Acute abdominal pain PT1

Question 1

4 common presentations of hernias

Answer 1

palpable mass
pain
cough impulse
abdominal discomfort

Question 2

position for examination of a hernia

Answer 2

examine whilst standing

Question 3

what is a inguinal hernia

Answer 3

peritoneal contents protruding through abdo wall where its weakened by the inguinal canal

Question 4

who is more at risk of inguinal hernias

Answer 4

men

Question 5

why are males more prone to inguinal hernias

Answer 5

superficial inguinal ring to transport contents of the spermatic cord to testes

Question 6

what does an inability to reduce a hernia suggest

Answer 6

it has been incarcerated /intestinal obstruction

Question 7

what does severe pain in a hernia suggest

Answer 7

strangulation

Question 8

risk factors for inguinal hernias

Answer 8

chronic cough 
constipation 
urinary obstruction 
heavy lifting 
ascites 
surgery

Question 9

2 types of inguinal hernia

Answer 9

direct

indirect

Question 10

most common type of inguinal hernia

Answer 10

indirect (80%)

Question 11

what is an indirect inguinal hernia

Answer 11

hernia protrudes through the internal inguinal ring

Question 12

what are indirect inguinal hernias usually due to

Answer 12

failure of embryonic closure of the processus vaginalis (mainly congenital)

Question 13

direct inguinal hernia=

Answer 13

protrusion through a weakened area of abdominal fascia into the inguinal canal

Question 14

femoral hernia=

Answer 14

peritoneal contents protruding through femoral canal

Question 15

femoral hernia more common in _____ and why

Answer 15

female- wider bone structure of pelvis

Question 16

what is high risk about femoral hernias

Answer 16

strangulation due to femoral vessels

Question 17

where is the lump in a femoral hernia

Answer 17

below the line of the inguinal ligament -medially in groin and lateral to pubic tubercle

Question 18

cough impulse in femoral hernia ?

Answer 18

no

Question 19

incisional hernia =

Answer 19

incompletely healed surgical wound

Question 20

umbilical hernia=

Answer 20

abdominal wall posterior to the navel s damaged causing weakness along linea alba causing peritoneal contents to protrude through

Question 21

what is rare in umbilical hernias

Answer 21

strangulation and incarceration

Question 22

3 causes of umbilical hernias

Answer 22

congenital
acquired
paraumbilical

Question 23

epigastric hernia=

Answer 23

protrusion of intestine in middle of abdomen along linea alba above umbilicus below breast bone

Question 24

spigelian hernia=

Answer 24

herniation of intestinal contents through spigelian fascia in lower abdomen

Question 25

what is the spigelian fascia

Answer 25

aponeurotic layer between rectus abdominus muscle and semilunar line

Question 26

other word for spigelian hernia

Answer 26

lateral ventral hernia

Question 27

2 complications of hernias

Answer 27

strangulation | incarceration

Question 28

why does strangulation of a hernia occur

Answer 28

hernias become tightly constricted by posterior wall forming a narrow neck which can occlude blood supply

Question 29

signs of hernia strangulation (4)

Answer 29

- sudden growth and discolouration - pain - irreducible - nausea and vomiting

Question 30

incarceration of a hernia =

Answer 30

hernia becomes occluded part of bowel so solids cannot pass -bowel obstruction

Question 31

what is the only solution for hernia incarceration

Answer 31

surgery

Question 32

signs of an incarcerated hernia (4)

