Colorectal surgery: Acute abdomen Flashcards
Define what is meant by acute abdomen? [1]
Abdominal pain of non-traumatic origin with a maximation duration of 5 days
Name 3 pathologies that might cause pain the upper right abdomen [3]
- inflammation of gallbladder
- enlargement of liver
- hepatitis
- liver abscesses
- perforated duodenal ulcer
Name 3 pathologies that might cause pain the lower right abdomen [3]
- appendicitis
- diverticulitis
- meckel diverticulitis
- crohns disease}
Name three pathologies that could be causing pain the upper left abdomen [3]
- gastritis
- gastric ulcer
- abscess in spleen
- ruptured spleen
State a pathology that would be indicated by pain in lower left abdomen [1]
diverticulitis
How would Meckel’s diverticulitis present? [5]
- most common: painless rectal bleeding
- age < 2 years
- passage of bright red blood per rectum (haematochezia)
- intractable constipation (obstipation)
- It is clinically indistinguishable from appendicitis: Right sided pain
Describe the pathophysiology of Meckel’s diverticulum
Meckel’s diverticulum is a small outpouching extending from the wall of the intestine and located in the lower portion of the small intestine.
Name 4 causes of bleeding that may cause acute abdominal pain [4]
Bleeding:
- AAA
- Ulcer
- Ectopic
- Trauma
Name 4 causes of perforation that may cause acute abdominal pain [4]
Perforation:
- ulcer
- obstruction
- IBD
- diverticulitis
Name 2 causes of ischaemia that may cause acute abdominal pain [2]
- Mesenteric ischaemia
- Cardiac ischaemia}
Basic investigations for ptx with acute abdomen pain? [3]
- ECG: if cardiac issues considered
- Urine dip
- Pregnancy
Asides from standard testing, name two tests that are good indicator for urgent intrabdominal patholgies [2]
CRP
Amylase / lipase
Imaging used to investigate acute abdominal pain [3]
Plain radiographs (clinical effectiveness is queried)
- Erect chest XR: pneumonia
- Supine abdomen XR: small bowel obstruction
CT (investigation of choice)
Ultrasound
- Highly sensitive & first line for biliary pathology
- Good for gynaecological
- Bad for appendicitis
You suspect a patient has a biliary pathology, what is the first line of imaging used to diagnose this? [1]
Ultrasound
What imaging modality should be preffered for investigating pregnant populations? [2]
US or MRI
What is rebound tenderness? [1]
What does positive sign for rebound tenderness suggest? [1]
Rebound tenderness:
- said to be present when the abdominal wall, having been compressed slowly, is released rapidly resulting in a sudden stab of pain
- Suggests peritonitis: e.g. caused by appendicitis
What is ascending cholangitis? [1]
What is it most commonly caused by? [1]
What is a classic triad of symptoms? [3]
Ascending cholangitis:
- is a bacterial infection of the biliary tree
- common predisposing factor is gallstones
- Charcots triad: RUQ; fever & jaundice
Epigastric pain relieved by eating is indicates which type of ulcer? [1]
Epigastric pain worsened by eating is indicates which type of ulcer? [1]
Eating relieves duodenal ulcers
Eating worsens gastric ulcers
‘Tinkling’ bowel sounds & central bowel pain would suggest which pathology? [1]
Intestinal obstruction
Describe the character of the pain described in aortic dissection [1]
tearing pain
Describe the character of the pain described in a inflammation [1]
Constant dull pain: think appendicitis, diverticulitis
Describe the character of the pain described in peritonitis [1]
Constant sharp pain
Bowel sounds are helpful in suspected obstruction. Describe how this can be helpful [2]
High pitched (tinkling): obstruction
Absent: ileus (non-mechanical obstruction)
Describe how you would take a CXR for investigating perforation [1]
Erect chest x-ray: to look for free air under the diaphragm that suggests perforation of a hollow abdominal viscus
Describe how you would take a CXR for investigating pneumonia [1]
PA chest x-ray: look for lower lobe pneumonia
Describe how you would take a CXR for investigating obstruction? [1]
Abdominal x-ray: can look for signs of bowel obstruction, volvulus or even bowel wall thickening (e.g. colitis)
