Acute Abdominal Inflammatory Conditions Flashcards
Upper abdominal inflammatory conditions
Gall stone disease (cholecystitis, cholangitis), pancreatitis, peptic
ulcer disease, gastro-oesophageal reflux disease (GORD)
oesophagitis.
Lower abdominal inflammatory conditions
Appendicitis, diverticular disease, inflammatory bowel disease,
Clostridioides (Clostridium) difficile colitis, radiation proctitis.
Other name for gall stones
Cholelithiasis
How many people get symptoms of gall stones
60-80 % asymptomatic
Types of stones
Cholesterol stones
Pigmented
Mixed
Pigmented stones suggest
Black- haemolytic/ cirrhosis
Brown- stasis and infection in biliary siystem
Ecoli and klebsiella
Biliary colic
Pain
Pain subsides?
Pain when stone obstructs cystic duct
Pain subsides when stone falls back from suspicion duct
Biliary colic onset
Sudden
Biliary colic lasts how long
1-4 hours
Radiating / non radiating
Right scapula
Is it obvious from patient they are experiencing biliary colic
Patient doesn’t look unwell
What test do we do for inflamed gall bladder
Murphy sign
Process of Murphy sign
Hand at costal margin RUQ
Deep inspiration diaphragm moves
down •
Pain when inflamed gallbladder
contacts palpating hand
• Manoevure in LUQ should not elicit
pain
Cholangitis classically leads to
Charcots triad
Charcots triad
Jaundice fever RUQ pain
Gallstone lleus is
Gallstone causing small bowel obstruction
What investigation confirms presence of gallstones
USS
MRCP does what
Helps visualise biliary tree accurately
Diagnostic non invasive
Spyglass does what
Allows visual examine the biliary ducts,
• take biopsy samples and
• treat large biliary stones by either electrohydraulic or laser lithotripsy.
Management of GB diseases
Remove the gall bladder
Complications of laparoscopic cholecystectomy
Early: bleeding
Bile leak
Damage to common bile duct
Late:
Retained stones
Bile duct structure
Aetiology of acute pancreatitis
I GET SMASHED
Pathophysiology of acute pancreatitis
May extend to local and distant extrapancreatic tissues
Diagnosis of acute pancreatitis
Epigastric pain and vomiting
Serum amylase or lipase
Mild pancreatitis
No organ failure
No local or systemic complications
No imaging required
Discharge within one week
75% of cases
Moderately severe pancreatitis
Transient organ failure
Local or systemic complications
Discharge within 2/3 weeks
Morality <8%
Severe pancreatitis
Persistent organ failure > 48 hours
Infected necrosis
Managed in HDU/ICU
Develops during early phase
Local or systemic complication
Clinical scoring system what score is seen as severe AP
More than or equal to 3
Peptic ulcers are found where
Both gastric and duodenal ulcers
Which PUD are more common
Duodenal
Symtomps of PUD are
nonspecific
Epigastric pain 1 to 3 hours
Gastro- oesophageal reflux disease (GORD)
Prolonged contact of gastric contents with lower oesophageal mucosa resulting in symptom or complications
What grading used for GORD
Salary miller grading