Acute abdominal pain Flashcards
What is acute abdominal pain?
- Sudden onset of severe abdominal pain
What is the differential diagnosis of acute abdominal pain?
- Appendicitis
- Peritonitis
- Bowel perforation
- Pancreatitis
- Diverticular disease
- Cholecystitis
- Perforating ulcer
- Ruptured ectopic pregnancy
- Ruptured or haemorhhagic ovarian cyst
- Pelvic inflammatory disease
- Abdomina aortic aneurysm
- Tubo-ovarian abscess
Investigations, causes, management, risk factors of peritonitis?
Inflammation of the peritoneum
- May be primary or secondary (due to an infection from elsewhere not peritoneum)
Investigations of peritonitis
Management of peritonitis
Clinical signs of acute appendicitis
- Clinical Signs
- RIF tenderness and guarding
- Rovsing’s sign – Palpation of LIF causes RIF pain
- Psoas sign – RIF pain with extension of right hip
Differential diagnosis of left lilac fossa region
- Gynaecological: ovarian cyst rupture, ectopic pregnancy, pelvic inflammatory disease
- Renal: UTI, ureteric stones, pyelonephritis
- Gastrointestinal: IBD, Meckel’s diverticulum, or diverticular disease
- Urological: Testicular torsion, epididymo-orchitis
Investigations of acute appendicitis
Management of acute appendicitis
- Definitive treatment is laparoscopic appendicectomy
- Antibiotic treatment alone has a failure rate of 25-30% at 1 year
Complications of acute appendicitis
-
Perforation, if left untreated the appendix can perforate and cause peritoneal contamination
- This is particular note in children who may have a delayed presentation
-
Surgical site infection
- Rates vary depending on simple or complicated appendicitis
- Appendix mass, where omentum and small bowel adhere to the appendix
-
Pelvic abscess
- Presents as fever with a palpable RIF mass, can be confirmed by CT scan.
Clinical signs of acute pancreatitis and what is it?
Causes of acute pancreatitis
What investigations would you do for acute pancreatitis?
Explain glasgow score in acute pancreatitis
Management of acute pancreatitis
- Supportive management
- Analgesia
- Opioids
- Fluid resuscitation
- Fluid balance monitoring
- NG Feeding
- Treatment of underlying causes
- ERCP for gallstones
Complications of acute pancreatitis
Local
- Pancreatic pseudocyst
- Collection of pancreatic enzymes, blood, necrotic tissue surrounded by vascular/fibrotic wall
- Form weeks after episode
- Incidental finding or symptoms of mass effect
- Pancreatic Necrosis
- Inflammation → ischaemic infarction of pancreas
- Suspect if evidence of persistent systemic inflammation for over 7-10 days
Systemic
- Disseminated Intravascular Coagulation (DIC)
- Acute Respiratory Distress Syndrome (ARDS)
- Hypocalcaemia
- Hyperglycaemia
Diverticulum
outpouching of bowel wall
Commonly affects sigmoid colon but can affect whole bowel.
Diverticulosis
presence of diverticulae without symptoms
Diverticular disease
symptoms arising from diverticula
Diverticulitis
inflammation of diverticula
Diverticular bleed
erosion into vessel causing large volume painless bleed
Explain diverticular disease
Diverticular disease=symptoms arising from diverticula
- Intermittent lower abdominal pain
- Colicky
- Relieved by defecation
- Altered bowel habit, nausea, flatulence
Explain diverticulitis
Diverticulitis=inflammation of diverticula
- Acute abdominal pain, sharp in nature
- Usually localised to LIF
- Worse with movement
- Localised tenderness
- Systemically unwell
- In perforation there may be localised or generalised guarding
Note these patients are often very unwell and deteriorate quickly
Management of diverticulitis
Conservative management
- Antibiotics
- Fluids
- Analgesia
- Encourage oral intake
Surgical management
- Required if perforation or sepsis
- Hartmann’s procedure
- Sigmoid colectomy with formation of end colostomy
Usually improves within 2-3 days of treatement
Complications of diverticular disease
- Diverticular Stricture
- Colovesical fistula
- Tract between bowel and bladder
- Colovaginal fistula
- Tract between bowel and vagina
Explain gall stones
-
Cholesterol Gallstones (80%)
- Made from excess cholesterol
- Associated with poor diet and obesity
- Yellow and oval shaped
-
Pigment Gallstones
- Made from bile pigments from bilirubin
- Common in patients with haemolytic anaemia
- Dark brown colour
•Mixed Gallstones•Mixture of cholesterol and bile pigments
What are the risk factors of gallstones?
Risk factors
- Female
- Forties
- Fat
- Fertile
- Family History
Label biliary system
Explain biliary colic
Biliary Colic
- Gallstone impacted at gallbladder neck
- Pain from contraction of gallbladder against gallbladder neck
- Dull, colicky, RUQ pain associated with nausea and vomiting
Explain acute cholecystitis
Acute Cholecystitis
- Inflammation of gallbladder
- Systemic features – lethargy, fever
- Constant RUQ pain +/- guarding
- Murphy’s sign positive
Clinical features of acute cholangitis
- Classically presents with abdo pain, fever and jaundice
- Itching, pale stool, dark urine due to obstructive jaundice
Explain investigations in biliary colic, acute cholecystitis and acute cholangitis (results of bloods too)
Management of biliary colic
Biliary Colic
- Analgesia
- Lifestyle factors (low fat diet, weight loss, exercise)
- Elective laparoscopic cholecystectomy
Management of Acute Cholecystitis
- Antibiotics
- Analgesia/Anti-emetics
- Laparascopic cholecystectomy within 1 week
Management of Acute Cholangitis
Acute Cholangitis
- IV Antibiotics and treat sepsis
-
ERCP (Endoscopic Retrograde Cholangiopancreatography)
- Endoscopic removal of gallstones
- May also carry out sphincterotomy and insert stent.
- Laparascopic cholecystectomy
Explain post op assessment
