Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Surgery block (Y3) > General surgery (1) (The acute abdomen, common presentation and history) > Flashcards

General surgery (1) (The acute abdomen, common presentation and history) Flashcards

1
Q

define the acute abdomen

A

A sudden onset of severe abdominal pain developing over a short time period

  • It has a large number of possible causes and so a structured approach is required.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

initial assessment of the acute abdomen

A

Is the patient critically unwell- end-of-bed-o -gram and observations?

  • Yes?
    • Call for help early
    • Start initial management steps early
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

presentations requiring urgent intervention

A
  • bleeding
  • perforated viscus
  • ischaemic bowel
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

less acute presentations

A
  • colic
  • peritonism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

causes of bleeding

A
  • Most serious cause is AAA
  • Ruptured ecotopic pregnancy
  • Bleeding gastric ulcer
  • Trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

presentation of bleeding

A
  • hypovolaemic shock
    • Tachycardia
    • Hypotension
    • Pale
    • Clammy
    • Cool to touch
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

perforated viscus cause

A

perforation (peptic ulceration, obstruction, diverticular disease and IBD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

presentation of perforated viscus

A

peritonism (diff to peritonism)

  • Lie completely still
  • Look unwell
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

examintion of perforated viscus

A
  • Tachycardia and potential hypotension
  • Rigid abdomen and percussion tenderness
  • Involuntary guarding
  • Reduced or absent bowel sounds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

ischaemic bowel presentation

A
  • Presentation
    • Severe pain out of proportion to the clinical signs
    • Acidaemic with raised lactate and physiologically compromised
    • Diffuse and constant pain
    • Definitive diagnosis- CT with IV contrast
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

colic

A
  • Abdominal pain that crescendos and then goes away completely
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

cause of colicky pain

A
  • Biliary colic
  • Ureteric colic
  • Bowel obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

peritonism

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

presentation of peritonism

A
  • Diff to peritonitis
  • Localised inflammation of peritoneum- usually due to inflammation of viscus that irritate visceral peritoneum

e.g. acute appendicitis (pain migrates from umbilical region to the RIF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

types of abdominal pain

A

visceral

somatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

visceral pain

A

(originating from organs)- vague pain felt in midline (autonomic)

  • Results from stimulation of receptors in smooth muscle
  • By ischaemia, distension/stretching, tension (often colicky)
  • Conducted by autonomic nerves
  • Poorly localised midline pain
  • Associated with malaise, nausea, vomiting and sweating
  • Example: appendicitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

somatic pain

A

(body wall)- localised, specific pain

Referred

  • Biliary tract pain
  • Diaphragmatic irritation e.g with gall stones
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

differential diagnosis fo acute abdomen related to extra-abdominal organs

A

cardiac, resp, gynaecological, testicular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

common causes of the acute abdomen

A
  • Appendicitis
  • Cholecystitis and biliary colic
  • Diverticulitis
  • Obstruction
  • Pancreatitis
  • Gynae pathology renal/urology pathology
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Differential diagnosis of acute abdomen based on located

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

investigations for the acute abdomen

A

laboratory tests

imaging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

laboratory tests

A

The investigations in all cases of the acute abdomen share the same generic outline:

  • Urine dipstick – for signs of infection or haematuria ±MC&S.
    • Include a pregnancy test for all women of reproductive age
  • Arterial Blood Gas – useful in bleeding or septic patients, especially for the pH, pO2, pCO2, and lactate for signs of tissue hypoperfusion, as well as a rapid haemoglobin level
  • Routine bloods – FBC, U&Es, LFTs, CRP, amylase*
    • Do not forget a group & save (G&S) if the patient is likely to need surgery soon
  • Blood cultures – if considering infection as a potential diagnosis

*Any amylase 3x greater than the upper limit is diagnostic of pancreatitis. Any raised value lower than this may also be due to another pathology, such as perforated bowel, ectopic pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

imaging

A

Following assessment, initial imaging may help to further help focus the diagnosis if still unclear:

