GI test 2: Acute abdomen-Ileus

Question 1

What 3 types of pain can acute abdomen cause?

Answer 1

visceral pain, parietal/somatic pain & referred pain

Question 2

One thing that can cause inflammation? Ischemia? Obstruction? Perforation/rupture? Peritonitis?

Answer 2

inflammation: appendicitis
ischemia: pulmonary emboli
obstruction: adhesions, tumor
perforation/rupture: ulcers
peritonitis: perforation & then bac infxn

Question 3

How will the pt appear when presenting with acute abdomen?

Answer 3

anxious, pale, sweaty, in obvious pain, restless (with obstruction) or still (with infxn)

Question 4

What is the most common cause of acute abd pain?

Answer 4

APPENDICITIS

Question 5

What are the 4 causes of appendicitis?

Answer 5

lyphoid hyperplasia
fecaliths
parasites
benign or malignant tumors

Question 6

When does appendicitis peak in occurrence? In what gender?

Answer 6

10-19 yo then gradually declines in geriatric yrs, higher in males

Question 7

Classic presentation of appendicitis?

Answer 7

periumbilical pain followed by N/V & anorexia & pain migrates to RLQ

Question 8

Vomiting that occurs after the pain is usu indicative of what? Whereas vomiting before pain is usu indicative of what?

Answer 8

vomiting after pain usu indicates appendicitis

vomiting before pain usu indicates intestinal obstruction

Question 9

PE of a pt presenting with appendicitis?

Answer 9

low grade fever, may rise as inflam worsens
McBurney's point tenderness
Rebound tenderness, pain on percussion, rigidity & guarding
Rovsing's sign
Obturator sign
Psoas sign
Cough sign
Markle sign

Question 10

What 2 exams may be needed to differentiate rectocecal appendix from an adenexal mass?

Answer 10

DRE & pelvic exams

Question 11

Labs for appendicitis?

Answer 11

CBC= 80-85% of adults have WBC count >10,000 w/left shift (LOTS of neutrophils)

Question 12

Imaging for appendicitis?

Answer 12

contrast-enhanced CT, graded compression US

Question 13

DDX for appendicitis?

Answer 13

females: PID, ovarian pathology, endometriosis
males: epididymis, testicular torsion
acute gastroenteritis, ileitis
pancreatitis, Crohn’s cholecystitis, pyelonephritis, IBS, renal colic
cecal diverticulitis, Meckel’s diverticulitis
children: volvulous, intussusception

Question 14

What is acute mesenteric ischemia?

Answer 14

AN EMERGENCY

decrease in mesenteric blood flow= bowel wall ishcemia, inflam & infarction

Question 15

2 mechanisms of acute mesenteric ischemia?

Answer 15

1. diminished bowel perfusion dt low CO (see w/pts w/cardiac dz or w/shock or w/drugs)
2. occlusive dz of vascular supply of bowel dt thrombosis or embolism which collateral circulation isn’t good enough

Question 16

Risk factors for acute mesenteric ischemia?

Answer 16

CAD, atrial fibrillation, hypercoaguable states, portal HTN

Question 17

Epidemiology of acute mesenteric ischemia?

Answer 17

rarely seen in <60 yos

Question 18

Ssxs of acute mesenteric ischemia? When does mortality reach 70-90%?

Answer 18

severe abd pain w/minimal physical findings, sudden onset of pain suggest arterial embolism, gradual suggests venous thrombosis
mortality reaches 70-90% after an INFARCT

Question 19

When would you suspect acute mesenteric ischemia?

Answer 19

pt >50 yo w/predisposing conditions & sudden onset severe abd pain

Question 20

Imaging for acute mesenteric ischemia?

Answer 20

mesenteric angiography

abd plain film or CT

Question 21

What is ischemic colitis?

Answer 21

episodic, transient reduction of blood flow to bowel from sm vessel atherosclerosis
milder, slower onset of sxs

Question 22

What is hernia of abd wall? When is it an emergency?

Answer 22

protrusion of abd contents through abd wall (acquired or congential)
asx until strangulated then an EMERGENCY & will also gets sxs of increasing pain, N/V & signs of peritonitis
need surgery to repair

Question 23

What is an intestinal obstruction?

Answer 23

AN EMERGENCY

complete or partial blockage of small bowel or colon

Question 24

Classifications of intestinal obstruction?

Answer 24

complete or partial
simple or strangulated
location
onset: acute or gradual

Question 25

Pathophys of intestinal obstruction? What does diminished blood flow lead to?

Answer 25

proximal bowel distends, distal bowel collapses, walls edematous, strangulation w/diminished blood flow leads to infarction/gangrene in <6h!

Question 26

SSxs of intestinal obstruction in the sm intestine? complete vs incomplete ssxs? strangulation vs non-strangulation ssxs?

Answer 26

small intestine: sudden onset periumbilical or epigastric cramping, vomiting, complete= constipation, partial= diarrhea, non-tender abd if no strangulation, severe constant pain if strangulation

Question 27

Ssxs of intestinal obstruction in the colon?

Answer 27

gradual onset of pain, obstipation, vomiting, abd distention, non-tender, mb palpable mass, borborygmi

Question 28

What would you see on an abd x-ray with intestinal obstruction? What would a volvulus look like?

Answer 28

bowel loops, fluid lines, distention

volvulus= contrast enema shows “bird-beak” deformity

Question 29

What is an ileus?

Answer 29

temporary arrest of intestinal peristalsis

Question 30

Causes of an ileus?

Answer 30

post-surgery, appendicitis, diverticulitis, perforation, AAA, hypokalemia, drugs, lower lobe pneumonia, MI

Question 31

Ssxs of an ileus?

Answer 31

distention, vomiting, abd discomfort, coicky pain, watery stool

Question 32

PE of an ileus? Difference if cause is inflam?

Answer 32

absent bowel sounds, non-tender abd unless cause is inflam

Question 33

What would you see on an X-ray or abd CT with an ileus?

Answer 33

free air (usu in the colon)