Acute abdominal pain Pt2 Flashcards
symptoms of peritonitis
acute abdo pain abdo tenderness abdo guarding rebound tenderness rigidity
blumberg sign=
rebound tenderness- less pain when hand is pressed down severe pain on release
localised peritonitis is due to
involvement of the somatic parietal peritoneum
what is the nerve supply of parietal peritoneum
same somatic nerve supply as the region of the abdominal wall that it lines
what does the nerve supply of parietal peritoneum mean
pain from the parietal peritoneum is well localised.
what nerves coordinate generalised peritonitis
splanchnic nerves
what is generalised peritonitis
peritonitis affecting the entire abdomen
what is the pain pattern in localised peritonitis
pain starts as epigastric pain but becomes specific in location when the impacted organ distends and impacts the parietal peritoneum
where are the splanchnic nerves located
visceral peritoneum
where is the visceral peritoneum
inside
where is the parietal peritoneum
outside
pain in generalised peritonitis
diffuse and widespread
2 types of peritonitis
infection
non-infective
non-infective peritonitis=
leakage of bodily fluids into the peritoneum via perforation of a viscus
ruptured viscus=
rupturing of an abdominal organ
main definitive cause of a ruptured viscus
trauma
possible medical conditions causing a ruptured viscus
appendicitis
diverticulitis
peptic ulcer
ischaemic bowel disease
perforated duodenal ulcer–>
sudden onset epigastrium pain
perforated gastric ulcer–>
burning sensation in epigastrium associated with flatulence and dyspepsia
small intestine rupture =
sudden onset pain
large intestine rupture=
more gradual onset pain
oesophageal rupture=
sudden onset chest pain
symptoms of ruptured viscus (6)
- severe abdominal pain (worse with movement)
- N&V
- fever and rigors
- rigid abdomen
- abdominal distention
- generalised peritonitis
causes of small intestine bowel obstruction (3)
hernias
adhesions
tumours
adhesions=
areas of tough fibrous connective tissue that form a scar
where do adhesions develop after surgery
outside of injured intestines or pelvic organs
what surgerys are particularly likely to cause adhesions (2)
- gynaecological surgeries
- appendix surgeries
4 causes of large bowel obstruction
diverticular disease
volvulus
crohns
colorectal cancer
volvulus=
twisted intestine
what happens in volvulus
usually produces a closed loop of bowl with a pinched base causing obstruction
strictures in Crohns due to
muscular hypertrophy
stoma =
opening of the surface of the abdomen surgically created to divert flow of feces or urine
3 main types of stoma
colostomy
ileostomy
urostomy
colostomy=
colon redirected through abdomen -normally left flank
output of a colostomy
1-3 times/ day
ileostomy=
opening of the small intestine onto abdomen -especially ileum
ileostomy usually done in
Crohns skip lesions severe in ileo-cecal region
ouput of ileostomy
looser
3-6 times/ day
urostomy=
opening of urine using part of the small intestine and attaching ureters to it forming a passage way to abdominal wall
usual urostomy location
right side of body
5 consequences of stomas
retraction herniation prolapse stenosis skin complications
stoma retraction=
when stoma falls below skin levels
what type of stoma is retraction more common with
ileostomy
what patients is stoma retraction more common in
obese patients
consequence of stoma retraction
more prone to leaks -skin irritation
what type of hernia is a stoma hernia
incisional hernia
appearance of stoma hernia
stoma can look more raised
stoma prolapse=
bowel protrudes through stoma opening at abnormal lengths
consequences of stoma prolapse
infection
trauma
blood constriction
stoma stenosis=
narrowing of the stoma
presentation of stoma stenosis
cramps combined with no stoma output
what type of skin complications from a stoma
- allergic reactions to adhesive
- fungal infections
- skin irritation
