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Hospital Based Medicine And Surgery > L22: Acute Abdomen- Bowel Obstruction Ad Appendicitisn > Flashcards

L22: Acute Abdomen- Bowel Obstruction Ad Appendicitisn Flashcards

1
Q

What is the duration of acute abdominal pain

A

Less than 7 days

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2
Q

What is the period for chronic abdominal pain

A

More than 2 weeks

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3
Q

What are the 3 types of abdominal pain

A

Inflammatory pain
Colicky pain
Perforation pain

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4
Q

What is inflammatory pain

A

Pain that gets worse e.g appendicitis

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5
Q

What is colicky pain

A

Pain that comes in waves

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6
Q

What is perforation pain

A

Pain that is sudden and in high intensity

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7
Q

How does appenditis pain present

A

Starts in the centre of the umbilus and radiates to the right iliac fossa
Gradually worsening pain (inflammatory pain)

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8
Q

What is the managament of inflammatory pain

A

Analgesia
Fluids
Antibiotics
Emergency operations

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9
Q

What are examples of inflammatory pain

A

Appendicitis
Cholecytitis
Pancreatitis
Diverticulitis

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10
Q

What is colicky pain due to

A

pain that comes in waves, due to smooth muscle contraction against an obstruction in a hallow viscus

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11
Q

What is ureteric colic

A

Kidney stones in the kidney

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12
Q

What is biliary colic

A

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

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13
Q

What is intenstinal colic

A

Bowel obstruction and peristalsis causes pain

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14
Q

What is biliary colic pain

A

Pain in the right upper qaudrant
Sharp pain radiating to the shoulder - due to irritation of th phrenic nerve
Nausea
Brought on with food

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15
Q

What are the investigations for colicky pain

A 
Bloods: crp/esr, lft
Ultrasound- biliary colic
Erect cxr
Abdominal x-ray- kidney stones
Ct
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16
Q

What is perforations

A

Rupturing a wall of a hallow viscus

17
Q

What can the leakage of a viscus content due to perforation result in

A

Bacterial contamination: large and small intestine

Chemical contamination: gaastric, duodenal and biliary

18
Q

What is gastric perforation presentaton

A

Sudden severe pain
Generalised pain
Can cause peritonitis (irritation of the periotenum)

19
Q

What is mesenteric ishcaemia

A

When the blood supply to the bowel becomes cut off

20
Q

What is the difference between perforation and mesenteric ischaemia pain

A

Perforation; rigid abdomen

Mesenteric ichaemia: bowel that is dying is causing the pain so there is a soft abdomen

21
Q

What investigations can we do for perforation

A

Erect chest xray which will show pneumoperitonueam (air under the diaphragmatic and in the peritoneum)

22
Q

What is the presentation of bowel obstruction

A

Colicky pain
Distension
Absolute constipation
Nausea and vomiting

23
Q

Upon an examination what would bowel obstruction show

A

Distended abdomen
Tinkling bowel sound
PR- empty rectum
Tympanic percussion

24
Q

What is the classification of bowel obstruction

A
  1. Small or large bowel
  2. Closed (obstruction in 2 places) vs open loop
  3. Functional (causes bowel wall dysfunction) vs mechanical (phyical barrier)
25
Q

What are the causes of small bowel obstruction

A 
Adhesions
Malignancy
Hernias
Inflammatory bowel disease
Functional
26
Q

What are the causes of small bowel obstruction

A

Malignancy
Stricture
Volvulus
Constipation

27
Q

Where do ahesion, herna and volvulus occur

A

Extramural

28
Q

Where do malignancy, crohsn and stricture occur

A

Mural

29
Q

What investigations can be carried out for bowel obstruction

A

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

30
Q

What is the management for small bowel obstruction

A

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

31
Q

What is the management of large bowel obstruction

A

Suck and drip technique

Surgery

32
Q

What are the signs in appendicits upon physical examination

A

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

33
Q

What is the management of appendicits

A

A-e assessemnt
Anitbiotics
Appendicectomy: open or laparoscopic

Hospital Based Medicine And Surgery (30 decks)

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