September 24, 2015 - Acute Abdomen

Question 1

Acute Abdomen

Answer 1

A condition of the abdomen which requires urgen diagnosis and treatment. Almost always involves abdominal pain, and often requires surgery.

Some examples can be… pancreatitis, bowel obstruction, Crohn’s, UC, appendicitis, etc.

Question 2

Types of Abdominal Pain

Answer 2

1. Visercal
2. Somatic (parietal)

Question 3

Visceral Abdominal Pain

Answer 3

Derives from the visceral peritoneum. This is often sensitive to stretching, pulling, contraction. Mediated by the autonomic nervous system.

The pain is often poorly localized, dull, crampy, and not made worse with movement. May come and go in waves and can be very severe.

Question 4

Somatic (Parietal) Abdominak Pain

Answer 4

Derives from the parietal peritoneum and is mediated by somatic nerves. This is sensitive to cutting, burning, and imflammation.

Pain is often sharp, well-localized, severe, persistent, and made worse with movement. Patients typically like to stay still.

Eg. peritonitis, appendicitis, diverticulitis.

Question 5

High CBC and Dehydration

Answer 5

CBC can appear artificially high in the presence of dehydration. This is because there is less plasma volume to dilute it.

Question 6

Appendectomy

Answer 6

The removal of the appendix.

Can be performed openly or laparoscopically.

Question 7

McBurney’s Point

Answer 7

2/3 along the line between ASIS and umbilicus.

Question 8

Pathophysiology of Appendicitis

Answer 8

1. Obstruction of the appendiceal lumen
2. Increased lumen pressure and spasm (visceral pain)
3. Impaired circulation to the wall of the appendix (ischemia)
4. Bacterial invasion of wall with inflammation and eventual necrosis of the wall (somatic pain)
5. Perforation with peritontis or abscess

Question 9

Causes of Appendiceal Obstruction

Answer 9

Fecalith (inspissated stool)

Lymphoid hyperplasia

Fibrosis, foreign bodies, parasites

Neoplasia

Question 10

Appendicitis: Patient History

Answer 10

Classic is non-specific periumbilical pain (visceral), followed by nausea and shark RLQ pain (somatic) 12-36 hours later.

The migration of pain to the RLQ is classic.

Question 11

Rovsing’s Sign

Answer 11

RLQ pain with the palpation of the LLQ.

Question 12

Obturator Sign

Answer 12

RLQ pain with the rotation of the hip.

Question 13

Psoas Sign

Answer 13

RLQ pain with the hyper-extension of the hip.

Question 14

DDx of Appendicitis

Answer 14

Could also be…

Pelvic inflammatory disease

Ruptured ovarian cyst (women in child-bearing age)

Ruptured follicular cyst

Mesenteric adenitis (children)

Question 15

Imaging for Appendicitis

Answer 15

US or CT

Question 16

Meckel’s Diverticulum

Answer 16

Is a true congeinital diverticulum. It is a slight bulge in the small intestine that is present at birth and is the most common malformation of the GI tract and is present in about 2% of the population.

May cause issues by being different cells and secreting products such as alkaline pancreatic juice or acid.

Question 17

Etiology of Diverticulosis

Answer 17

A low fibre diet.

Low fibre diets lead to longer transit times, harder and smaller stools, increased intra-colonic pressure, segmentation and narrowing of the colon.

Question 18

Acute Diverticulitis

Answer 18

Microperforation with surrounding infection.

Presents with LLQ pain, fever, a history of constipation and bowel complaints, altered bowel habit.

Need a CT scan.

Question 19

Complications of Diverticulitis

Answer 19

Abscess

Colovesicular fistula

Fistula to other organs

Stricture