  • An erect chest plain film radiograph (eCXR) – for evidence of free abdominal air e.g. pneumoperitoneum or lower lobe lung pathology
  • Ultrasound
    • Kidneys, ureters, and bladder (‘KUB’) – can check for hydronephrosis and cortico-medullary differentiation
    • Biliary tree and liver – can check for the presence of gallstones, gallbladder thickening, or duct dilatation
    • Transvaginal – for suspected tubo-ovarian pathology
  • CT imaging of the abdomen, often best discussed with a senior depending on the suspected underlying diagnosis if required

In the emergency setting, every patient with abdominal pain should have electrocardiogram to exclude cardiac pathology, as referred pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

management of the acute abdomen

A

Depends largely on the cause. However, a good initial management plan includes core points, regardless of the underlying aetiology.

These include:

  • Intravenous access
  • Nil-by-mouth (NBM) status set
  • Analgesia +/- antiemetics
  • Imaging
  • VTE prophylaxis
  • Urine dip
  • Bloods
  • If the patient is unwell, consider a urinary catheter and/or nasogastric tube if necessary,
  • Intravenous fluids and monitor fluid balance.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

cause of generalised peritonitis

A
  • Perforated viscus
  • Primary infective peritonitis
  • Rupture of cyst
26
Q

cause of localised peritonitis

A
  • Appendicitis
  • Cholecystitis
  • Pancreatitis
  • Diverticulitis
  • Abscesses
  • Salpingitis/ruptured ectopic
27
Q

causes of motility disorders

A
  • Spasms
    • Irritable colon, uterine contractions
  • Obstruction
    • Intestinal, ureteric, biliary
28
Q

causes of ischameic

A
  • Mesenteric angina
  • Splenic infarction
  • Torsion of ovarian cyst, testicle, omentum
  • Tumour necrosis
29
Q

presentation of ruptured AAA

A
  • Sharp and tearing
  • Radiates to the back
30
Q

thoracic pain causes

A
  • Lung disease
  • Ischaemic heart disease
  • Oesophageal disease
31
Q

neurological diseases

A
  • Herpes zoster
  • Spinal arthritis
  • Radiculopathy from tumours
  • Tabes dorsalis (form of neurosyphilis, which is a complication of late stage syphilis infection)
  • Abdominal epilepsy
32
Q

metabolic causes of acute abdomen

A
  • DM
  • Chronic renal failure
  • Porphyria
  • Acute adrenal insufficiency
33
Q

causes of acute abdomen: toxins

A
  • Snake and insect bites
  • Lead poisoning

e.g. scorpion skin- pancreatitis

34
Q

broad categories of common surgival presentation

A
  • Abdominal pain
  • Perforation
    • UGI
      • Perforated duodenal ulcer
      • LGI
        • Perforated diverticular disease
        • Perforated tumour
        • Iatrogenic
  • Obstruction
  • GI bleeding
  • Hernias
  • HPB emergencies
  • Abscesses (inc perianal abscess)
35
Q

GI perforation

A
  • Presenting features
    • Haemodynamically unstable
    • Sharp constant pain
    • Vomiting
    • Fever
  • Examination findings
    • GI exam
  • Investigations
    • CT
    • Blood gases
  • Management
    • IV fluids
    • Antibiotics
    • Oxygen if needed
    • Surgery (not very often)
      • Dependent on performance status of the patient
      • UGI perforation e.g. DU are genrally close
      • LGI perforation e.g. due to diverticular disease generally resected
      • Mortality and morbidity high
36
Q

bowel obstruction presentation

A
  • Colicky pain
  • Abdominal distention
  • Vomiting
  • Not opening bowels
37
Q

causes of bowel obstruction an be split into

A
  • Within the tube
    • Constipation
    • Foreign body
  • Within the wall of the tub
    • Tumours
    • Stricture
    • Connective tissue disorder e.g. Hirshsprungs, achalasia
  • Outside
    • Adhesions/strictures
    • Tumour
    • Twists
    • Hernias
    • Intra-abdominal malignancy
38
Q

causes of small bowel obstruction

A
  • Adhesions (50-75%)
  • Hernia (7-25%)
  • Tumours (7-14%)
39
Q

causes of large bowel obstruction

A

Large bowel

  • Colorectal (65%)
  • Diverticular disease (20%)
  • Sigmoid volvulus (10%)
40
Q

