1 acute abdomen CT Flashcards
What is the appendicitis triad?
abdominal pain, anorexia, and nausea and vomiting
McBurney’s point is?
McBurney point is defined as a point that lies one-third of the distance laterally on a line drawn from the umbilicus to the right anterior superior iliac spine. Classically, it corresponds to the location of the base of the appendix
What is Rovsing’s sign
Rovsing’s sign is the finding of right lower quadrant pain during palpation of the left side of the abdomen or when left-sided rebound tenderness is elicited
What is the vitelline duct and why is it relevant to a surgical pathology
The vitelline duct (VD) is an embryonic structure providing communication from the yolk sac to the midgut during fetal development: this can produce a Meckel’s diverticulum if vestigial remnant left behind
What is a Meckel’s diverticulum
Meckel’s diverticulum is the most common congenital anomaly of the gastrointestinal tract. It results from incomplete obliteration of the vitelline duct leading to the formation of a true diverticulum of the small intestine
Why is a Meckel’s diverticulum called a “true diverticulum?”
All layers of bowel wall (diverticulitis is “false diverticulum”: does not contain all layers (typically mucosa pushed through defect in muscular layer)
What is the meckel’s diverticulum rule of 2
The rule of 2s is a useful mnemonic for the features of Meckel diverticulum, although the figures do have a broad range:
occur in 2% of the population
are 2 inches (5 cm) long
are 2 feet (60 cm) from the ileocaecal valve
2/3 have ectopic mucosa
2 types of ectopic tissue are commonly present (mostly gastric and pancreatic)
the commonest age at clinical presentation is 2 years
How can Meckel’s sometimes cause ulceration?
Can be lined with gastric mucosa
what’s the most common ddx for appendix (RLQ pain)
1) Mesenteric adenitis, (or meckel’s diverticulum)
what is Mesenteric adenitis
Mesenteric adenitis is a syndrome characterized by right lower quadrant pain secondary to an inflammatory condition of mesenteric lymph nodes.
What is boerhaave’s syndrome
Effort rupture of the esophagus, or Boerhaave syndrome, is a spontaneous perforation of the esophagus that results from a sudden increase in intraesophageal pressure combined with negative intrathoracic pressure (eg, severe straining or vomiting)
What is Mackler’s triad suggestive of
Mackler’s triad consists of the clinical symptoms of vomiting, followed by severe pain in the chest, usually retrosternal, lower thoracic, and upper abdominal, associated with subcutaneous emphysema detected on physical examination, which is suggestive of oesophageal rupture (Boerhaave syndrome)
what’s the gold standard investigation for suspected esophageal perforation
Oral contrast (CT/X-Ray) with water soluble agent b/c barium free has high mortality
SAD PUCKER helps you remember what…
S: suprarenal (adrenal) gland
A: aorta/IVC
D: duodenum (second, third and fourth parts)
P: pancreas (except tail)
U: ureters
C: colon (ascending and descending)
K: kidneys
E: (o)oesophagus
R: rectum
