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ACC > Emergency medicine: Abdominal pain > Flashcards

Emergency medicine: Abdominal pain Flashcards

1
Q

What are the symptoms of perforation?

A

Acute severe abdominal pain
Rebound tenderness (i.e. peritonitis)
Acute pyrexia
Nausea, vomiting

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2
Q

What are the key investigative findings of perforation?

A
  1. A/CXR =
    - Pneumo-peritoneum (air under diaphragm)
  2. Bloods =
    - Low Hb
    - Raised WCC
    - Raised lactate
    - (Raised amylase)
  3. ABG =
    - Metabolic acidosis
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3
Q

What is the management for perforation? (8 - think RRAPID)

A
  1. ABCDE
  2. Oxygen high flow 15L/min via NRBM
  3. Fluid resuscitation
  4. Morphine with cyclizine
  5. ABx - metronidazole and co-amoxiclav
  6. Cross Match (urgent)
  7. NBM, NGT
  8. Surgery
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4
Q

What are the symptoms of bowel obstruction

A

Acute abdominal pain

  • Colicky and intermittent
  • Severe
  • Distended ± rigid
  • Tender ± peritonitic

Vomiting

  • Bilious
  • Faecal (worrying)

Tinkling bowel sounds

Constipation - partial or complete

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5
Q

What are the key investigations for bowel obstruction?

A
  1. AXR =
    - distended loops of bowel
    - absence of gas distal to obstruction
  2. Contrast enema (for lower obstructions)
  3. Bloods
    - Cross-match
    - FBC
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6
Q

What is the treatment for bowel obstruction

A

DRIP and SUCK

  1. NGT (Rhyles tube to remove GI contents)
  2. NBM
  3. IV fluids
  4. Surgery
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7
Q

In whom is acute appendicitis most common (age range)?

A

10-20 yo

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8
Q

What are the symptomatic sequelae of acute appendicitis?

A

Classic (>60%)

  1. Central colicky abdominal pain
    - worse with movement
    - tender with voluntary guarding
  2. Nausea, vomiting, diarrhoea
  3. Fever + fatigue

Late

  1. Severe pain in RIF (McBurneys)
    - Rigid and tender abdomen
    - Peritonitis
  2. Rovsing sign
  3. Mucous coated faeces
  4. Swinging pyrexia
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9
Q

What is the treatment for appendicitis?

A
  1. ABCDE
  2. NBM, NGT, IV fluids
  3. Abx - IV co-amoxiclav, metronidazole, cefuroxime
  4. Appendectomy
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10
Q

What are the symptoms of AAA?

A
  1. Central abdominal pain
    - Acute (?rupture) or Chronic (developing)
    - Radiates to back, groin, thigh
    - Pulsatile and expansile mass
  2. Fatigue
  3. Absent leg pulses
  4. Acutely unwell, drowsy, confused, low GCS, Cullens and Grey turners (?rupture)
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11
Q

What is the key investigative findings which determines clinical decision regarding treatment in patients with AAA?

A
  1. USS abdomen
    - 3 - 4.4 cm = annual review
    - 4.5 - 5.4 cm = 3 monthly review
    - >5.5 cm = elective surgery
    - Ruptured = urgent surgery
  2. Bloods
    - FBC: Low Hb (may indicate bleed), raised WCC (may indicate infection)
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12
Q

What are the primary causes of acute pancreatitis?

A

Gall stones (majority), Ethanol (alcohol), Trauma

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13
Q

What are the symptoms and signs of acute pancreatitis?

A
  1. Constant epigastric pain
    - radiates to back
    - Worse with alcohol
    - Relieved with leaning forward
    - Tender and rigid
  2. Cullens and Grey turners (late)
  3. RUQ pain - if a/w gall stones
  4. N, V, D, Anorexia
  5. Dehydration
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14
Q

What are the symptoms of acute cholecystitis?

