Surgery - Acute Abdomen Flashcards
visceral (colic) pain is usually ..
a.deep , localised ,pain free intervals
b. generalised, constant
a.deep , localised
localised to the area of the organ during dvelopment
billiary colic has no pain free intervals
which part of the GI tract originates from the foregut
a.duodenum
b.appendix and 2/3 transverse colon
c.1/3 transverse colon - rectum
a.duodenum
which part of the GI tract originates from the midgut
a.duodenum
b.appendix and 2/3 transverse colon
c.1/3 transverse colon - rectum
b.appendix and 2/3 transverse colon
which part of the GI tract originates from the hindgut
a.duodenum
b.appendix and 2/3 transverse colon
c.1/3 transverse colon - rectum
c.1/3 transverse colon - rectum
which type of pain is eased by moving
a.colic
b.peritonitis
a.colic
patient cannot lie still
which type of pain is eased by lying still
a.colic
b.peritonitis
b.peritonitis
also will have guarding on examination
acute abdominal pain < 1 week requires
a.admission to hospital
b. urgent referal for endoscopy
c. NSAID treatment
d.Urgent CT abdo
a.admission to hospital
possible causes of abdo pain
non specific
acute appendicitis
acute cholycystitis
PUD
small bowel obstruction
gynaecological conditions
acute pancreatitis
patterns of presentation to look out for
abdo pain and shock
generalised peritonitis
localised peritonitis
intestinal obstruction
patient with acute abdo pain, pale and sweaty with hypotension and increased heart rate
which pattern of presentation does this indicate
a. abdo pain and shock
b. generalised peritonitis
c. localised peritonitis
d. intestinal obstruction
a. abdo pain and shock
SURGERY NOW SITUATION
in a patient presenting with abdo pain and shock what should be considered until proven otherwise
a. AAA
b. ruptured ectopic pregnancy
c.intestinal obstruction
d.mesenteric ischaemia
e.severe acute pancreatitis
a. AAA
c,d,e = third space fluid loss present similarly
motionless patient, tenderness, board like rigidity
are characteristic of which presentation pattern
a. abdo pain and shock
b. generalised peritonitis
c. localised peritonitis
d. intestinal obstruction
b. generalised peritonitis
generally caused by perforation
eg , perforated ulcer
colonic perforation
perforated appendix
SURGERY LATER
perforations eg of an ulcer, colon or appendix present with which pattern
a. abdo pain and shock
b. generalised peritonitis
c. localised peritonitis
d. intestinal obstruction
b. generalised peritonitis
in cases of generalised peritonitis what should be done first to check for free air under a diaphragm (perforated viscous)
a. CXR
b. amylase
c.FBC
d.CT abdo
a. CXR
sudden onset peritonitis + free gas = perforated viscous
sudden onset peritonitis and free gas under the diaphragm indicates what
perforated viscous
if there is sudden onset peritonitis and no free gas shown on chest x ray what test should be done next
a. serum amylase
b.u and e
c. fbc
d.ct abdo
a. serum amylase
there is no free gas in just under half of cases of perforation
if amylase is normal (diagnostic test for pancreatitis )
still indicates perforated viscous
request a CT
if there is sudden onset peritonitis and no free gas shown on chest x ray serum amylase is normal
a. serum amylase
b.u and e
c. fbc
d.ct abdo
d.ct abdo
sudden onset peritonitis + no free gas + amylase normal = perforated viscous
CT needed to confirm
localised peritonitis ( still patient with guarding ) in the right upper quadrant which condition is most likely
a. acute cholecystitis
b.acute appendicitis
c.acute diverticulitis
a. acute cholecystitis
localised peritonitis ( still patient with guarding ) in the left lower quadrant which condition is most likely
a. acute cholecystitis
b.acute appendicitis
c.acute diverticulitis
c.acute diverticulitis
localised peritonitis ( still patient with guarding ) in the right lower quadrant which condition is most likely
a. acute cholecystitis
b.acute appendicitis
c.acute diverticulitis
b.acute appendicitis
central colic pain with distention , constipation and vomiting indicates what pattern
a.abdo pain and shock
b.generalised peritonitis
c.localised periotnitis
d.intestinal obstruction
d.intestinal obstruction
can be a SURGERY NOW situation if there is fever, peritonitis and increased WCC/lactate
patient with intestinal obstruction ( vomiting and colic) which part of bowel is most likely obstrcuted
a.small bowel
b.large bowel
a.small bowel
patient with an intestinal obstruction presented with constipation and distention which part of the bowel is most likely obstructed ?
