THE ABDOMEN Flashcards by Javeria Anzar

Things to reduce intra abd adhesion

Laparoscopy over open procedure

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Things which promote intra abdominal adhesions?

open procedures
Talc usage on gloves
Anastomotic leak

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Which artery ismostly affected by laproscopic ports and surgical draine

Inferior epigastric artery

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Which artery ismostly affected by laproscopic ports and surgical draine

Inferior epigastric artery

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Use of Verres Needle to establish pneumoperitoneum causes which complication

Bowel perforation

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During re-do open hernia surgery what structure can be damaged

Testicular vessels

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Hepatic veins can be damaged due to

Liver mobilization

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Neurosurgical electrolyte disturbance

SIADH following cranial surgery causing hyponatraemia

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Meckels diverticulum is a derivative of

The Meckels divertic ulum is a persistence of the vitello-intestinal duct.

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Rule of 2 of Meckels diverticulum

2% of population
2 inches (5cm) long
2 feet (60 cm) from the ileocaecal valve
2 x’s more common in men
2 tissue types involved

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Arterial supply of Meckel

omphalomesenteric artery

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Mucosa of Meckel

ileal mucosa mostly
sometimes gastric
rarely Pancreatic and jejunal

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Surgical opt for Meckel if symptomatic

wedge excision or formal small bowel resection and anastomosis.

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Right iliac fossa pain

causes

Appendicitis
Crohn’s disease
Mesenteric adenitis
Diverticulitis
Perforated peptic ulcer
Meckel’s diverticulitis
Thread worms infection

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Causes of Mesenteric adenitis

Adenoviruses, Epstein Barr Virus, beta-haemolyticStreptococcus,Staphylococcusspp.,Escherichia coli,Streptococcusviridansand Yersinia spp

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Rx of ileo ileal intussuscaption vSileo-colic varian

Ileo-ileal intussusception are far less common than the ileo-colic variant. However, where they occur, they require surgery and are not amenable to pneumatic reduction

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Causes of Intussusception

polyps, lymphadenopathy and diseases such as cystic fibrosis

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most common variant of Intussusception

ileocaecal valve and terminal ileum is the most common variant and typically affects young children and toddlers.

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Intussusception diagnosis by

U/S

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When pneumatic reduction of Intussusception shouldn’t occur

Impending perforation
Small bowel intussusception.

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commonest cause of acute abdominal pain in acute unselected surgical ‘take’?

Non specific abdominal pain is a commonly recorded diagnosis for patients presenting with acute abdominal pain.

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In suspected large bowel obstruction a key investigation is

either a water soluble contrast enema or CT scan.

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Plain film radiology usually cannot detect

<1mm free air

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Boas sign is in

Acute cholecystitis
hyperesthesia felt by the patient to light touch in the right lower scapular region or the right upper quadrant of the abdomen.

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weight loss and intermittent diarrhea

inflammatory bowel disease the most likely diagnosis.

Oral contraceptive pills

Mesenteric venous thrombosis

Fitz-Hugh-Curtis occurs exclusively in

Females

Fitz-Hugh Curtis syndrome Rx

Usually medically managed- doxycycline or azithromycin

Mid cycle pain Usually occurs two weeks after last menstrual period Pain usually has a supra-pubic location

Mittelschmerz

pain is typically greater than the physical signs

Mesenteric infarction

Mesenteric infarction most sensitive test

Arterial phase CT scanning

Severe and pain with acidemic and raised lactate

Bowel ischemia

Key points of ischemic bowel

Pain out pf proportion of symptoms Acidaemic and raised lactate

How much raised amylase levels in pancreatitis

3x the normal limit

tender swelling that lies below and lateral to the pubic tubercle.

Femoral hernia : if +ve cough impulse Saphena varix: if -ve cough impulse

positive Howship-Romberg sig

hip and knee pain exacerbated by thigh extension, medial rotation, and abduction).

Keypints of obturator hernia

More common in females and elderly More in people who has lost weight very fast Positive Howship-Romberg sig

abdominal hernia, whereby there is herniation of a Meckel’s diverticulum

Littre’s Hernia

Richter hernia

can occur at any of the above sites and is a partial herniation of bowel, whereby the anti-mesenteric border becomes strangulated

Surgery of umbilical hernia ais performed after

Third birthday

Bochdalek hernia vs Morgagni Hernia

B: more common, on left and posterior side, lung hypoplasia, contains stomach M: less common, on right and anterior side, rarely lung hypoplasia, contains transverse colon

Intestinal causes of malabsorption

coeliac disease Crohn's disease tropical sprue Whipple's disease Giardiasis brush border enzyme deficiencies (e.g. lactase insufficiency)

Bllod supply of Meckels diverticulum

Vitelline artery/ Omphalosmesenteric artery a branch of SMA'

an attachment between the vitello-intestinal duct and the yolk sac disappears at

6 weeks gestation

evidence of pelvic inflammatory disease together with peri-hepatic inflammation

Fitz-Hugh Curtis syndrome

Cullens sign is seen with

intra peritoneal haemorrhage

Is suspected ileus secondary to anastomotic l3ak

CT with contrast

If excessive discharge in drain due after cholecystectomy then what to do

Perform ERCP

Infant with high pitched scream and draws up her legs. 3 to 4 days hx of being unwell

Intussusception

The history of varicose veins with positive cough impulse

Saphena varix

M3ckel is distal or proximal to ileocaecal valve?