A 
Constant RUQ pain 
- Radiates to right shoulder 
- Worse after eating fatty foods
- Tender RUQ 
- Mass felt RUQ 
Nausea, vomiting, fever, bloating 
Murphys sign (pain in RUQ on palpation during inspiration)
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15
Q

What is acute cholecystitis?

A

Inflammation of the gall bladder due impaction of a gall stone in the neck of the gall bladder

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16
Q

What is cholangitis?

A

Bile statsis causes infection of the gall bladder –> inflammation and Charcot’s triad

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17
Q

What are the symptoms of cholangitis?

A
  1. Fever
  2. Jaundice
  3. Abdominal pain i.e. RUQ pain
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18
Q

What are the symptoms of cholangitis?

A
  1. Fever
  2. Jaundice
  3. Abdominal pain i.e. RUQ pain
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19
Q

What are the symptoms of obstructive jaundice?

A

RUQ pain radiating to R.Shoulder
Dark urine
Pale faeces

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20
Q

What are the symptoms of Peptic Ulcer Disease (PUD)?

A
  1. Epigastric pain
    - Intermittent
    - Epigastric tenderness + bloating
    - Duodenal - relieved with food and milk
    - Gastric - worsened by food
  2. Dyspepsia
  3. Anorexia
  4. Haematemesis or malaena (if ruptures)
21
Q

What are the causes of acute and chronic PUD?

A

Acute - Hyperacidity

Chronic - H.Pylori

22
Q

What are the key investigations for PUD?

A
  1. Upper GI endoscopy with biopsy and Clo test
  2. H.Pylori tests:
    - Urea breath test
    - Serology (detects IgG)
23
Q

What is the treatment for PUD?

A
  1. ABCDE
  2. Fluid rests if required
  3. Analgesia for pain - avoid NSAIDs as this can exacerbate
  4. PPI (lansoperazole or omeprazole) to reduce damage
  5. H.Pylori treatment (ACL):
    - Amoxicillin
    - Clarithromycin
    - Lansoperazole
  6. Repeat endoscopy in 6 weeks - ensure it has gone
24
Q

What symptoms would worry you of gastric cancer in a patient with PUD?

A

ALARMS

  • Acute onset
  • LoA
  • Anaemia
  • Reduced weight
  • Malaena
  • Swallowing difficulty
25
Q

What are the symptoms of diverticulitis?

A
  1. Acute onset
  2. Left (common) or Right lower quadrant pain
    - Constant or intermittent
    - Relieved with defecation
    - Localised tenderness and palpable mass
  3. PR Bleeding
  4. Fever, tachycardia, nausea, vomiting, diarrhoea
26
Q

What are the key investigative findings for diverticulitis?

A
  1. AXR - look for any sign of ileus, perforation
  2. Colonoscopy - diagnostic
  3. Bloods - Raised WCC, ESR, CRP
27
Q

What are the signs of haemorrhage during diverticulitis?

A

PR Bleeding - acute and often painless
Abdominal pain and or urge to defecate
Blood clots

28
Q

What are the common locations to find renal stones?

A

PUJ
VUJ
Pelvic Brim

29
Q

What are the symptoms associated with renal stones?

A
  1. Renal colic
    - Intermittent spasming pain
    - Loin to groin
    - Worse when moving or when drinking
    - Tender flank
  2. Nausea, vomiting, anorexia
  3. Sweating and restless
  4. Fever and systemically unwell (if infection present)
30
Q

What are the key investigative findings for renal stones?

A
  1. Urine dip - +Blood, + Nitrates (if inf)
  2. Bloods - raised Urea, Creatinine, K+; Low Na+
  3. KUB - detects 60%
  4. CTKUB - detects 99%
31
Q

What is the treatment for renal colic? (7)

A
  1. ABCDE
  2. Fluids - encourage plenty of oral; give IV if required
  3. Analgesia - NSAIDs effective (Diclofenac or Ibuprofen)
  4. Tamsulosin (a blocker dilates SM of prostate and bladder to help pass stone)
  5. Shock wave lithotripsy
  6. Metoclopramide (A/E)
  7. Nephrostomy if pyelonephritis develops
32
Q

What are the symptoms of ectopic pregnancy?

