Gen Surg Flashcards
DDx of generalised abdo pain
- peritonitis
- ruptured AAA
- intestinal obstruction
- ischaemic colitis
DDx RUQ pain
- Biliary colic
- Acute cholecystitis
- Acute cholangitis
DDx epigastric pain
- Acute gastritis
- Peptic ulcer disease
- Pancreatitis
- Ruptured AAA
Ddx central abdominal pain
- Ruptured AAA
- Intestinal obstruction
- Ischaemic colitis
- Early stages of appendicitis
DDx LIF pain
- ectopic pregnancy
- diverticulitis
- Ruptured ovarian cyst
- Ovarian torsion
DDx RIF pain
- Acute appendicitis
- Ectopic pregnancy
- Ruptured ovarian cyst
- Ovarian torsion
- Meckel’s diverticulitis
DDx suprapubic pain
- urinary retention
- lower UTI
- Pelvic inflammatory disease
- Prostatitis
DDx loin to groin pain
- Renal colic (kidney stones)
- Ruptured AAA
- Pyelonephritis
DDx testicular pain
- testicular torsion
- epididymo-orchitis
what is peritonitis
inflammation of the peritoneum, the lining of the abdomen
signs of peritonitis
- guarding
- rigidity
- rebound tenderness
- coughing test
- percussion tenderness
Spontaneous bacterial peritonitis
- associated with spontaneous infection of ascites in patients with liver disease
- Mx: broad-spectrum antibiotics
- poor prognosis
signs and sx of appendicitis
- central abdo and RIF pain
- tenderness at McBurney’s point (1/3 ASIS to umbilicus)
- loss of appetite
- N&V
- low grade fever
- Rovsing’s sign
- guarding, rebound and percussion tenderness
Ix for appendicitis
- inflammatory markers
- USS
what is Meckel’s diverticulum
- malformation of the distal ileum that occurs in around 2% of the population
- usually asymptomatic and does not require mx
- it can bleed, rupture or cause a volvulus or intussusception
what is mesenteric adenitis
- inflamed abdominal lymph nodes
- associated with tonsillitis or an upper RTI
- caused by viral or bacterial infections, such as streptococcal pharyngitis
- No specific mx is required
presentation of mesenteric adenitis
- Crampy abdominal pain
- poor appetite
- sore throat
- fever
- cervical lymphadenopathy
- tenderness in the RIF
- usually in younger children
is SBO or LBO more common
small bowel obstruction
causes of bowel obstruction
Big 3 (90%)
1. adhesions (SB)
2. hernias (SB)
3. malignancy (LB)
Others
- volvulus (LB)
- diverticular disease
- strictures
- intusussusception
main causes of intestinal adhesions
- Abdominal or pelvic surgery (particularly open)
- Peritonitis
- Abdominal or pelvic infections (e.g., PID)
- Endometriosis
what is closed loop bowel obstruction
- two points of obstruction along the bowel
- expands, ischaemia, perforation
- emergency surgery
presentation of bowel obstruction
- vomiting (green bilious)
- abdominal distension
- diffuse abdo pain
- constipation and lack of flatulence
- tinkling bowel sounds
- AXR: 3:6:9 SB:colon:caecum
what are valvulae conniventes
- in small bowel
- mucosal folds that form lines extending the full width of the bowel
- AXR: line across entire width
what are haustra
- in large bowel
- pouches formed by the muscles in the walls
- lines do not extend full width