Tutorial 4 - The acute abdomen Flashcards
5 Fs cholecystitis
Fat, forty, female, fertile, fair
US findings - cholecystitis
Dilated thick walled gallbladder, pericholecystic fluid, gallstones
Abx treatment
ceftriaxone + metronidazole?
Common management
- pain relief
- Antiemetics
- Fluids resus
- NG tube
- IV abx
- Surgery
Pancreatitis
- 2 main causes
- Hx
- Inv
- Tx
-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
Glasgow criteria
- Age
- WCC
- plasma urea
- Plasma glucose
- Serum albumin
- Lactate dehydrogenase
- ALT
- Areterial P02
Severity of pancreatitis
>3 = severe
Complications pancreatitis
Pancreatic necrosis - infected, lead to abscess
Psudocyst - in lesser sac
Abscess - Drainage (percutaneous, endoscopic, open surgical)
2 most common causes SBO
- what does rebound tenderness suggest?
- Tx
- 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
3 most common causes LBO
Inv
-Tumor, stricture, volvulus
Inv - Xray
Rectal exam w sigmoidoscopy - distal carcinoma
-Urget CT - diagnosis
Hartmans procedure
Sigmoid removed, and left colectomy in place
Diverticulitis management
- supportive, IV fluids, abx
- if this does not work, then CT and surgery maybe (hartmans)
Complications of Diverticular disease
Pericolic abscess (CT scan w contrast, percutenous draiange) Free perforation - surgery (resection, peritoneal toilet) Hartmans
Kidney stone
-Loin pain, radiating to scrotum, pain is constant, unable to lie still
- Most pass spontaneously
- pain relief, oral hydration
- alpha blockers (doxasozin)
Ruptured AAA
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
MI
-abdo pain out of proportion of physical findings
-hist - AF
Tx - laparotomy - resect ischaemic bowel