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(LUSUMA) Gastro-intestinal System > S8) Abdominal Catastrophes > Flashcards

S8) Abdominal Catastrophes Flashcards

1
Q

What is an abdominal catastrophe?

A

An abdominal catastrophe is an event within or behind the abdominal cavity that poses an imminent threat to life

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2
Q

What is referred pain?

A

Referred pain is pain perceived at a site distant from the site causing the pain

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3
Q

What is somatic referred pain?

A

Somatic referred pain is pain caused by a noxious stimulus to the proximal part of a somatic nerve that is perceived in the distal dermatome of the nerve

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4
Q

How does visceral referred pain occur?

A

Visceral referred pain occurs when visceral afferent pain fibres (thorax and abdomen) follow sympathetic fibres back to the same spinal cord segments that gave rise to the preganglionic sympathetic fibres

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5
Q

What causes visceral pain?

A
  • Abnormally strong muscle contraction and stretch
  • Inflammation
  • Ischaemia
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6
Q

Identify the three common regions where visceral pain is felt

A
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7
Q

Where is gastric and duodenal pain felt?

A
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8
Q

Where is gallbladder pain felt?

A
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9
Q

Where is splenic pain felt?

A
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10
Q

Where is pain due to acute appendicitis felt?

A
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11
Q

Where is pancreatic and abdominal aorta pain felt?

A
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12
Q

Where is small bowel colic felt?

A
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13
Q

Where is large bowel colic felt?

A
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14
Q

Where is renal/ureteric colic felt?

A
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15
Q

Where is pain due to peritonitis felt?

A
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16
Q

In terms of pain, how do patients with peritonitis present?

A
  • Severe pain all over abdomen
  • Pain may be referred to shoulder tips
  • Shallow rapid breathing (diaphragmatic and abdominal wall movement)
  • Very tender abdomen (on examination)
  • ‘Rebound tenderness’ (early stages)
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17
Q

Explain why an inflamed peritoneal cavity can exude litres of fluid

A
  • Large surface area
  • Fluid can collect in abdomen
  • Perfusion rate can increase
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18
Q

In a bowel obstruction, dehydration and increased haematocrit occur due to increased fluid loss.

Why is this?

A
  • Accumulation of fluids
  • Increased secretion
  • Decreased reabsorption
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19
Q

In four steps, explain why several patients with bowel obstructions are in hypovolaemic shock at the time of presentation

A

⇒ 3-4 L of isotonic fluid sequesters in gut

⇒ Vomiting begins & fluid is lost

⇒ More space for fluid to sequester

⇒ Hypovolaemic shock (±7 litres lost)

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20
Q

Identify 2 useful indicators of dehydration in the context of bowel obstruction

A
  • Raised haematocrit (>55%)
  • Raised serum urea
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21
Q

Identify 5 types of abdominal catastrophes

A
  • Blood loss
  • Perforation of a viscus (inflammation, hypovolaemia, sepsis)
  • Acute pancreatitis
  • Acute cholangitis
  • Acute gut ischaemia
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22
Q

Where is blood lost to in an abdominal catastrophe?

A
  • Into the gut
  • Into the retroperitoneum
  • Into the peritoneal cavity
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23
Q

Identify three common causes of bleeding into the gut and briefly describe how they present

A
  • Bleeding oesophageal varices (haematemesis and melaena)
  • Bleeding peptic ulcer (haematemesis and melaena)
  • Bleeding diverticular disease (haematochezia)
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24
Q

What is haematemesis?

A

Haematemesis is the vomiting of blood

25
Q

What is haematochezia?

A

Haematochezia is bright red bleeding from the rectum, often seen with/in stools

26
Q

What do haematemesis and haematochezia indicate?

A

Patient is bleeding massively from the upper GI tract

27
Q

What is melaena?

A

Melaena is the passage of black tarry stools

28
Q

What causes melaena and when does it occur?

A
  • Caused by alteration of blood by digestive enzymes and intestinal bacteria
  • Occurs with bleeding anywhere from the mouth to caecum
29
Q

Patients taking oral iron have black stools.

What is the difference between this and melaena?

A

The smell will reveal the difference

30
Q

How do bleeding duodenal ulcers present?

A

Bleeding duodenal ulcers nearly always present as a posterior duodenal ulcer that has eroded into the gastroduodenal artery

31
Q

Why is serum urea a helpful indicator of upper GIT bleeding?

A
  • Patients bleeding from the stomach/oesophagus present a large protein meal to the small bowel where it is converted by the liver into urea
  • A rise in serum urea with a normal serum creatinine indicates: the source & magnitude of the bleeding
32
Q

What are the two commonest causes of retroperitoneal bleeding?

