underlying pathology of the acute abdomen Flashcards
What is a twisted ovarina cytst
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
What are the commonest causes of twisted ovarian cyst?
lesions
teratoma
WHat is an ectopic pregangncy?
pregnancy outside the ovarian mostly in the fallopian tube
What are the dangers of an ectopic pregancy
chronic salpingitis
rupturing of fallopian tube that leads to haemorhage
What is needed to make the diagnosis of an ectopic pregnagncy
- positive hcg
- ultrasound
presence of blood in the culdocentesis
What are symptoms of an ectoppic pregangcy
normal pregnancy
- morining sickeness, amenorrhea, breast swelling and positive hcg
- sudden severe intermittent lower abdominal pain
What is the cause of intestinal obstruction?
cystic fibrosis
colonic adenocarcinoma
What is a volvulus?
twisting of the bowel
In what demographic is volvus the most common?
adults
results in ischemia of the bowel
What is the ultimate result of volvulus?
ischemia of the bowel
gangrene and necrosis
symptoms of vovlus
abdominal pain and abdominal distension and constipation
What are the symptoms of bowel obstruciton?
- true collic- intermittent severe central pain
- small bowel -every 2-20 min
- large bowel ever 30 min
What happens in appendicitis?
- obstruction of the lumen leads to faecolith
- increased pressure in the bowel
- ischemic changes to the bowel - more prone to bacterial invasion
what organisms are commonly associated with appendicitis?
e coli
and streptococci
Where are diverticulr diseases the most common?
western world
What is diverticulitis ?
is a blind ending pouch which is an area of weakness
What are clinical presentations of diverticulitis?
severe left iliacfossa pain nausea loss of appetite and constipation pyrexia and tachycardia tender indistinct mass lying parallel to inguinal ligament
What are causes of peptic ulcers?
chronic: h pilory
acute: NSAID, Alcohol, Smoking
What is the presetnaiton of a pepptic ulcer?
epigastric pain
previously similar events
What are the different types of abdominal aneurysm
saccular and fusiform
What are the causes for leaking abdominal aorta?
arthermoatous lesion
and aneurysm
What is the clinical presentation of an abdominal leaking aneurysm?
severe central abdominal pain
radiates to the back and groin along hte course of the genito femoral nerve
die from the sudden hypotensive shock
what is your typical patient with a leaking abdominal aorta
smoker with history of angina MI intermittent claudication TIA or stroke
what are the different degrees of severity of ischemic bowel disease ?
transmural infarction (most severe)
Mural infarction
mucosal infaction
What are causes of ischemic bowel disease?
arterial thrombosis: Arteroma
Arterial embolism: Mural thrombi
Venous thrombosis: Factor V Leiden
non occlusive ischaemia: Shock
Miscellaneous: Volvulus
What are the consequences of ischaemic bowel disease?
intestinal bacteria produce gangrene and perforate the bowel
What is acute cholecystitis
inflammation of the wall due to chemical damage due to concentrated bile - promoted by stones
Clinical presentation of acute cholecystitis infections?
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
What is the clinical presentation of gallstones and biliary colic?
generalised severe upper abdominal pain
not colic in nture
nausea and vomiting
What is pancreatitis? What happens in pancreatitis?
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
What happens in acute pancreatitis
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.
What is the clinical presentation of pancreatitis
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
Why can kidney stones be seen on x ray?
70% calcium
are big or smal;l stones more hazardous
• Smaller stones are more hazardous because they may pass into
ureters.
• Big stones never leave the kidneys therefore they are less
hazardous.
What is acute saolpingitis?
Caused by ascending infection. • Gonococcus causes over ½ of cases. • May involve ovary. • Can result in abscess formation (localised tissue necrosis with Neutrophils)
What is the presentation of renal stones?
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