They are typically found 2 feet proximal to the ileocaecal valve (or approximately 60cm).

Gro in mass with red streaks onthigh

Lymphadenitis

retroperitoneal VS anterior abdominal aorta rupture

(anterior ones generally don't survive to hospital

when to do immediate Ioprotomy in suspected Abd aorta aneurysm rupture

systolic BP of <100mmHg at presentation mandates immediate laparotomy.

abdominal aortic aneurysm (AAA) is defined as

dilatation of the abdominal aorta greater than 3cm

ROME III diagnostic criteria of IBS

Recurrent abdominal pain or discomfort at 3 days per month for the past 3 months associated with two or more of the following: •Improvement with defecation. •Onset associated with a change in the frequency of stool. •Onset associated with a change in the form of the stool.

Pain Rx in IBS

low dose tricyclic antidepressants

Mesenteric cysts can cause

Volvulrs or infarct Not Intussusception

Causes of Intussusception

•Cystic fibrosis •Mucosal polyps •Meckel •Inflammation of Peyer Patches

Which GIT part shouldn't show fluid levels on a plain abdominal film?

Descending colon

Features which are usually abnormal on abdominal x ray

Large amounts of free air (colonic perforation), smaller volumes seen with more proximal perforations. A positive Riglers sign (gas on both sides of the bowel wall). Caecal diameter of >8cm Fluid levels in the colon Ground glass appearance to film (usually due to large amounts of free fluid). Sentinel loop in patients with inflammation of other organs (e.g. pancreatitis

Riglers sign

(gas on both sides of the bowel wall)

Chiladitis sign

loop of bowel may be interposed between the liver and diaphragm,

Features which should be expected/ or occur without pathology

In Chiladitis sign, a loop of bowel may be interposed between the liver and diaphragm, giving the mistaken impression that free air is present. Following ERCP (and sphincterotomy) air may be identified in the biliary tree. Free intra abdominal air following laparoscopy / laparotomy, although usually dissipates after 48-72 hours.

In which appendicitis does Rousing sign is absent

retrocaecal appendicitis

Mesenteric cysts usually occur in

•young children before 15 •Smooth •Incidental finding

If suspected perforated abdominal visCus in pregnant 🤰 then what test to confirm it

Abd CT Scan as it's suspected

Obese patients with ileus following major abdominal surgery with mesh repair ddevelops anuria and increase nasogastric aspirates

Abd compartment syndrome

Abdominal compartment syndrome

sustained intra abdominal pressure >20mmHg coupled with new organ dysfunction / failure

Operative Rx of Abdominal compartment syndrome

Bogota bag or VAC techniques

Non operative management of Abdominal compartment syndrome

Gastric decompressionImprove abdominal wall compliance e.g. muscle relaxants/ sedationDrain abdominal fluid collections.Consider fluid restriction/ diuretics if clinically indicated.

Intra abdominal hypertension

12-25 mm Hg

If suspected fluid leakage in child then

Perform USS to confirm itnot CT Like in adults

sudden onset of deep seated colicky abdominal pain with adenexal tendernes

Ovarian torsion

Pelvic inflammatory disease tests

High vaginal and urethral swabs

Bilateral lower abdominal pain associated with vaginal discharge. Dysuria

PID

menstrual irregularity, infertility, pain and deep dyspareunia

Endometriosis

Endometriosis affect on bowel

May result in adhesion formation ,obstruction,localised inflammation

Positive psoas sign

Pain in his extension

Tests to do in bowel obstruction

•Gastrograffin enema, •Sigmoidoscopy or • CT scanning prior to surgery.

If flu-like Symptoms in children then Severe abdominal Pain and no abd sign on examination then mostprobably it is

Mesenteric adenitis

If severe mid cyclic pain in females with normal inflmamatpry markers

Mittelschmerz

Pale opalescent liquid discharge poat surgery

Chyle leak

Howsurgeons mark lymphatics to chk for iatrogenic injury to lymphs

some surgeons administer a lipid rich material immediately prior to surgery to facilitate its identification in the event of iatrogenic damage.

Risk factors for the development of post operative incisional hernias

post operative wound infections, long term steroid use, obesity and chronic cough

Bowel obstruction or tenderness at the hernia sit

mandate early surgical intervention

Mature incisional hernias with a wide neck, and no symptoms Rx

may be either left or listed for elective repair

Diverticular abscess Rx

If <5cm ...Antibiotics If >5 cm .... Radiological drainage

If a young boy with Fe defi anemia and post Prandial pain with normal gastroscopy and colonoscopy Dx?

Meckels not crohn