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Year 3 > MedEd acute abdomen > Flashcards

MedEd acute abdomen Flashcards

1
Q

who is most likely to get acute appendicits?

A

10-20 y/o

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2
Q

how does appendicits present?

A

periumbilical pain that moves to RIF
nausea and vomiting
low grade fever

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3
Q

what is murphys triad used to diagnose?

A

appendicits

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4
Q

what triad is used to diagnose appendicits?

A

murphys triad

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5
Q

what is murphys triad?

A

abdominal pain that moves from the umbilicus to the RIF
nausea and vomitting
low grade fever

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6
Q

what signs are seen in appendicitis and what do you see?

A

rovsings sign- palpation of the LIF will cause referred pain in the RIF
psoas sign- extension of the hip causes pain
obturator sign- internal rotation of the flexed thigh causes pain
percussion rebound tenderness and guarding
mc burney’s sign- pain at mcburneys point 1/3 of the way from ASIS to umbilicus

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7
Q

how is appendicitis managed?

A

make patient NBM
give fluid if there are signs of shock
abx
laparoscopic appendectomy

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8
Q

what are complications of appendicitis?

A

rupture which can cause peritonitis

abscess which will require drainage

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9
Q

what is diverticular disease?

A

herniation of mucosa and submucosa through muscle layer of the colonic wall

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10
Q

what is the difference between diverticular disease and diverticulosis?

A

diverticulosis= presence of diverticula but asymptomatic

diverticular disease= presence of diverticula but symptomatic

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11
Q

where along the colon does herniation occur in diverticular disease?

A

in between bands of tenia coli

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12
Q

where are diverticula never found?

A

in the rectum

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13
Q

what are RF for diverticular disease?

A

low fibre diet
age over 50
obesity

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14
Q

out of diverticulosis and diverticular disease which is worse? why?

A

diverticular disease because it is symptomatic

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15
Q

how des diverticulitis present?

A

LIF pain
fever
tachycardia
abdo distention

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16
Q

whats the difference between diverticular disease and diverticulosis?

A

both are symptomatic but diverticulosis is severe symptoms due to diverticula getting very inflammed or infected

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17
Q

what imaging is done for diveritcular disease and what do you see?

A

GS: colonoscopy to visualise the diverticula
Barium enema: sawtooth appearance
CT- can confirm diagnosus

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18
Q

how is diverticular disease managed?

A

you can’t reverse growth but you can slow progression- high fibre diet, hydration, reduce weight, stop smoking

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19
Q

what analgesics should you avoid in diverticular disease and why?

A

opioids because it will make them more constipated

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20
Q

what are complications of diverticular disease?

A 
diverticulitis
abscess
perforation
peritonitis 
fistulas and stricture formation
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21
Q

what happens to fluid when there is an intraluminal pressure due to bowel obstruction?

A

third spacing because fluid is squeezed out

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22
Q

what part of the bowel is most likely to get obstructed?

A

small bowel

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23
Q

what is strangulation in bowel obstruction?

A

compromised blood supply which can lead to ischaemia and gangrene

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24
Q

what are the most common causes of small v large bowel obstruction?

A

small bowel obstruction= mainly from adhesions from surgery

large bowel obstruction= mainly from malignancy

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25
Q

what is the most common cause of small bowel obstruction?

A

adhesions from surgery

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26
Q

what is the most common cause of large bowel obstruction?

A

malignancy

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27
Q

what are signs and symptoms of bowel obstruction?

A 
severe colicky pain
abdo distention
tinkling bowel sounds 
bilious vomitting 
constipation
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28
Q

what is the main imaging for bowel obstruction?

A

supine abdominla x ray

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29
Q

on abdo x ray how do you differentiate between small and large bowel obstruction?

A

small bowel= vulvae coniventae are seen which are lines that go all the way across the bowel
large bowel= haustra which go halfway across the bowel

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30
Q

what are vulvae coniventae, how do you spot them and in what are they seen?

A

they are lines that go all the way across the bowel and help identify small bowel obstruction

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31
Q

what is the difference between vulvae coniventae and haustra and where is each seen on an abdo x ray?

A

vulvae coniventae= lines on the small bowel that go all the way across
haustra= lines on the large bowel that only go halfway across

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32
Q

how is bowel obstruction managed?

A

conservative: NDM, NG tube to decompress bowels, IV fluids, urinary catheter and analgesia
if acute and theres evidence of strangulation/ichaemia then do a laparotomy

33
Q

how is bowel obstruction secondary to adhesions managed?

A

conservatively- NMD, NG tube to decompress bowel

then check in 24 hrs

34
Q

what is volvulus?

A

rotation of a loop of bowel around the axis of its mesentery that results in obstruction and ischaemia

35
Q

what part of the bowel is most commonly affected in volvulus?

A

most commonly the sigmoid colon

sometimes the caecum

36
Q

what are RF for volvulus?

A 
long sigmoid colon
long mesentery 
mobile caecum 
chronic constipation
adhesions
37
Q

what are signs and symptoms of volvulus?

A 
severe colicky pain
constipation
absent or tinkling bowel sounds 
vomitting 
abdo distention and tenderness 
signs of dehydration
38
Q

what is seen on abdo x ray in volvulus?

A

coffee bean sign

39
Q

how is volvulus managed?

A

if sigmoid colon then sigmoidoscopy and detorsion, there is a high rate of recurrence and if so surgery may be needed

if caecum them colonoscopy cannot be done due to risk of detorsion so surgery is done

40
Q

describe how acute pancreatitis arises

A

when a apcnreas is inflammed calcium build up in it

this causes release of enzymes like lipase and amylase

this damages local structures and causes systemic signs

41
Q

what is the most common cause of pancreatitis in women vs men?

