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Emodules Y3 > Pathology of the Acute Abdomen > Flashcards

Pathology of the Acute Abdomen Flashcards

1
Q

What is the underlying pathology of a twisted ovarian cyst?

A

The cyst is attached by a pedicle of blood vessels, which twists around and increases the pressure. Venous flow away is decreased, if it twists further, even the arterial flow into the ovary will be reduced. Decreased venous return leads to congestion because blood is still continually pumped in. The ovary becomes haemorrhagic and necrotic (despite blood coming in, perfusion isn’t good).

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2
Q

What are some causes of a twisted ovarian cyst?

A

Mature cystic teratoma
Lesion

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3
Q

Which condition is associated with 1/2 of all causes of ectopic pregnancy?

A

Chronic salpingitis

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4
Q

What is the pathology of chronic salpingitis?

A

There is chronic inflammation in the fallopian tube which disturbs the movement of the fertilised ovum.
The ovum implants while still in the fallopian tubes and grow within the narrow tube.
Increased pressure can cause the fallopian tube to burst open, leading to major haemorrhage.

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5
Q

Why is an ectopic pregnancy a surgical emergency?

A

Rupture of the fallopian tubes can lead to life-threatening haemorrhage.

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6
Q

What is the epidemiology of ectopic pregnancy?

A

Occurs in 1 in 150 pregnancies

90% occurs in the fallopian tubes

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7
Q

How do you diagnose ectopic pregnancy?

A

Pregnancy test

Ultrasound

Culdocentesis with traces of blood

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8
Q

In which demographic does meconium ileus occur?

A

Children with cystic fibrosis.

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9
Q

What is the cause of meconium ileus?

A

Meconium ileus is a bowel obstruction that occurs when the meconium in a child’s intestine is even thicker and stickier than normal meconium, creating a blockage in the ileum.

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10
Q

In which pattern does a colonic adenocarcinoma typically grow?

A

Annular, ring-like fashion around the bowel wall, causing constriction and obstruction.

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11
Q

What is caecal volvulus?

A

Twisting of the caecum.

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12
Q

Why is caecal volvulus a surgical emergency?

A

The twisting of the bowel can cause necrosis and ultimately gangrene.

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13
Q

What are the symptoms of caecal volvulus?

A

Abdominal pain

Distension

Absolute constipation

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14
Q

What is a the typical pathology of appendicitis?

A

Obstruction of lumen by faecolith (very hard piece of faeces) which leads to inference with the blood supply which decreases the wall’s resistance to infection.
The appendix constricts to try and drive the faecolith out of the appendix which leads to an increased pressure in the bowel wall.
Blood flow is disturbed which leads to ischaemic changes; therefore the bowel wall is more prone to bacterial invasion.
Inflammation of the wall is cause by bacterial invasion.

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15
Q

What are the usual pathogens associated with appendicitis?

A

E. Coli
Streptococci

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16
Q

What is the underlying pathology of ACUTE appendicitis?

A

The earliest lesion is superficial ulceration of mucosa.
Interference with circulation leads to areas of necrosis and perforation which spread to the peritoneal cavity.
If the infection becomes walled off, this leads to a localised abcess which can eventually lead to generalise peritonitis.
Ulceration stops at the mucosal surface.

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17
Q

Where is the pain from appendicitis typically localised?

A

Generalised dull pain which becomes sharp and localised to the RIF.

18
Q

What is a diverticulum?

A

Blind ending pouch (outpocketing from bowel) whch is an area of weakness.

19
Q

What is the pathology of perforated diverticulitis?

A

Increased pressure in these areas of weakness can drive the mucosa through these areas of weakness which can become infected and perforated.

20
Q

What are some signs and symptoms of diverticulitis?

A

Severe LIF pain
Nausea, loss of appetite, constipation
Patients are usually pyrexial and have a tachycardia
There may be a tender indistinct mass lying parallel to the inguinal ligament

21
Q

What is the most common cause of a CHRONIC peptic ulcer?

A

Helicobacter pylori

22
Q

What are some common causes of an ACUTE peptic ulcer?

A

NSAIDs

Alcohol

Smoking

23
Q

What is the epidemiology of a perforated peptic ulcer?

A

Occurs in 2% of patients
2/3 of ulcer deaths are due to trupture of ulcers.

24
Q

What is the clinical presentation of a perforated peptic ulcer?

A

Epigastric pain
Patient with acute peptic ulceration present with acute pain of short duration but may have had previous similar episodes interspersed with periods of relief which last for many months or even years.

25
Q

Where is the most common site for a ruptured AAA?

A

Infrarenal

26
Q

Why is a leaking AAA dangerous?

A

Aneurysm may rupture into the peritoneal or retroperitoneal tissue which is almost always fatal.

27
Q

What is the clinical presentation of a leaking AAA?

A

Severe central abdominal pain, commonly radiating to the back and may be to the groin along the course of the genito-femoral nerve.
The patient may collapse from the accompanying hypotensive shock or suddenly die.
Often the patient is a smoker with a history of angina, MI, intermittent claudication, TIA or stroke.

28
Q

What are the three degrees of severity for ischaemic bowel disease in decreasing level of severity?

A

Transmural infarction - most severe
Mural infarction - less severe
Mucosal infarction - least severe

29
Q

What is the typically clinical presentation of ischaemic bowel disease?

A

Pain of infarction is usually severe and continuous and quickly develops all the hallmarks of peritonitis.
Generalised pain accompanied by vomiting.
History of angina, MI, intermittent claudication, TIA or stroke.

30
Q

What is the underlying pathology of acute cholecystitis?

A

Inflammation of wall due to chemical damage due to concentrated bile; this is promoted by obstruction by stones (90% of cases).
Bacterial superinfection may supervene (once the wall is damaged).

31
Q

What are the different types of gallstones?

A

Cholesterol

Pigment - dark

Mixed

32
Q

What is the typical clinical presentation of acute cholecystitis?

A

Sudden onset RUQ pain which radiates through to the back close to the tip of the right scapula
Continuous pain exacerbated by movement and respiration
Nausea and vomiting
Murphy’s sign - only positive if the same test in LUQ does not cause pain.

33
Q

What is the typical clinical presentation for gallstones/biliary colic?

A

Generalised severe upper abdominal pain

Non-colicky pain

Nausea and vomiting

34
Q

What is the underlying pathology of pancreatitis?

A

Autoattack due to inappropriate release of enzymes.

35
Q

What sort of damage do the different enzymes do in pancreatitis?

A

Proteolytic digestion of tissues - proteases
Necrosis of vessels leading to haemorrhage - elastase
Fat necrosis - lipase

36
Q

What is the typical clinical presentation of pancreatitis?

A

Epigrastric pain increasing in severity
Patient lies still and breathes shallowly
Radiates through to the back
Sitting forward may relieve the pain
Frequent vomiting and retching
Pain can often be worse after eating fatty foods.

37
Q

What are the different types of kidney stones?

A

Calcium (oxalate and phosphate) - 70%

Uric acid

Cystine stones

38
Q

Which is more hazardous, small kidney stones or large ones and why?

A

Small stones can pass into the ureters whereas large stones don’t tend to leave the kidney so small ones are more dangerous.

39
Q

What is the clinical presentation of renal stones?

A

Kidney stones - excrutiating loin pain
Uretetic stones - ureteric colic, classically radiating from the loin to the groin
Associated nausea and vomiting
Bladder or urethral stones cause pain on micrturition and interrupt urine flow
Microscopic haematuria

40
Q

What is the underlying pathology of acute salpingitis?

A

Ascending infection from gonorrhoea

Emodules Y3 (8 decks)

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