Signs and Symptoms IV Flashcards
Which of the following is a subcostal incision used to gain access to the gall bladder? A) Midline B) Thoracotomy C) Pfannenstiel D) Kocher
D) Kocher
Which surgical incision is made in an appendicectomy?
Lanz incision
What are the routinely used incisions in abdominal surgery?
Midline and paramedian incisions, Lanz incision and the Kocher incision.
What is a laparotomy?
A laparotomy is a large surgical incision through the abdominal wall to gain access into the abdominal cavity.
Where is the lower border of the liver on full inspiration?
At the costal margin in the mid-clavicular line.
What is the difference between diverticulosis and diverticulitis?
Diverticulosis refers to pouches in the large intestines.
If these pouches are inflamed, it is known as diverticulitis.
What are the signs and symptoms of diverticulitis and what is a differential diagnosis of diverticulitis?
Diverticulitis typically presents with left quadrant abdominal pain of sudden onset. There may be fever, nausea, diarrhoea or constipation, and blood in the stools. Irritable Bowel Syndrome
What is Mallory-Weiss Syndrome? What is the most common cause of this syndrome?
Mallory-Weiss syndrome is a gastro-esophageal laceration syndrome commonly caused by violent or prolonged vomiting due to alcoholism or bulimia.
What are the 2 important signs that Mallory-Weiss Syndrome patients may present with?
Malaena or Haematemesis
Describe the pain presented by patients with pancreatitis.
What other symptoms are there?
Epigastric pain that radiates to the back.
Nausea and vomiting
Describe the pain in appendicitis.
What are the other symptoms?
Umbilical or Hypogastric pain that shifts to the right iliac fossa.
Fever, vomiting, anorexia, Guarding or rebound tenderness
Rovsing’s positive
Describe the pain in sigmoid diverticulitis.
Hypogastric pain that radiates to the Left iliac fossa
Fever, nausea and vomiting, altered bowel habits and a history of constipation
Describe the pain of bowel ischaemia/necrosis
Central abdominal tenderness and global abdominal pain
Describe the pain in cholecystitis.
What other symptoms are there?
Epigastric pain that moves to the right hypochondrium, pain may radiate to the shoulder tip
Fever, vomiting and anorexia
Fat intolerance
With pancreatitis, what are the results of blood tests?
High serum amylase (>1000u/mL or a 3-fold increase) and high protein
Raised serum lipase
What is the most common cause of pancreatitis?
Alcoholism
What is tested for if serum amylase levels are requested?
What is the other test conducted, which is more sensitive and specific than serum amylase?
Acute pancreatitis
Serum lipase is also tested, it is more sensitive and specific than serum amylase.
What is the definition of AAA?
Localised, abnormal dilatation of the abdominal aorta to more than 1.5 its normal diameter.
Are males or females more likely to have AAA?
Males, with a ratio of M:F = 6:1
Where does AAA commonly occurs at?
Infrarenal, below the renal arteries
What is a possible treatment of AAA?
- Endovascular surgery where a stent graft is inserted into an artery at the groin and then carefully passed up into the aorta.
- Open surgery where a graft is placed in the aorta with a cut in the patient’s abdomen
Usually, what is the size of a large AAA?
more than 5.5cm across
What is Cullen’s sign and Grey-Turner’s sign?
What are these findings indicative of?
Cullen’s sign is periumbilical bruising. Grey-Turner’s sign is bruising to the flanks.
They are indicative of retroperitoneal haemorrhage or autodigestion of blood vessels by pancreatic enzymes - complications in acute pancreatitis.
What are the complications of acute pancreatitis? Give explanations for each.
Peritonitis - from spread of infection throughout the peritoneal cavity.
Diabetes - from autodigestion of beta-cells of Islets of Langerhans by pancreatic enzymes
Acute Renal Failure - from hypovolaemia
Abscess or fistula formation, haemorrhage.
What can be seen on abdominal X-ray in a patient with pancreatitis?
Loss of Psoas shadow, which indicate inflammation around the psoas muscle, or shift of fluid to the retroperitoneum.
What is the phrase used to describe pancreatitis management? Describe.
‘Drip and Suck’.
Drip refers to IV therapy - giving IV fluids and IV analgesia. Insertion of urinary catheter to monitor fluid balance (aim urine output for >30mL/hour)
Suck refers to an NG tube.
Insertion of a wide bore NG tube to drain gastric contents. This ensures the bowel is rested and can help with symptoms of nausea and vomiting through relief of stomach distension.
Is this statement true or false: IV fluids and IV antibiotics are the first line management of acute pancreatitis.
False.
Only IV fluids for fluid resuscitation is needed. IV antibiotics is NOT needed as pancreatitis is not due to a bacterial infection.