A 
women= gallstones
men= alcohol
42
Q

what electrolyte imbalance can cause pancreatitis?

A

hypercalcaemia

43
Q

what drugs can cause pancreatitis?

A

sodium valproate, steroids, thiazides and azathioprine

44
Q

what are signs and symptoms of acute pacreatitis?

A

severe epigastric pain that radiates to the back- relieved by sitting forward and worse when lying down
nausea and vomitting
fever
hypovolemia

45
Q

what are the 2 signs of acute pancreatitis and where are they found?

A

cullens sign= periumbilical bruising

grey turners sign= flank bruising

46
Q

how do you remember which way around grey turners and cullens sign is?

A

cullens= bella cullen from twilight had a really fucked up baby and a baby is in the tummy so cullens sign= tummy/perumbilical bruising

grey turners sign= flank bruising

47
Q

what are grey turners and cullens signs a sign of?

A

acute pancreatitis

48
Q

what ix are done for acute pancreatitis? what will you see

A

amylase lipase- 3x higher than normal
CT abdo GS to confirm diagnosis
ALP +bilirubin to check for gallstones
Ca/triglyceride levels

49
Q

what is GS imaging for acute pancreatitis?

A

CT abdomen

50
Q

how high are amylase and lipase in acute pancreatitis? what must you be careful to remember?

A

3x normal

the level of enzyme does not correspond to the severity of the pancreatitis

51
Q

out of amylase and lipase which is more sensitive for pancreatitis?

A

lipase

52
Q

describe glasgow/ PANCREAS score

A 
PaO2= <8kpa/60 mmHg
Age >55
Neutrophils- high WBC
Calcium <2 mmol/L
Renal function- urea >16 mmol/L
Enzymes- high AST/ALT or LDH
Albumin <32g/L
Sugar- glucose >10 mmol/L
53
Q

how is acute pancreatitis managed?

A 
analgesia
IV fluids
NG tube 
Control blood sugar 
abx if infected 
treat cause
54
Q

if acute pancreatitis is caused by gallstones how is this managed?

A

ERCP with sphincterotomy
cholecystectomy
remove nectrotic tissue

55
Q

what is a predictor of pancreatitis severity? what is not

A

heamatocrit is a good indicator of severity

enzymes (amylase/lipase) ARE NOT good severity predictors

56
Q

what is peritonitis?

A

inflammation of the peritoneal lining of the abdominal cavity

57
Q

what is the difference between primary and secondary generalised peritonitis?

A

primary is due to bacterial infection without an obvious source

secondary is due to a pre existing abdominal condition

58
Q

what are signs and symptoms of peritonitis?

A

nausea and vomitting
acute onset severe abdomen pain that is generalised at first and then becomes localised
reduced bowel sounds (due to paralytic ileus)
signs of sepsis
gaurding and rebound tenderness
washboard rigidity

59
Q

what is seen on ascitic tap in SBP?

A

neutrophil count over 250

60
Q

what is seen on erect CXR in peritonitis?

A

air under the diaphragm

61
Q

what is SBP?

A

spontaneous infection of ascitic fluid not originating from an obvious place in the abdomen eg hole in intestines or collection of pus

62
Q

how is peritonitis managed?

A

conservative: IV fluids, abx, NG tube
primary generalised/septic= broad spectrum abx
localised/secondary generalised= treat cause, may need surgery (necrosectomy and peritoneal lavage)

63
Q

what is a hernia and what are the 2 common types?

A

usually inguinal or femoral

it is a protrusion of contents through areas of weakness in the wall that contains them

64
Q

what are the causes of hernia?

A 
anything that increases intra abdominal pressure eg
pregnancy 
chronic cough
constipation 
weakened abdo muscles
65
Q

where are femoral vs inguinal hernias located? how do you remember this

A

femoral= inferior and lateral to the pubic tubercle (remember because the femoral vein goes below/inferior and is lateral to the pubic tubercle)

inguinal= superior and medial to the pubic tubercle

66
Q

what are the borders of hesselbach’s triangle?

A

lateral border of rectus abdominis
inferior epigastric vessels
inguinal ligament

67
Q

what type of hernia is related to hesselbach’s triangle and how?

A

direct inguinal hernia

68
Q

what anatomical triangle does a direct inguinal hernia protrude through?

A

hesselbach’s triangle

69
Q

in what gender are inguinal hernias more common?

A

males

70
Q

describe anatomically where an direct vs indirect inguinal hernia starts and ends

A 
direct= in through a hole in the back of the inguinal canal and out through superficial inguinal ring  
indirect= in through deep inguinal ring and out through superficial inguinal ring
71
Q

in what gender is femoral hernia more common in and how do you remember?

A

females because femoral and female both start with an f

72
Q

how do you remember the positioning of inguinal v femoral hernia?

A

femoral artery is below and lateral to pubic tubercle and so is the hernia

inguinal= intimate to it extends towards the genitalia therefore it is superficial and medial to the pubic tubercle

73
Q

what is an incarcerated hernia?

A

when the contents of a hernia are stuck inside by adhesions

74
Q

what is a strangulated hernia?

A

when the blood supply to the hernia is cut off

75
Q

how are inguinal or femoral hernias managed?

A

conservative- weight loss
elective repair- mesh repair where stent is placed over the defect where the hernia protruded from
obstructed/strangulated- emergency laparotomy

76
Q

how are incarcerated/strangulated hernias repaired?

A

via emergency laparotomy

77
Q

how dies intestinal ischaemia arise?

A

obstruction of a mesenteric vessel leading to bowel ischaemia and necrosis

78
Q

what are RF for intestinal ischaemia?

A

increasing age
AF
other causes of emboli eg endocarditis, malignancy
cardiovascular disease RF eg hypertension, diabetes, hyperlipidaemia

Year 3 (104 decks)

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