A 
Abdominal pelvic pain U/L usual 
- Vague --> colicky --> constant 
- Adnexal mass 
- Localised tenderness 
Cervical os small 
Uterus small 
Cervical excitation 
Vaginal bleeding (small) 
Amenorrhoea (6-8 wks)
Nausea and vomiting --> dehydration, dizzy, syncope
33
Q

What are the investigative findings for ectopic?

A
  1. Pregnancy test - +Ve –> USS
  2. HCG
    - if > 1000 = likely IUP
    - if <1000 but increases > 66% in 48 hours = likely IUP
    - if slow rising or declining = ectopic or MisC
  3. USS
    - determine if IUP, adnexal mass, free fluid
34
Q

What is the treatment for an ectopic?

A
  1. ABCDE - Oxygen, fluids if required
  2. Methotrexate single dose –> r/v HCG at 4 and 7 d
  3. Salpingostomy –> r/v HCG at 7 d
35
Q

What are the primary causes of pelvic inflammatory disease (PID)?

A

Chlamydia

Gonorrhoea

36
Q

What are the symptoms of PID?

A 
Pelvic pain 
Deep dyspareunia
Vaginal discharge and dysuria (due to concomitant infection)
Erratic, irregular, painful menses 
Cervical motion pain 
Adnexal mass + tenderness 
Fever
Previous Hx of STIs
37
Q

What are the key investigations of PID?

A
  1. Transurethral or vulvovaginal swab with NAATS
    - if C. Trahamotis –> Tx
    - if N. Gonorrhoea –> CS
  2. FBC - Raised WCC
  3. USS - exclude ovarian abscess
38
Q

What are the treatment options for PID?

A

High gonorrhoea risk

  • Ceftriaxone IM, metronidazole, doxycline (14 d) or
  • Olfloxacin and metronidazole or
  • Ceftriaxone and azithromycin

Low gonorrhoea risk
- Ceftriaxone IM, metrondiazle, doxycycline (14 d)

39
Q

What are the risk factors for PID?

A

Age < 25yo, sexually active women, past history of STIs, multiple partners

40
Q

What is the definition of a miscarriage?

A

Spontaneous abortion of child by < 24wks (often occurs at 12 wks)

41
Q

What are the symptoms of miscarriage?

A

Pelvic pain
Offensive vaginal loss
PV bleeding
Uterine contractions

42
Q

What are the types of ovarian cyst and in whom are they common?

A

Benign epithelial neoplastic ovarian cyst

  1. Mucinous cystadenoma (20-40)
  2. Serous cystadenoma (40-50)
43
Q

What are the symptoms and signs of ovarian cyst?

A 
Pelvic pain 
- radiates to back 
- dull ache 
Dyspareunia 
Bleeding (if rupture): abdominal --> peritonitis; pelvic --> discharge and bleeding
44
Q

What are the symptoms and signs of ovarian cyst?

A 
Pelvic pain 
- radiates to back 
- dull ache 
Dyspareunia 
Bleeding (if rupture): abdominal --> peritonitis; pelvic --> discharge and bleeding
45
Q

What are the key investigations for ovarian cyst?

A
  1. Preg test = -ve
  2. HCG = -ve
  3. USS (diagnostic)
  4. CA125 (ovarian Ca tumour marker)
46
Q

What are the key investigations for MisC?

A
  1. B-HCG = slowly rising or declining

2. USS = determine if IUP or ectopic etc.

47
Q

What is the treatment for ovarian cyst?

A
  1. Expectant - watch and wait, most resolves spontaneously
  2. Analgesia and Anti-emetic
  3. Laprocystectomy if cyst > 5cm
  4. Laproscopy
48
Q

What is the treatment for Miscarriage?

A
  1. ABCDE - oxygen and fluid if req
  2. IM Oxytocin - reduce any bleeding
  3. Analgesia and Anti-emetics
  4. Anti-D for mothers
  5. Wait for it to spontaneously come out

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