Clinical signs of obstruction

A
  • Distension
  • Visible hernia/scars
  • High pitched, tinkling bowel sounds
  • Dehydration
  • Tachycardia
  • Hypotension
  • Fever
  • Tenderness
41
Q

management of obsturction

A
  • NBM, NGT
  • IVI, catheter
  • Analgesic
  • A definitive diagnosis – AXR + CT
  • Definitive management
42
Q

SBO on AXR

A
  • Central
  • SB lines up as a ladder
  • Lines go right across
43
Q

Hernia

A

A condition in which part off an organ is displaced and protrudes through the wall of the activity containing it

44
Q

common hernias

A
  • Inguinal
  • Umbilical
  • Femoral
  • Incisional
45
Q

complications of hernias

A
  • Obstruction
  • Strangulation
46
Q

presenation of hernia

A
  • Tender, painful, non-reducible lump
  • Skin erythema
  • Systemic upset
  • Abdominal distension/vomiting
47
Q

HPB emergencies

A
  • Biliary colic
  • Cholecystitis
  • Choledocholithiasis
  • Ascending cholangitis
  • Pancreatitis
  • Gallstone ileus
48
Q

general HPB themes

A
  • Imaging modality
    • MRCP
    • Role of urgent/early surgery in gallstone disease
    • ERCP
49
Q

GI history taking: introduction

A
  • Wash your hands and don PPE if appropriate.
  • Introduce yourself to the patient including your name and role.
  • Confirm the patient’s name and date of birth.
  • Explain that you’d like to take a history from the patient.
  • Gain consent to proceed with history taking.
50
Q

GI history taking: PC

A
  • “What’s brought you in to see me today?”
  • “Tell me about the issues you’ve been experiencing.”
  • Can you tell me more?
51
Q

GI history taking: HPC key GI symptoms

A

nausea, vomiting, abdominal pain, distension, weight loss and jaundice

52
Q

GI history taking: HPC- exploring symptoms

A

Use SOCRATES to explore symptoms

Site

Ask about the location of the symptom:

  • “Where is the pain?”
  • “Can you point to where you experience the pain?”

Onset

Clarify how and when the symptom developed:

  • “Did the pain come on suddenly or gradually?”
  • “When did the pain first start?”
  • “How long have you been experiencing the pain?”

Character

Ask about the specific characteristics of the symptom:

  • “How would you describe the pain?” (e.g. sharp, dull ache)
  • “Is the pain constant or does it come and go?”

Radiation

Ask if the symptom moves anywhere else:

  • “Does the pain spread elsewhere?”

Associated symptoms

Ask if there are other symptoms which are associated with the primary symptom:

  • “Are there any other symptoms that seem associated with the pain?” (e.g. fever in intrabdominal infection, vomiting in bowel obstruction)

Time course

Clarify how the symptom has changed over time:

  • “How has the pain changed over time?”

Exacerbating or relieving factors

Ask if anything makes the symptom worse or better:

  • “Does anything make the pain worse?” (e.g. GORD is worsened by lying flat)
  • “Does anything make the pain better?” (e.g. GORD is improved with antacid medication)

Severity

Assess the severity of the symptom by asking the patient to grade it on a scale of 0-10:

  • “On a scale of 0-10, how severe is the pain, if 0 is no pain and 10 is the worst pain you’ve ever experienced?”
  • If the symptom is weight loss, try to quantify the amount of weight the patient has lost over a specific time period.
53
Q