a.small bowel
b.large bowel
b.large bowel
patient presented with vomiting and colic central pain indicative of a small bowel obstruction, surgery is more liekly to be performed in which case ..
a.patient has had previous surgery
b.patient has had no previous surgery
b.patient has had no previous surgery
can be surgery now if fever , peritonitis etc
more often surgery later or conservative management
patient presented with vomiting and colic central pain indicative of a small bowel obstruction, conservative management is more liekly to be performed in which case ..
a.patient has had previous surgery
b.patient has had no previous surgery
a.patient has had previous surgery
how is large bowel obstruction treated
a.surgery
b.conservative management
a.surgery
patient has central colic initially has constipation and distention
which part of the bowel has valvulae commitantes ( transverse the whole bowel)
a.small
b.large
a.small
which part of the bowel has haustrations ( transverse the bowel partly )
a.small
b.large
b.large
a functional obstruction cannot be seen on x ray alone what else is required ?
a.endoscopy
b.ct
c.pet ct
b.ct
senior input is needed for which groups ?
post op
children
elderly
pregnant
immunocompromised
elderly with arrhythmia ( a.fib) and sudden onset abdo pain
a.acute appendicitis
b.acute mesenteric ishcaemia
c.incarcerated femoral hernia
d.caecal tumour
e.gallstone ileus
b.acute mesenteric ishcaemia
in the SUPERIOR MESENTERIC AA
elderly , obese with no previous surgery and showing signs of small bowel obstruction (vomiting and central colic)
a.acute appendicitis
b.acute mesenteric ishcaemia
c.incarcerated femoral hernia
d.caecal tumour
e.gallstone ileus
c.incarcerated femoral hernia
part of intestine becomes intwined in hernia causing small bowel obstruction
femoral hernia is lateral and below pubic tubercle
elderly and adhesive small bowel obstruction from previous surgery currently on conservative treatment what should be done next
a.serum amylase
b.CT for large bowel obstruction
c.CT caecal tumour
d. x ray for air in billiary tree
e.x ray for free air under the diaphragm
c.CT caecal tumour
elderly with partial small bowel obstruction (vomiting and colic ) that resolves and reoccurs indicative of gallstone ileus
what investigative test should be done to confirm this
a.serum amylase
b.CT for large bowel obstruction
c.CT caecal tumour
d. x ray for air in billiary tree
e.x ray for free air under the diaphragm
d. x ray for air in billiary tree
the pain from perforation (generalised peritonitis )
a.sudden high intensity
b.increases and decreases
c.gradual increase
a.sudden high intensity
the pain from obstruction (colic localised and deep)
a.sudden high intensity
b.increases and decreases
c.gradual increase
b.increases and decreases
the pain from inflammation (localised peritonitis )
a.sudden high intensity
b.increases and decreases
c.gradual increase
c.gradual increase
what should be done prior to history taking for a patient with acute abdo pain
analgesia given
dunphy sign
pain on coughing
murphys sign
right upper quadrant tenderness
acute cholecytstitis
rovsings sign
right lower quadrant pain when left lower quadrant palpated
other exams you would like to perform ..
gynaecological
digital rectal
INVESTIGATIONS in order
urinalysis and pregnancy test
bloods (if suspect non urgent but .. CRP>100mg/l. or WBC > 15x109 g/l) suspicion of an urgent condition rises
1. request ultrasound if not critical then CT
- if critical but stable do CT first
diagnostic laparoscopy is good for appendicitis
patient with acute abdo suspected non urgent . bloods done if CRP is over ………. suspicion or urgency should rise and an ultrasound should be performed
a.30 mg/l
b.50 mg/l
c.75 mg/l
d.100 mg/l
d.100 mg/l
patient with acute abdo suspected non urgent . bloods done if WCC is over ………. suspicion or urgency should rise and an ultrasound should be performed
a.5 x 10^9
b.10 x 10^9
c.15x 10^9
d.20 x 10^9
c.15x 10^9
if suspicion of an urgent condition is raised which imaging test should be done first in a non critical patient
a.ct
b/laparoscopy
c.endoscopy
d.ultrasound
d.ultrasound
if suspicion of an urgent condition is raised which imaging test should be done first in a critical patient
a.ct
b/laparoscopy
c.endoscopy
d.ultrasound
a.ct
