Physiology-Peritonitis Flashcards
A patient presents with acute abdomen. You operate on her and the next day she looks like this. What was her condition?
Henoch Schonlein Purpura
A patient presents with RLQ pain. The next day he develops this rash. What is your diagnosis?
Herpes zoster
How can you use your knowledge of anatomy to test for appendicitis?
Obturator test. The obturator internis sits next to an inflamed appendix and will elicit pain when you internally rotate a flexed thing. Psoas test is similar.
Where is abdominal pain often coming from if it is referred to the shoulder?
Just below the diaphragm. During development the diaphragm migrates down from the neck and takes the phrenic nerve (C3,C4,C5) with it.
Referred right sub scapular pain
Biliary
Referred groin and testicle pain
Renal
Referred pain around kidneys
Pancreatitis and renal pain
Referred pain in the tramp stamp region
Uterine and rectal
Where does foregut pain present?
Epigastric
Where does midgut pain present?
Periumbilical
Where does hindgut pain present?
Hypogastric
A patient had periumbilical pain that progressed to RLQ pain. After a few days, the pain went away for a couple of hours. What happened?
His appendix went from visceral pain, to parietal pain to a burst appendix that temporarily relieved his discomfort.
What causes abdominal colic?
There is obstruction and violent peristalsis occurs to try and clear the obstruction
A patient presents to the ED with an acute abdomen. What drugs do you want to wait to give until the patient is seen by the surgeon?
Steroids can mask peritonitis. Antibiotics can blunt the inflammatory response. Narcotics decrease pain.
A patient presents with an acute abdomen. When you walk into the room she is sitting up and leaning forward. What are you thinking when you see this?
Pancreatitis
A patient presents with an acute abdomen. When you walk into the room he is curled up in the fetal position, not moving. What are you thinking when you see this?
Appendicitis, perforated ulcer, perforated diverticulum, diffuse peritonitis.
A patient presents with an acute abdomen. When you walk into the room he is moving around and just can’t seem to get comfortable. What are you thinking when you see this?
Renal colic, biliary colic.
6 common cause of acute abdomen
Biliary colic, perforated duodenal ulcer, appendicitis, perforated gastric ulcer, pancreatitis, intestinal obstruction.
What are you looking for when you take an x-ray of a patient presenting with obstruction?
Air-fluid levels.
Where do you see most diverticula?
Sigmoid colon
Where does 60% of GI bleeding come from?
Upper GI tract (mouth, esophagus, stomach and jejunum)
Where is the last place you want a perforation to occur?
Gastroduodenal artery, it can really bleed
What happens if you take out a part of someone’s spleen?
Some will grow back. However, they will struggle with H. flu and pneumococcus infections because they are encapsulate organisms.
What gets you a trip to the operating room almost every time?
Free air. It typically represents a perforated ulcer or ruptured diverticulum.
What causes pancreatitis?
Alcohol and gallstones that block the pancreatic duct.
What acute abdomen is a surgical emergency often seen in young kids?
Diaphragmatic hernia
A baby presents with a currant jelly stool and vomiting. What is your diagnosis?
Intussusception
Most common location of intussusception?
Ileum into the cecum.
How can hernias cause acute abdomen?
They can get obstructed
How does ulcerative colitis cause acute abdomen?
Toxic megacolon
When would women get acute abdomen that men can’t get?
Ruptured ovarian cysts and ectopic pregnancy
