GI test 2: Acute abdomen-Ileus Flashcards
What 3 types of pain can acute abdomen cause?
visceral pain, parietal/somatic pain & referred pain
One thing that can cause inflammation? Ischemia? Obstruction? Perforation/rupture? Peritonitis?
inflammation: appendicitis
ischemia: pulmonary emboli
obstruction: adhesions, tumor
perforation/rupture: ulcers
peritonitis: perforation & then bac infxn
How will the pt appear when presenting with acute abdomen?
anxious, pale, sweaty, in obvious pain, restless (with obstruction) or still (with infxn)
What is the most common cause of acute abd pain?
APPENDICITIS
What are the 4 causes of appendicitis?
lyphoid hyperplasia
fecaliths
parasites
benign or malignant tumors
When does appendicitis peak in occurrence? In what gender?
10-19 yo then gradually declines in geriatric yrs, higher in males
Classic presentation of appendicitis?
periumbilical pain followed by N/V & anorexia & pain migrates to RLQ
Vomiting that occurs after the pain is usu indicative of what? Whereas vomiting before pain is usu indicative of what?
vomiting after pain usu indicates appendicitis
vomiting before pain usu indicates intestinal obstruction
PE of a pt presenting with appendicitis?
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
What 2 exams may be needed to differentiate rectocecal appendix from an adenexal mass?
DRE & pelvic exams
Labs for appendicitis?
CBC= 80-85% of adults have WBC count >10,000 w/left shift (LOTS of neutrophils)
Imaging for appendicitis?
contrast-enhanced CT, graded compression US
DDX for appendicitis?
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
What is acute mesenteric ischemia?
AN EMERGENCY
decrease in mesenteric blood flow= bowel wall ishcemia, inflam & infarction
2 mechanisms of acute mesenteric ischemia?
- diminished bowel perfusion dt low CO (see w/pts w/cardiac dz or w/shock or w/drugs)
- occlusive dz of vascular supply of bowel dt thrombosis or embolism which collateral circulation isn’t good enough
Risk factors for acute mesenteric ischemia?
CAD, atrial fibrillation, hypercoaguable states, portal HTN
Epidemiology of acute mesenteric ischemia?
rarely seen in <60 yos
Ssxs of acute mesenteric ischemia? When does mortality reach 70-90%?
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
When would you suspect acute mesenteric ischemia?
pt >50 yo w/predisposing conditions & sudden onset severe abd pain
Imaging for acute mesenteric ischemia?
mesenteric angiography
abd plain film or CT
What is ischemic colitis?
episodic, transient reduction of blood flow to bowel from sm vessel atherosclerosis
milder, slower onset of sxs
What is hernia of abd wall? When is it an emergency?
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
What is an intestinal obstruction?
AN EMERGENCY
complete or partial blockage of small bowel or colon
Classifications of intestinal obstruction?
complete or partial
simple or strangulated
location
onset: acute or gradual
Pathophys of intestinal obstruction? What does diminished blood flow lead to?
proximal bowel distends, distal bowel collapses, walls edematous, strangulation w/diminished blood flow leads to infarction/gangrene in <6h!
SSxs of intestinal obstruction in the sm intestine? complete vs incomplete ssxs? strangulation vs non-strangulation ssxs?
small intestine: sudden onset periumbilical or epigastric cramping, vomiting, complete= constipation, partial= diarrhea, non-tender abd if no strangulation, severe constant pain if strangulation
Ssxs of intestinal obstruction in the colon?
gradual onset of pain, obstipation, vomiting, abd distention, non-tender, mb palpable mass, borborygmi
What would you see on an abd x-ray with intestinal obstruction? What would a volvulus look like?
bowel loops, fluid lines, distention
volvulus= contrast enema shows “bird-beak” deformity
What is an ileus?
temporary arrest of intestinal peristalsis
Causes of an ileus?
post-surgery, appendicitis, diverticulitis, perforation, AAA, hypokalemia, drugs, lower lobe pneumonia, MI
Ssxs of an ileus?
distention, vomiting, abd discomfort, coicky pain, watery stool
PE of an ileus? Difference if cause is inflam?
absent bowel sounds, non-tender abd unless cause is inflam
What would you see on an X-ray or abd CT with an ileus?
free air (usu in the colon)
