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Year 3 - Junior Surgery > Surgical History and the Acute Abdomen > Flashcards

Surgical History and the Acute Abdomen Flashcards

1
Q

What is the acute abdomen?

A

Onset of severe abdominal pain lasting less than 24 hours

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2
Q

What other symptoms can constitute part of an ‘acute abdomen’?

A

Change in bowel habit

GI bleeding (PR/haematemesis)

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3
Q

Why is the acute abdomen important?

A

Can be potentially life threatening

Can often be surgically managed

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4
Q

What diagnoses will need surgical intervention?

A

Bleeding

Perforation

Ischaemia

Peritonism (including RIF localised appendicitis)

Colic (potentially)

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5
Q

What is visceral pain?

A

Pain that occurs in a generalised area of the abdomen (i.e. upper, middle or lower) due to damage of viscera

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6
Q

How do visceral nerve fibres reach the structure that they innervate?

A

Hitchhike on autonomic nerve fibres

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7
Q

What do the general areas of innervation (and subsequently areas of pain) correspond to?

A

Embryological divisions:

Foregut - Upper 1/3 abdomen pain

Midgut - Middle 1/3 abdomen pain

Hindgut - Lower 1/3 abdomen pain

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8
Q

What stimuli can cause visceral pain?

A

Ischaemia

Stretch

Heat

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9
Q

What type of ‘activation’ is visceral pain associated with?

Badly worded question 🙃

A

Autonomic activation

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10
Q

How does autonomic activation occur due to visceral pain?

A

Stimulation of Vagus nerve

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11
Q

What are the symptoms associated with autonomic activation?

A

Malaise

Nausea

Sweating

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12
Q

What is the ‘Rule of Five’ when examining a patient?

A
  1. Consent
  2. Inspect
  3. Palpate
  4. Percuss
  5. Auscultate

(Special tests)

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13
Q

What are the 3 types of possible abdominal pain?

A

Somatic

Visceral

Referred

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14
Q

What assessments must be made when handling the acute abdomen?

A

Assess clinical state

Will they need surgery?

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15
Q

If the patient is clinically critically unwell what is next?

A

Begin immediate acute assessment (A-E)

Begin management

Call for help if needed

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16
Q

How should a critically unwell patient be managed?

A

Oxygen

Fluid balance

Pharmacological intervention (3 A’s)

VTE prophylaxis (if needing surgery)

Escalation (if needed)

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17
Q

What are the 3 A’s of pharmacological intervention in a critically unwell surgical patient?

A

Analgesia

Antiemetics

Antibiotics

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18
Q

If a patient is not critically unwell, what early management steps should be taken when dealing with the acute abdomen?

A

IV access

NBM (2/4/6 rule)

Three A’s (drugs)

Imaging (not strictly management but will dictate further treatment)

VTE prophylaxis

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19
Q

What is the 2/4/6 rule of NBM?

A

2 hours water

4 hours breast milk

6 hours food

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20
Q

What is referred pain?

A

Pain that is felt at a site distant to the structure being affected

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21
Q

Where does diaphragmatic irritation refer to?

A

Left shoulder-tip pain

22
Q

How can visceral nerves create referred pain?

A

They cause pain at areas innervated by somatic nerves that leave the spinal cord at the same level as the autonomic fibres on which they hitchhike

23
Q

What are some common causes of acute abdomen?

A

Appendicitis

Biliary colic

Bowel obstruction

Diverticulitis

Gynae pathology

24
Q

What sieve can be used to generate differentials?

A 
Metabolic
Endocrine
Degenerative
Iatrogenic/idiopathic
Congenital

Haematological
Autoimmune
Traumatic

Psychological
Infective/inflammatory
Neoplastic

25
Q

What are the 5 types of investigations?

A

Bedside tests

Blood tests

Microbiology

Imaging

Special tests

26
Q

What bedside tests are appropriate for acute abdomen?

A

Urine dipstick

Pregnancy test

27
Q

What bloods should be ordered in an acute abdomen?

A

FBC

CRP

U + E’s

LFT

G&S (if going to theatre)

28
Q

What imaging modalities may be useful in the acute abdomen?

A

Erect CXR/AXR

USS

CT

29
Q

What is somatic pain?

A

Localised pain conducted by somatic nerves

30
Q

What effect does somatic pain have on visceral pain?

A

Overrides it

31
Q

What often causes visceral pain to become somatic in the acute abdomen?

A

Involvement of the parietal peritoneum

32
Q

In appendicitis where does the visceral pain typically occur?

A

Central abdomen (around umbilicus)

33
Q

Why does appendicitis visceral pain centre around the umbilicus?

A

Because the appendix is a midgut structure

34
Q

Where does appendix pain localise when there is peritoneal involvement (somatic pain)?

A

RIF (McBurney’s point)

35
Q

What are the potential causes of perforation?

A

Peptic ulcer

Diverticulitis

Appendicitis

Obstruction

IBD

36
Q

What follows bowel perforation?

A

Peritonitis and possible sepsis

37
Q

What are the signs of peritonitis?

A

Patient lays still

Tachycardia

Washboard abdomen (rigid abdomen)

No bowel sounds

Guarding

Rebound tenderness

Very painful

38
Q

What structures can bleeding in the abdominal cavity?

A

Vasculature

Viscera

39
Q

What is the most serious type of abdominal bleeding?

A

Ruptured AAA

40
Q

What GI structures can cause abdominal bleeding?

A

Gastric ulcer

Pancreatitis

Rupture

41
Q

How will abdominal bleeding with a GI cause present?

A

Haematemesis/PR bleeding/Melena

42
Q

If bleeding is severe what will patients present with?

A

Hypovolaemic shock

43
Q

What are the symptoms of hypovolaemic shock?

A

Tachycardia

Clammy

Cold peripheries

Hypotensive

44
Q

What is the classic triad of a ruptured AAA?

A

Back pain

Hypotension

Pulsatile mass

45
Q

What can cause epigastric pain?

A

Oesophagitis

Peptic ulcer

Perforated ulcer

Pancreatitis

IHD

46
Q

What can cause RHypochondriacal pain?

A

Gallstones

Cholangitis

Hepatitis

IHD

Basal pneumonia

47
Q

What can cause LHypochondriacal pain?

A

Acute splenomegaly

Spleen abscess

Spleen rupture

IHD

Basal pneumonia

48
Q

What can cause umbilical pain?

A

Early appendicitis

Mesenteric adenitis

Meckel’s diverticulitis

Lymphoma

49
Q

What can cause right flank pain?

A

Ureteric colic

Pyelonephritis

50
Q

What can cause left flank pain?

A

Ureteric colic

Pyelonephritis

51
Q

What can cause LIF pain?

A

Diverticulitis

UC

Constipation

Ovarian cyst

Ectopic pregnancy

Hernias

52
Q

What can cause RIF pain?

A

Appendicitis (late)

Crohn’s

Caecum obstruction

Ovarian cyst

Ectopic pregnancy

Hernia

Year 3 - Junior Surgery (12 decks)

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