A
  • Ruptured abdominal aortic aneurysm (AAA)
  • Patients on anticoagulants may bleed from torn retroperitoneal veins
33
Q

Describe the typical presentation of a ruptured AAA

A
  • Sudden death (50%)
  • Sudden onset of severe abdominal, back or loin pain
  • Sudden collapse
  • Hypovolaemic shock
34
Q

Briefly outline the outcome of a ruptured AAA

A
  • Overall survival is about 17% (hospital, operation, recover)
  • Overall mortality is 83% (sudden death/multi-organ failure in ITU)
35
Q

How does ectopic pregnancy present in women of reproductive age?

A
  • Lower abdominal pain
  • Vaginal bleeding
  • Collapse
  • Left shoulder tip pain on lying down
36
Q

What are the two commonest causes of perforation of the viscus?

A
  • Perforated peptic ulcer
  • Perforated diverticular disease
37
Q

What are the two types of perforated peptic ulcers?

A
  • Anterior perforated duodenal ulcer (more common)
  • Posterior perforated gastric ulcer
38
Q

What are the effects of the posterior perforation of a gastric ulcer?

A
  • Initially allows gastric contents to enter the lesser sac
  • Then fluid can track into the greater sac via the epiploic foramen
39
Q

State the respective complications of perforated peptic ulcerations and perforated diverticular disease respectively as well as their associated mortality rates

A
  • Perforated peptic ulceration leads to a chemical peritonitis (mortality 10%)
  • Perforated diverticular disease leads to peritoneal sepsis and septicemia (mortality rate 50%)
40
Q

What is a major clinical indicator of perforated viscus?

A

Pneumoperitoneum

41
Q

Which two abnormalities must be corrected before the administration of anaesthesia?

A
  • Potassium imbalances (hyperkalaemia & hypokalaemia)
  • Fluid and electrolyte imbalances
42
Q

Why must potassium imbalances be corrected before the administration of anaesthesia?

A

Many anaesthetic agents affect cardiac muscle/conduction function

43
Q

Why must electrolyte and fluid imbalances be corrected before the administration of anaesthesia?

A
  • Anaesthetic agents dramatically reduce sympathetic tone & have a negative inotropic effect
  • In a patient who is dehydrated the SNS is maximally activated to maintain vital organ perfusion & hence could develop hypotension and possible die
44
Q

Identify 4 causes of obstruction to the small bowel

A
  • Adhesions due to previous surgery
  • Femoral/inguinal hernia
  • Volvulus
  • Carcinoma of the caecum
45
Q

Identify 3 causes of obstruction to the large bowel

A
  • Carcinoma (particularly left-sided)
  • Sigmoid volvulus
  • Diverticular disease
46
Q

What is the end result of a bowel obstruction?

A
  • Isotonic hypovolaemia
  • Hypochloremia
  • Hypokalemia
  • Metabolic alkalosis
47
Q

In 4 steps, describe how bowel obstructions lead to metabolic alkalosis and hypokalaemia

A

⇒ Vomiting leads to loss of H+ and Cl-

⇒ Metabolic alkalosis

⇒ Renal compensation preserves H+ at the expense of K+

⇒ Hypokalemia ensues

48
Q

What is acute pancreatitis?

A

Acute pancreatitis is a clinical condition involving the autodigestion by proteases of the retroperitoneum

49
Q

Describe the aetiology of acute pancreatitis

A
  • Alcohol
  • Gallstones
50
Q

Describe the management of acute pancreatitis

A
  • No specific treatment
  • Supportive management (fluid resuscitation & pain relief)
51
Q

What can be used to diagnose acute pancreatitis?

A

Raised serum amylase

52
Q

What is the commonest cause of acute gut ischaemia?

A

Embolism (atrial fibrillation)

53
Q

How do patients with acute gut ischaemia present?

A
  • Severe abdominal pain
  • Tender over ischaemic gut (on examination)
  • Patients rapidly become ‘toxic’ and hypotensive
54
Q

How can acute gut ischaemia be diagnosed?

A

Very high white cell count >20 x109/l (normal – 4-11/l)

55
Q

What is the treatment for acute gut ischaemia?

A

Urgent laparotomy and resection of dead bowel

56
Q

What is acute cholangitis?

A

Acute cholangitis is a clinical condition involving an infection in the bile ducts

57
Q

What is the commonest cause of acute cholangitis?

A

Obstruction of the common bile duct by the gallstone, leading to jaundice and biliary stasis

58
Q

What is the commonest causative organism in acute cholangitis?

A

E.Coli

(LUSUMA) Gastro-intestinal System (18 decks)

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