GI history taking: Upper GI symptoms

A
  • Jaundice: yellowing of the skin/sclera and dark urine. Causes include hepatitis, liver cirrhosis and biliary obstruction (e.g. gallstone, pancreatic cancer).
  • Aphthous ulceration: round or oval ulcers occurring on the mucous membranes inside the mouth. Aphthous ulcers are typically benign (e.g. due to stress or mechanical trauma), however, they can be associated with iron, B12 and folate deficiency as well as Crohn’s disease.
  • Vomiting: a common symptom of many gastrointestinal disorders including infections (e.g. gastroenteritis), gastro-oesophageal reflux disease (GORD), pyloric stenosis (projectile non-bilious vomiting), bowel obstruction (typically bilious), gastroparesis (e.g. secondary to diabetes), pharyngeal pouch and oesophageal stricture (vomit containing undigested food).
  • Haematemesis: the vomiting of blood which can be fresh red in colour (e.g. Mallory-Weiss tear, oesophageal variceal rupture) or coffee ground in appearance (e.g. gastric or duodenal ulcer).
  • Gastro-oesophageal reflux: backflow of the stomach’s contents into the oesophagus secondary to lower oesophageal sphincter incompetence. Patients typically describe epigastric discomfort which is burning in nature.
  • Dysphagia: difficulty swallowing which may affect solid food, liquids or both depending on its severity (e.g. oesophageal cancer).
  • Odynophagia: pain during swallowing which may be associated with oesophageal obstruction (e.g. stricture) or infection (e.g. oesophageal candidiasis).
54
Q

GI history taking: lower GI symptoms

A

Lower gastrointestinal symptoms include:

  • Abdominal pain: may be localised (e.g. right iliac fossa in appendicitis) or generalised (e.g. spontaneous bacterial peritonitis).
  • Abdominal distension: associated with a wide range of gastrointestinal pathology including ascites, constipation, bowel obstruction, organomegaly and malignancy.
  • Constipation: causes include dehydration, reduced bowel motility (e.g. autonomic neuropathy) and medications (e.g. opiates, ondansetron, iron supplements).
  • Diarrhoea: causes include infection (e.g. C.difficle), irritable bowel syndrome, inflammatory bowel disease, medications (e.g. laxatives), constipation (with overflow) and malignancy.
  • Steatorrhoea: the presence of excess fat in faeces causing them to appear pale and be difficult to flush. Causes of steatorrhoea include pancreatitis, pancreatic cancer, biliary obstruction, coeliac disease and medications (e.g. Orlistat).
  • Malaena: dark, tar-like sticky stools containing digested blood secondary to upper gastrointestinal bleeding (e.g. peptic ulcer).
  • Haematochezia: fresh red blood passed per rectum which may be caused by haemorrhoids, anal fissures and lower gastrointestinal malignancy.
55
Q

GI history taking: systemic symptoms

A
  • Systemic: fevers, weight change, fatigue
  • Cardiovascular: chest pain, oedema, syncope, palpitations
  • Respiratory: dyspnoea, cough, sputum, wheeze, haemoptysis, pleuritic chest pain
  • Genitourinary: oliguria, polyuria, dysuria, urinary frequency
  • Neurological: visual changes, motor or sensory disturbances, headache, confusion
  • Musculoskeletal: chest wall pain, trauma
  • Dermatological: rashes, skin lesions, jaundice
56
Q

GI history taking: family history

A

cancers etc

57
Q

GI history taking: past medical history

A

ask about previous GI issues and surgeries

are they being seen by a doctor for anything regularly

58
Q

GI history taking: drug history

A
  • any daily medication
  • any pain medication
  • any over counter
  • how good are thye at taking it
59
Q

GI history taking: allergies history

A

any allergies- what kind of response

60
Q

GI history taking: social history

A
  • General context
  • Travel history
  • Smoking
  • Alcohol
  • Recreational drug use
  • Gambling
  • Diet
  • Exercise
  • Sexual history

Surgery block (Y3) (38 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions