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Surgery block > Acute abdominal pain > Flashcards

Acute abdominal pain Flashcards

1
Q

What is acute abdominal pain?

A
  • Sudden onset of severe abdominal pain
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2
Q

What is the differential diagnosis of acute abdominal pain?

A
  • 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
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3
Q

Investigations, causes, management, risk factors of peritonitis?

A

Inflammation of the peritoneum

  • May be primary or secondary (due to an infection from elsewhere not peritoneum)
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4
Q

Investigations of peritonitis

A
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5
Q

Management of peritonitis

A
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6
Q

Clinical signs of acute appendicitis

A
  • Clinical Signs
    • RIF tenderness and guarding
    • Rovsing’s sign – Palpation of LIF causes RIF pain
    • Psoas sign – RIF pain with extension of right hip
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7
Q

Differential diagnosis of left lilac fossa region

A
  • 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
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8
Q

Investigations of acute appendicitis

A
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9
Q

Management of acute appendicitis

A
  • Definitive treatment is laparoscopic appendicectomy
  • Antibiotic treatment alone has a failure rate of 25-30% at 1 year
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10
Q

Complications of acute appendicitis

A
  • 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.
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11
Q

Clinical signs of acute pancreatitis and what is it?

A
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12
Q

Causes of acute pancreatitis

A
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13
Q

What investigations would you do for acute pancreatitis?

A
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14
Q

Explain glasgow score in acute pancreatitis

A
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15
Q

Management of acute pancreatitis

A
  • Supportive management
  • Analgesia
  • Opioids
  • Fluid resuscitation
  • Fluid balance monitoring
  • NG Feeding
  • Treatment of underlying causes
  • ERCP for gallstones
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16
Q

Complications of acute pancreatitis

A

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
17
Q

Diverticulum

A

outpouching of bowel wall

Commonly affects sigmoid colon but can affect whole bowel.

18
Q

Diverticulosis

A

presence of diverticulae without symptoms

19
Q

Diverticular disease

A

symptoms arising from diverticula

20
Q

Diverticulitis

A

inflammation of diverticula

21
Q

Diverticular bleed

A

erosion into vessel causing large volume painless bleed

22
Q

Explain diverticular disease

A

Diverticular disease=symptoms arising from diverticula

  • Intermittent lower abdominal pain
  • Colicky
  • Relieved by defecation
  • Altered bowel habit, nausea, flatulence
23
Q

Explain diverticulitis

A

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

24
Q

Management of diverticulitis

A

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

25
Q

Complications of diverticular disease

A
  • Diverticular Stricture
  • Colovesical fistula
  • Tract between bowel and bladder
  • Colovaginal fistula
  • Tract between bowel and vagina
26
Q

Explain gall stones

A
  • 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

27
Q

What are the risk factors of gallstones?

A

Risk factors

  • Female
  • Forties
  • Fat
  • Fertile
  • Family History
28
Q

Label biliary system

A
29
Q

Explain biliary colic

A

Biliary Colic

  • Gallstone impacted at gallbladder neck
  • Pain from contraction of gallbladder against gallbladder neck
  • Dull, colicky, RUQ pain associated with nausea and vomiting
30
Q

Explain acute cholecystitis

A

Acute Cholecystitis

  • Inflammation of gallbladder
  • Systemic features – lethargy, fever
  • Constant RUQ pain +/- guarding
  • Murphy’s sign positive
31
Q

Clinical features of acute cholangitis

A
  • Classically presents with abdo pain, fever and jaundice
  • Itching, pale stool, dark urine due to obstructive jaundice
32
Q

Explain investigations in biliary colic, acute cholecystitis and acute cholangitis (results of bloods too)

A
33
Q

Management of biliary colic

A

Biliary Colic

  • Analgesia
  • Lifestyle factors (low fat diet, weight loss, exercise)
  • Elective laparoscopic cholecystectomy
34
Q

Management of Acute Cholecystitis

A
  • Antibiotics
  • Analgesia/Anti-emetics
  • Laparascopic cholecystectomy within 1 week
35
Q

Management of Acute Cholangitis

A

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
36
Q

Explain post op assessment

A

Surgery block (13 decks)

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