Acute abdominal pain PT1 Flashcards
4 common presentations of hernias
palpable mass
pain
cough impulse
abdominal discomfort
position for examination of a hernia
examine whilst standing
what is a inguinal hernia
peritoneal contents protruding through abdo wall where its weakened by the inguinal canal
who is more at risk of inguinal hernias
men
why are males more prone to inguinal hernias
superficial inguinal ring to transport contents of the spermatic cord to testes
what does an inability to reduce a hernia suggest
it has been incarcerated /intestinal obstruction
what does severe pain in a hernia suggest
strangulation
risk factors for inguinal hernias
chronic cough constipation urinary obstruction heavy lifting ascites surgery
2 types of inguinal hernia
direct
indirect
most common type of inguinal hernia
indirect (80%)
what is an indirect inguinal hernia
hernia protrudes through the internal inguinal ring
what are indirect inguinal hernias usually due to
failure of embryonic closure of the processus vaginalis (mainly congenital)
direct inguinal hernia=
protrusion through a weakened area of abdominal fascia into the inguinal canal
femoral hernia=
peritoneal contents protruding through femoral canal
femoral hernia more common in _____ and why
female- wider bone structure of pelvis
what is high risk about femoral hernias
strangulation due to femoral vessels
where is the lump in a femoral hernia
below the line of the inguinal ligament -medially in groin and lateral to pubic tubercle
cough impulse in femoral hernia ?
no
incisional hernia =
incompletely healed surgical wound
umbilical hernia=
abdominal wall posterior to the navel s damaged causing weakness along linea alba causing peritoneal contents to protrude through
what is rare in umbilical hernias
strangulation and incarceration
3 causes of umbilical hernias
congenital
acquired
paraumbilical
epigastric hernia=
protrusion of intestine in middle of abdomen along linea alba above umbilicus below breast bone
spigelian hernia=
herniation of intestinal contents through spigelian fascia in lower abdomen
what is the spigelian fascia
aponeurotic layer between rectus abdominus muscle and semilunar line
other word for spigelian hernia
lateral ventral hernia
2 complications of hernias
strangulation
incarceration
why does strangulation of a hernia occur
hernias become tightly constricted by posterior wall forming a narrow neck which can occlude blood supply
signs of hernia strangulation (4)
- sudden growth and discolouration
- pain
- irreducible
- nausea and vomiting
incarceration of a hernia =
hernia becomes occluded part of bowel so solids cannot pass -bowel obstruction
what is the only solution for hernia incarceration
surgery
signs of an incarcerated hernia (4)
palpable mass
pain
nausea and vomiting
constipation
10 causes of pain in right iliac fossa
acute appendicitis diverticulitis mesenteric adenitis perforated duodenal ulcer pelvic inflammatory disease inflammed meckel's diverticulum ectopic pregnancy crohns biliary disease renal colic
most common cause of acute appendicitis
obstruction of the lumen of the appendix
what can obstruct the lumen of the appendix
faecolith
normal stool
infective agent
lymphoid hyperplasia
what is the dangerous consequence of acute appendicitis is not treated
perforate and release purulent fecal contents
symptoms of acute appendicitis (6)
- general central abdo pain progressing to right iliac fossa
- pain worse on movement
- anorexia
- nausea and vomiting
- dysuria
- constipation
diverticulitis=
small pouches of mucosa in the large intestine becoming inflammed
why do diverticular form
increased intraluminal pressure from fecal accumulation due to lack of fiber in diet
presentation of diverticulitis (5)
- acute left lower quadrant abdo pain
- fever
- nausea
- diarrhoea
- blood in stool
mesenteric adenitis=
inflammation of the mesenteric lymph nodes causing abdominal pain
who gets mesenteric adenitis
children under 16
what usually triggers inflammation of the lymph nodes
viral infection
presentation of mesenteric adenitis (4)
- cold prior to abdo pain
- abdo pain in umbilicus and right iliac fossa
- fever and generally unwell
- nausea and diarrhoea
management of mesenteric adenitis
usually self-limiting -analgesia and fluids
high association between duodenal ulcers and (3)
H.pylori
smoking
NSAIDs
symptoms of a perforated duodenal ulcer (4)
- meal dyspepsia
- sudden acute abdo pain
- syncope
- generalised peritontis
pelvic inflammatory disease=
infection of the upper female reproductive system
upper female reproductive system =
uterus
fallopian tubes
ovaries
what causes pelvic inflammatory disease
bacteria spreading from the vagina upwards
common infective agents for pelvic inflammatory disease (2)
Neisseria gonorrhoeae
chlamydia
long term complications of pelvic inflammatory disease
infertility
ectopic pregnancy
cancer
symptoms of pelvic inflammatory disease (6)
- fever
- cervical motion tenderness
- vaginal discharge
- painful intercourse
- uterine tenderness
- irregular mestruation
meckels diverticulum=
remnant of the attachment of small bowel to the embryological yolk sac
inflamed meckels diverituculum mainly occurs in
children
where is meckels diverticulum located
terminal ileum proximal to appendix
what can inflamed meckel’s diverticulum mimic (symptoms wise)
appendicitis
symptoms of meckel’s diverticulum (4)
- painless rectal bleeding
- central abdo pain
- melena
- intestinal obstruction
ectopic pregnancy=
embryo attached outside uterus
where can an ectopic pregnancy be (3)
fallopian tubes,
ovarian
cervical
risk factors for ectopic pregnancy (7)
- pelvic inflammatory disease
- infertility
- IUD
- tubal surgery
- smoking
- endometriosis
- STIs
symptoms of ectopic pregnancy (5)
- vaginal bleeding
- lower abdominal pain
- pelvic pain
- tender cervix
- pain can radiate into shoulder
is crohns or UC more prevalent
UC
disease of biliart tree –>
obstructive jaundice
bilirubin accumulation presents with (5)
dark urine jaundice pale stools pruritus nausea and vomiting
murphy’s sign=
tenderness causing muscle guarding worse on inspiration
