L22: Acute Abdomen- Bowel Obstruction Ad Appendicitisn Flashcards
What is the duration of acute abdominal pain
Less than 7 days
What is the period for chronic abdominal pain
More than 2 weeks
What are the 3 types of abdominal pain
Inflammatory pain
Colicky pain
Perforation pain
What is inflammatory pain
Pain that gets worse e.g appendicitis
What is colicky pain
Pain that comes in waves
What is perforation pain
Pain that is sudden and in high intensity
How does appenditis pain present
Starts in the centre of the umbilus and radiates to the right iliac fossa
Gradually worsening pain (inflammatory pain)
What is the managament of inflammatory pain
Analgesia
Fluids
Antibiotics
Emergency operations
What are examples of inflammatory pain
Appendicitis
Cholecytitis
Pancreatitis
Diverticulitis
What is colicky pain due to
pain that comes in waves, due to smooth muscle contraction against an obstruction in a hallow viscus
What is ureteric colic
Kidney stones in the kidney
What is biliary colic
Gallstones that cant get out of the gallbladder, when you eat food cholecystokinin is released due to the fat in the food that leads to bilary contraction
What is intenstinal colic
Bowel obstruction and peristalsis causes pain
What is biliary colic pain
Pain in the right upper qaudrant
Sharp pain radiating to the shoulder - due to irritation of th phrenic nerve
Nausea
Brought on with food
What are the investigations for colicky pain
Bloods: crp/esr, lft Ultrasound- biliary colic Erect cxr Abdominal x-ray- kidney stones Ct
What is perforations
Rupturing a wall of a hallow viscus
What can the leakage of a viscus content due to perforation result in
Bacterial contamination: large and small intestine
Chemical contamination: gaastric, duodenal and biliary
What is gastric perforation presentaton
Sudden severe pain
Generalised pain
Can cause peritonitis (irritation of the periotenum)
What is mesenteric ishcaemia
When the blood supply to the bowel becomes cut off
What is the difference between perforation and mesenteric ischaemia pain
Perforation; rigid abdomen
Mesenteric ichaemia: bowel that is dying is causing the pain so there is a soft abdomen
What investigations can we do for perforation
Erect chest xray which will show pneumoperitonueam (air under the diaphragmatic and in the peritoneum)
What is the presentation of bowel obstruction
Colicky pain
Distension
Absolute constipation
Nausea and vomiting
Upon an examination what would bowel obstruction show
Distended abdomen
Tinkling bowel sound
PR- empty rectum
Tympanic percussion
What is the classification of bowel obstruction
- Small or large bowel
- Closed (obstruction in 2 places) vs open loop
- Functional (causes bowel wall dysfunction) vs mechanical (phyical barrier)
What are the causes of small bowel obstruction
Adhesions Malignancy Hernias Inflammatory bowel disease Functional
What are the causes of small bowel obstruction
Malignancy
Stricture
Volvulus
Constipation
Where do ahesion, herna and volvulus occur
Extramural
Where do malignancy, crohsn and stricture occur
Mural
What investigations can be carried out for bowel obstruction
Bedside: a-e assessment, pr
Bloods: fbc, ue,lft,crp,clotting, group and save
Radiology: abdomen and chest x-ray, ct scan to work out exact cause
What is the management for small bowel obstruction
Suck and drip: ng tube and no by motuh (suck) and insert the cannula and give iv fluid to correct electrolytes and rehydrate (drip)
Cather- monitor urine output
Surgery
What is the management of large bowel obstruction
Suck and drip technique
Surgery
What are the signs in appendicits upon physical examination
Mcburney point- tenderness
Rozvisgn sign: pain in the iliac fossa upon palpation of the left ilac fossa
Psoas sign: pain on stretch of the psoas muscle
What is the management of appendicits
A-e assessemnt
Anitbiotics
Appendicectomy: open or laparoscopic
