD
UTI
Gynaecological
Testicular torsion

22
Q

What are some common causes of pain in the epigastric region?

A

Peptic ulcer disease
Cholecystitis
Pancreatitis
Myocardial infarction

23
Q

What are some common causes of pain in the peri-umbilical region?

A

Small bowel obstruction
Large bowel obstruction
Appendicitis
Abdominal aortic aneursym.

24
Q

What initial tests are often done in an acute abdomen scenario?

A

Urine dipstick - infection, haematuria, MC&S, pregnancy test
ABG - for tissue hypoperfusion and Hb level
Routine bloods - FBC, U&Es, LFT, CRP, amylase/lipase, cross match, G&S
ECG - pre-op and referred myocardial pain

25
Q

What imaging tests are often done for an acute abdominal presentation?

A

Erect chest plain film radiograph - eCXR - for air or lower lobe lung pathology
Abdominal plain film radiograph - AXR - recurrent volvulus
Ultrasound - renal tract, biliary tree, liver, uterus and adenexa
CT - pathology in GIT bowel perforation

26
Q

What is an acute abdomen presentation?

A

Abdominal pain that occurs suddenly and often severely

27
Q

What are the four different four causes of acute abdominal presentations?

A

Infection
Inflammation
Obstruction
Vascular occlusion

28
Q

What can cause pain in the right hypochondriac region?

A

Cholecystitis
Cholangitis
Hepatitis
Peptic ulcer disease
Fitzhugh curtis
Referred pain (pulmonary or cardiac)

29
Q

What can cause pain in the epigastric region?

A

Visceral pain from stomach, proximal duodenum, liver, pancreas and biliary structures.
Peptic ulcer disease
Gastritis
Pancreatitis
Gastroparesis
Referred pain (pulmonary and cardiac)

30
Q

What can cause pain in the lumbar regions of the abdomen?

A

Kideny stones
Complicated UTI
Anterior cutaneous nerve entrapment syndrome
Shingles
Referred pain from the UQ/LQ on associated side
Right lumbar may also be hepatitis

31
Q

What can cause pain in the umbilical abdominal region?

A

Visceral pain from the distal small intestine and proximal colon
Pancreatitis
Early appendicitis
Incarcerated umbilical hernia
IBD
Small bowel obstruction

32
Q

What can cause pain the right inguinal region of the abdomen?

A

Diverticulitis (asian descent)
Appendicitis
Inflammatory bowel disease
Kideny stones
Ovarian torsion
Ectopic pregnancy
Testicular torsion

33
Q

What can cause pain the the hypogastric region?

A

Visceral pain from distal colon, rectum and intraperitoneal genitourinary structures.
Sigmoid volvulus
IBD
Distal kidney stones
Cystitis

34
Q

What can cause pain in the left inguinal region of the abdomen?

A

Diverticulitis
Kidney stones
Ectopic pregnancy
Testicular torsion

35
Q

What are important differentials to consider for the acute abdomen?

A

Cardiac related pain
Ectopic pregnancy
Bowel ischaemia
Renal causes
GI Ulcers
AAA

36
Q

Why is an ectopic pregnancy important to consider in acute abdomen?
What are the symptoms?

A

Is an extra-uterine pregnancy
Is a common differential in women of child-bearing age with acute abdomen presentation
Sx: Abdo pain, vaginal bleeding, missed period, shoulder tip pain.
Must have a pregnancy test in all acute abdo female of correct age.

37
Q

What cardiac condition can be a risk factors for acute bowel ischaemia?

A

Atrial fibrilation - increase risk of clot formation, cause sudden obstruction of blood supply to a section of the bowel.

38
Q

What is the basic presentation of pyelonephritis?

A

Kidney infection =
Flank/back pain, feverish, urinary symptoms

39
Q

What are the symtpoms of a renal stone?

A

Sever flank/groin/back pain
Nausea & vomiting
Blood in urine

40
Q

How does a AAA present in acute abdomen?

A

Mostly asymptomatic
If rupture - severe abdo/back pain, hemodynamically unstable.

41
Q

What is a laparotomy?

A

When a large surgical incision is made in the abdomen to examine its content (organs and peritoneal cavity)

42
Q

What is a laparoscopy?

A

Minimally invasive procedure, small incision in the abdomen, insert a laproscops (thin tube with a camera and light attached)
Can be viewed on a monitor
Key hole surgery.

Surgery block (23 decks)

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