Answer 32

palpable mass pain nausea and vomiting constipation

Question 33

10 causes of pain in right iliac fossa

Answer 33

``` acute appendicitis diverticulitis mesenteric adenitis perforated duodenal ulcer pelvic inflammatory disease inflammed meckel's diverticulum ectopic pregnancy crohns biliary disease renal colic ```

Question 34

most common cause of acute appendicitis

Answer 34

obstruction of the lumen of the appendix

Question 35

what can obstruct the lumen of the appendix

Answer 35

faecolith normal stool infective agent lymphoid hyperplasia

Question 36

what is the dangerous consequence of acute appendicitis is not treated

Answer 36

perforate and release purulent fecal contents

Question 37

symptoms of acute appendicitis (6)

Answer 37

- general central abdo pain progressing to right iliac fossa - pain worse on movement - anorexia - nausea and vomiting - dysuria - constipation

Question 38

diverticulitis=

Answer 38

small pouches of mucosa in the large intestine becoming inflammed

Question 39

why do diverticular form

Answer 39

increased intraluminal pressure from fecal accumulation due to lack of fiber in diet

Question 40

presentation of diverticulitis (5)

Answer 40

- acute left lower quadrant abdo pain - fever - nausea - diarrhoea - blood in stool

Question 41

mesenteric adenitis=

Answer 41

inflammation of the mesenteric lymph nodes causing abdominal pain

Question 42

who gets mesenteric adenitis

Answer 42

children under 16

Question 43

what usually triggers inflammation of the lymph nodes

Answer 43

viral infection

Question 44

presentation of mesenteric adenitis (4)

Answer 44

- cold prior to abdo pain - abdo pain in umbilicus and right iliac fossa - fever and generally unwell - nausea and diarrhoea

Question 45

management of mesenteric adenitis

Answer 45

usually self-limiting -analgesia and fluids

Question 46

high association between duodenal ulcers and (3)

Answer 46

H.pylori smoking NSAIDs

Question 47

symptoms of a perforated duodenal ulcer (4)

Answer 47

- meal dyspepsia - sudden acute abdo pain - syncope - generalised peritontis

Question 48

pelvic inflammatory disease=

Answer 48

infection of the upper female reproductive system

Question 49

upper female reproductive system =

Answer 49

uterus fallopian tubes ovaries

Question 50

what causes pelvic inflammatory disease

Answer 50

bacteria spreading from the vagina upwards

Question 51

common infective agents for pelvic inflammatory disease (2)

Answer 51

Neisseria gonorrhoeae | chlamydia

Question 52

long term complications of pelvic inflammatory disease

Answer 52

infertility ectopic pregnancy cancer

Question 53

symptoms of pelvic inflammatory disease (6)

Answer 53

- fever - cervical motion tenderness - vaginal discharge - painful intercourse - uterine tenderness - irregular mestruation

Question 54

meckels diverticulum=

Answer 54

remnant of the attachment of small bowel to the embryological yolk sac

Question 55

inflamed meckels diverituculum mainly occurs in

Answer 55

children

Question 56

where is meckels diverticulum located

Answer 56

terminal ileum proximal to appendix

Question 57

what can inflamed meckel's diverticulum mimic (symptoms wise)

Answer 57

appendicitis

Question 58

symptoms of meckel's diverticulum (4)

Answer 58

- painless rectal bleeding - central abdo pain - melena - intestinal obstruction

Question 59

ectopic pregnancy=

Answer 59

embryo attached outside uterus

Question 60

where can an ectopic pregnancy be (3)

Answer 60

fallopian tubes, ovarian cervical

Question 61

risk factors for ectopic pregnancy (7)

Answer 61

- pelvic inflammatory disease - infertility - IUD - tubal surgery - smoking - endometriosis - STIs

Question 62

symptoms of ectopic pregnancy (5)

Answer 62

- vaginal bleeding - lower abdominal pain - pelvic pain - tender cervix - pain can radiate into shoulder

Question 63

is crohns or UC more prevalent

Answer 63

UC

Question 64

disease of biliart tree -->

Answer 64

obstructive jaundice

Question 65

bilirubin accumulation presents with (5)

Answer 65

``` dark urine jaundice pale stools pruritus nausea and vomiting ```

Question 66

murphy's sign=

Answer 66

tenderness causing muscle guarding worse on inspiration