underlying pathology of the acute abdomen

Question 1

What is a twisted ovarina cytst

Answer 1

a twisted ovarian cyst is a when the ovary get twisted and there is reudced venous outflow and increased venous return to th e ovaray leading to a big haematoma and necrosis

Question 2

What are the commonest causes of twisted ovarian cyst?

Answer 2

lesions

teratoma

Question 3

WHat is an ectopic pregangncy?

Answer 3

pregnancy outside the ovarian mostly in the fallopian tube

Question 4

What are the dangers of an ectopic pregancy

Answer 4

chronic salpingitis

rupturing of fallopian tube that leads to haemorhage

Question 5

What is needed to make the diagnosis of an ectopic pregnagncy

Answer 5

1. positive hcg
2. ultrasound
   presence of blood in the culdocentesis

Question 6

What are symptoms of an ectoppic pregangcy

Answer 6

normal pregnancy
- morining sickeness, amenorrhea, breast swelling and positive hcg

• sudden severe intermittent lower abdominal pain

Question 7

What is the cause of intestinal obstruction?

Answer 7

cystic fibrosis

colonic adenocarcinoma

Question 8

What is a volvulus?

Answer 8

twisting of the bowel

Question 9

In what demographic is volvus the most common?

Answer 9

adults

results in ischemia of the bowel

Question 10

What is the ultimate result of volvulus?

Answer 10

ischemia of the bowel

gangrene and necrosis

Question 11

symptoms of vovlus

Answer 11

abdominal pain and abdominal distension and constipation

Question 12

What are the symptoms of bowel obstruciton?

Answer 12

1. true collic- intermittent severe central pain
2. small bowel -every 2-20 min
3. large bowel ever 30 min

Question 13

What happens in appendicitis?

Answer 13

1. obstruction of the lumen leads to faecolith
2. increased pressure in the bowel
3. ischemic changes to the bowel - more prone to bacterial invasion

Question 14

what organisms are commonly associated with appendicitis?

Answer 14

e coli

and streptococci

Question 15

Where are diverticulr diseases the most common?

Answer 15

western world

Question 16

What is diverticulitis ?

Answer 16

is a blind ending pouch which is an area of weakness

Question 17

What are clinical presentations of diverticulitis?

Answer 17

severe left iliacfossa pain
nausea
loss of appetite and constipation
pyrexia and tachycardia
tender indistinct mass lying parallel to inguinal ligament

Question 18

What are causes of peptic ulcers?

Answer 18

chronic: h pilory
acute: NSAID, Alcohol, Smoking

Question 19

What is the presetnaiton of a pepptic ulcer?

Answer 19

epigastric pain

previously similar events

Question 20

What are the different types of abdominal aneurysm

Answer 20

saccular and fusiform

Question 21

What are the causes for leaking abdominal aorta?

Answer 21

arthermoatous lesion

and aneurysm

Question 22

What is the clinical presentation of an abdominal leaking aneurysm?

Answer 22

severe central abdominal pain

radiates to the back and groin along hte course of the genito femoral nerve

die from the sudden hypotensive shock

Question 23

what is your typical patient with a leaking abdominal aorta

Answer 23

smoker
with history of angina
MI
intermittent claudication
TIA 
or stroke

Question 24

what are the different degrees of severity of ischemic bowel disease ?

Answer 24

transmural infarction (most severe)
Mural infarction
mucosal infaction

Question 25

What are causes of ischemic bowel disease?

Answer 25

arterial thrombosis: Arteroma

Arterial embolism: Mural thrombi
Venous thrombosis: Factor V Leiden

non occlusive ischaemia: Shock

Miscellaneous: Volvulus

Question 26

What are the consequences of ischaemic bowel disease?

Answer 26

intestinal bacteria produce gangrene and perforate the bowel

Question 27

What is acute cholecystitis

Answer 27

inflammation of the wall due to chemical damage due to concentrated bile - promoted by stones

Question 28

Clinical presentation of acute cholecystitis infections?

Answer 28

sudden onset upper quadrant pain that radiates to the back close to te tip of the right scapula
pain exacerbated by moving and breathing
nausea and vomitting
MURPHY’S SIGN: pressure on gallblader whilst patien is taking deep breath in

Question 29

What is the clinical presentation of gallstones and biliary colic?

Answer 29

generalised severe upper abdominal pain
not colic in nture
nausea and vomiting

Question 30

What is pancreatitis? What happens in pancreatitis?

Answer 30

Pancreatitis
Fat Necrosis Due to lipase
Necrosis of vessels Due to elastase
leading to
haemorrhage
Proteolytic digestion Due to proteases
of tissues
Extent and severity of features depend on duration
and degree of enzyme action

Question 31

What happens in acute pancreatitis

Answer 31

Acute Pancreatitis – Microscopic Features
• Acute inflammation
with leakage of fluid
from blood vessels
• Necrosis of fat:
lipases attack fat
locally which leads to
fat necrosis.

Question 32

What is the clinical presentation of pancreatitis

Answer 32

Epigastric pain increasing in severity
– Patient lies still and breathes shallowly
– Radiates through to the back
– Sitting forward may relieve the pain
– Frequent vomiting and retching

Question 33

Why can kidney stones be seen on x ray?

Answer 33

70% calcium

Question 34

are big or smal;l stones more hazardous

Answer 34

• Smaller stones are more hazardous because they may pass into
ureters.
• Big stones never leave the kidneys therefore they are less
hazardous.

Question 35

What is acute saolpingitis?

Answer 35

Caused by ascending
infection.
• Gonococcus causes over ½
of cases.
• May involve ovary.
• Can result in abscess
formation (localised tissue
necrosis with Neutrophils)

Question 36

What is the presentation of renal stones?

Answer 36

Kidney stones cause excruciating loin pain
– Ureteric stones cause ureteric colic,
classically radiating from the loin to the groin
– Associated nausea and vomiting
– Bladder or urethral stones cause pain on
micturition and interrupt urine flow
– Microscopic haematuria