Tutorial 4 - The acute abdomen Flashcards

1
Q

5 Fs cholecystitis

A

Fat, forty, female, fertile, fair

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2
Q

US findings - cholecystitis

A

Dilated thick walled gallbladder, pericholecystic fluid, gallstones

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3
Q

Abx treatment

A

ceftriaxone + metronidazole?

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4
Q

Common management

A
  • pain relief
  • Antiemetics
  • Fluids resus
  • NG tube
  • IV abx
  • Surgery
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5
Q

Pancreatitis

  • 2 main causes
  • Hx
  • Inv
  • Tx
A
-gallstones, alcohol 
Hx - severe epigastric pain radiating to back, N,V, heavy alcohol intake, gallstones
Inv - lipase 
-US - gallstones as cause 
-CT (unclear diangosis) 
-Ransons/glasgow criteria

Management

  • NG tube
  • Catheter (fluid monitoring)
  • IV fluids
  • O2
  • Daily bloods - crp, electrolytes
  • Pain relief, antiemetics
  • ABx

-ERCP - gallstones

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6
Q

Glasgow criteria

A
  • Age
  • WCC
  • plasma urea
  • Plasma glucose
  • Serum albumin
  • Lactate dehydrogenase
  • ALT
  • Areterial P02

Severity of pancreatitis
>3 = severe

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7
Q

Complications pancreatitis

A

Pancreatic necrosis - infected, lead to abscess
Psudocyst - in lesser sac
Abscess - Drainage (percutaneous, endoscopic, open surgical)

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8
Q

2 most common causes SBO

  • what does rebound tenderness suggest?
  • Tx
A
  • adhesions, hernias
  • suggests bowel strangulation (also w tachycardia)

Investigations

  • Erect Xray
  • Gastrograftin swallow, xray taken 4-6hrs after to see progress of contrast through bowel lumen

Tx

  • NG tube, fluid and electrolyte replacement, pain relief
  • gastrograftin

Operative - if strangulated or if gastrograftin does not reach cacecum in 24hrs

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9
Q

3 most common causes LBO

Inv

A

-Tumor, stricture, volvulus
Inv - Xray
Rectal exam w sigmoidoscopy - distal carcinoma
-Urget CT - diagnosis

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10
Q

Hartmans procedure

A

Sigmoid removed, and left colectomy in place

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11
Q

Diverticulitis management

A
  • supportive, IV fluids, abx

- if this does not work, then CT and surgery maybe (hartmans)

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12
Q

Complications of Diverticular disease

A
Pericolic abscess (CT scan w contrast, percutenous draiange)
Free perforation - surgery (resection, peritoneal toilet) Hartmans
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13
Q

Kidney stone

A

-Loin pain, radiating to scrotum, pain is constant, unable to lie still

  • Most pass spontaneously
  • pain relief, oral hydration
  • alpha blockers (doxasozin)
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14
Q

Ruptured AAA

A

Pulsatile epigastric or umbilical mass + abdo pain - ruptured AA until proven otherwise
Hx - pain severe, constant, center of abdomen, radiates to back
Exam - Blood loss signs (tachy, pallor, sweating, tachypnoea, hypotension)
tender expansive pulsation felt
Tx - immediate laparotomy and graft

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15
Q

MI

A

-abdo pain out of proportion of physical findings
-hist - AF
Tx - laparotomy - resect ischaemic bowel

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