THE ABDOMEN Flashcards
Things to reduce intra abd adhesion
Laparoscopy over open procedure
Things which promote intra abdominal adhesions?
open procedures
Talc usage on gloves
Anastomotic leak
Which artery ismostly affected by laproscopic ports and surgical draine
Inferior epigastric artery
Which artery ismostly affected by laproscopic ports and surgical draine
Inferior epigastric artery
Use of Verres Needle to establish pneumoperitoneum causes which complication
Bowel perforation
During re-do open hernia surgery what structure can be damaged
Testicular vessels
Hepatic veins can be damaged due to
Liver mobilization
Neurosurgical electrolyte disturbance
SIADH following cranial surgery causing hyponatraemia
Meckels diverticulum is a derivative of
The Meckels divertic ulum is a persistence of the vitello-intestinal duct.
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
Arterial supply of Meckel
omphalomesenteric artery
Mucosa of Meckel
ileal mucosa mostly
sometimes gastric
rarely Pancreatic and jejunal
Surgical opt for Meckel if symptomatic
wedge excision or formal small bowel resection and anastomosis.
Right iliac fossa pain
causes
Appendicitis
Crohn’s disease
Mesenteric adenitis
Diverticulitis
Perforated peptic ulcer
Meckel’s diverticulitis
Thread worms infection
Causes of Mesenteric adenitis
Adenoviruses, Epstein Barr Virus, beta-haemolyticStreptococcus,Staphylococcusspp.,Escherichia coli,Streptococcusviridansand Yersinia spp
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
Causes of Intussusception
polyps, lymphadenopathy and diseases such as cystic fibrosis
most common variant of Intussusception
ileocaecal valve and terminal ileum is the most common variant and typically affects young children and toddlers.
Intussusception diagnosis by
U/S
When pneumatic reduction of Intussusception shouldn’t occur
Impending perforation
Small bowel intussusception.
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.
In suspected large bowel obstruction a key investigation is
either a water soluble contrast enema or CT scan.
Plain film radiology usually cannot detect
<1mm free air
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.
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
