GI - * Flashcards
5 Fs of abdominal distention
Fat (obesity) Faeces (constipation) Foetus (pregnancy) Flatus (GI) Fluid (ascites)
Clinical features of pain
Constant/ intermittent/ severe/ loin/back, central/lower
Constant pain, gradual onset but progressive worsening: inflammatory cause
Intermittent pain, poorly localised: colic arising from a visceral structure
Severe pain out of proportion to clinical signs: ischaemic bowel, until proven otherwise
Loin/back pain: pancreas, renal tract, abdominal aorta i.e. retroperitoneal
Central & lower abdominal pain in children (<12yrs) is only pathological in 10-20%
GI causes of acute abdomen
Gastroduodenal: PU, gastritis, gastric volvulus, malignancy
Intestinal: appendicitis, obstruction, diverticulitis, gastroenteritis, IBD, mesenteric adenitis, strangulated hernia, intussusception (can be associated with a tumour/polyp as leading edge) , volvulus, TB
Hepatobiliary: acute/chronic cholecystitis, cholangitis, hepatitis
Pancreatic: acute/chronic pancreatitis, malignancy
Splenic: infarction, spontaneous rupture (associated with glandular fever)
Medical causes of acute abdomen
MI, DKA/HONK, lead poisoning, uraemia, sickle cell, Addison’s/phaeo, porphyria, shingles, TB, hypercalcaemia, Henoch-Schonlein Purpura, Tabes dorsalis, Bornholm disease (viral), pneumonia, Thyroid storm, polyarteritis nodosa
Porphyria, lead poisoning, Henoch-Schonlein purpura, polyarteritis nodosa, tabes dorsalis
Non-GI causes of acute abdomen
Urinary: cystitis, acute urinary retention, acute pyelonephritis, ureteric colic, hydro nephritis, pyelonephritis, polycystic kidney, tumour
Gynaecological: ruptured ectopic, torsion/ rupture of ovarian cyst, salpingitis, severe dysmenorrhoea, Mittelschmertz, endometriosis, red degeneration of a fibroid
Vascular: mesenteric angina (claudication), AAA, mesenteric embolus/venous thrombosis, ischaemic colitis, acute aortic dissection
Peritoneum: 1o/ 2o peritonitis
Abdominal wall: rectus sheath haematoma, cellulitis, strangulated hernia
Retroperitoneum: haemorrhage
Referred pain: herpes zoster, lobar pneumonia, thoracic spine disease, pleurisy, MI, pericarditis, testicular torsion
Acute abdomen according to position of pain
R-hypochondrium: gallstones, liver pain e.g. fitz hugh curtis syndrome (PID causing liver pain), referred pain
Epigastric: PUD, ulcer perforation, GORD, pancreatitis, appendicitis (early), referred heart pain
L-hypochondrium: splenic injury, tail of pancreas, pseudocyst of pancreas (cyst with no proper walls - build-up of fluid in lesser sac if pancreatic duct is blocked)
Umbilical: hernia, early appendicitis, gastroenteritis, SBO
Loin: pyelonephritis, renal calculi, diverticulitis, cancer of colon
R-iliac fossa: appendicitis, gynaecological (Mitelschmerz, PID & chlamydia, ectopic, twisted ovarian cyst), Meckel’s diverticulum, Crohn’s of the terminal ileum
Suprapubic: cystitis, pelvic pathology e.g. diverticular abscess, gynaecological problems
L-iliac fossa: diverticulitis, colon cancer, ureteric colic, back pain, gynaecological pathology
Acute abdomen Ix
U&E, FBC, amylase, LFT, CRP ABG urine dip CXR / AXR USS
Early treatment of acute abdomen
IV ABx are inappropriate without a clear diagnosis
Fluid balance, analgesia +/- antiemetics
Monitor vital signs
Syndromes requiring laparotomy
organ rupture - shock, abdo swelling, trauma Hx
Peritonitis - perforated PU/DU, diverticulum, appendix, bowel, GB
Check serum amylase - acute pancreatitis causes these signs but does not require laparotomy
Syndromes not requiring laparotomy
Local peritonitis: diverticulitis, cholecystitis, salpingitis, appendicits (surgery required), localised ileus
Colic
Definition of peritonitis
Inflammation of the peritoneum (covering of the external surfaces of all the abdominal & pelvic organs) → sepsis → septic shock → death
Aetiology of peritonitis
usually bacteral infection
Exterior cause: wound, peritoneal dialysis
Abdo viscera: perforation, anastomotic leak, bowel infarction)
septicaemia
Female genital tract
Spontaneous bacterial peritonitis (SBP)
infection of ascites fluid that cannot be attributed to any intra-abdominal cause;
one of the most freq encountered bacterial infections in patients with cirrhosis
Rx: cefotaxime or tazosin
Clinical Dx of SBP
↑ing tachycardia & pyrexia
constant abdominal pain (peritoneal inflammation) - exacerbated by any movements (e.g. coughing) & local pressure
abdo tenderness & guarding (involuntary spasm of anterior abdominal wall muscles over inflamed abdominal viscera)
rebound tenderness
localised pain during distant palpation
absence of bowel sounds in a tender, rigid abdomen
signs of shock
abdo distension (accumulation of free fluid)
Ix SBP
FBC (leucocytosis) Serum amylase (pancreatitis) Urinalysis Stool sample Ascitic tap USS Erect CXR (perforation) AXR (free gas) CT (cause of peritonitis)
