Acute Abdomen

Question 1

What is colicky pain?

Answer 1

Waxing & waning pain that occurs secondary to hyper-peristalsis of smooth muscle against mechanical site of obstruction

Question 2

What is biliary colic?

Answer 2

Constant, intense pain that lasts 30min to several hours

Question 3

DDx for pain that radiates to the back

Answer 3

Pancreatitis, AAA, aortic dissection

Question 4

DDx for pain radiating to flank

Answer 4

Pyelonephritis, AAA, retroperitoneal haematoma

Question 5

Bilious vomiting suggests a process ____

Answer 5

distal to duodenum

Question 6

Gastric ulcer pain ___ with food, duodenal ulcer pain ___

Answer 6

worsens
gets better

Question 7

Diffuse peritonitis pain causes patient to ____

Answer 7

lie still
pain worsens with movement

Question 8

Renal colic pain causes patient to ___

Answer 8

writh in pain, unable to keep still

Question 9

IO causes ___ pain that is improved with ___

Answer 9

visceral
vomiting

Question 10

Signs elicited in appendicitis

Answer 10

McBurney’s point tenderness

Psoas pain - right hip hyperextension causes abdo pain

Obturator pain - internal rotation of flexed R hip causes pain

Rovsing’s - RLQ pain with palpation of left lower quadrant

Question 11

What is Murphy’s sign and what does it indicate?

Answer 11

Inspiratory arrest with continuous gallbladder palpation - indicates acute cholecystitis

Question 12

Most common causes of small bowel IO

Answer 12

adhesions, hernia, stricture, cancer

Question 13

Most common causes of large bowel IO

Answer 13

CANCER, diverticular disease, volvulus

Question 14

progression of IO

Answer 14

simple obstruction -> ischemia -> gangrenous bowel -> perforation

**bowel proximal to obstruction dilates, compromises venous return -> increased capillary pressure -> compromised arterial supply

Question 15

In IO, bowel proximal to obstruction ___, distal to obstruction ___

Answer 15

dilates, collapses

Question 16

4 cardinal symptoms of bowel obstruction

Answer 16

pain - visceral (if localised need to suspect perforation)

distention

vomiting - projectile, bilious, faecal

obstipation/constipation

Question 17

Classifying Ddx for IO

Answer 17

Mechanical
1) intraluminal
2) mural
3) extramural

Functional
1) paralytic ileus
2) pseudo-obstruction

Question 18

Causes of luminal IO

Answer 18

intussusception
bezoars
gallstone ileus
foreign body
parasites

Question 19

Causes of mural IO

Answer 19

Malignancy
strictures

Question 20

Causes of extramural IO

Answer 20

intraperitoneal bands/adhesions
hernia
volvulus
malignancy (esp peritoneum)

Question 21

Causes of paralytic ileus

Answer 21

Post-operative
infection
infarction
metabolic - hypoK, hypoNa, hypoMg, uraemia, metabolic acidosis, hypothyroid

Question 22

Dehydration is hallmark of ___ IO

Answer 22

small bowel (esp proximal)

Question 23

Closed loop obstruction occurs due to

Answer 23

large bowel IO + competent ileocaecal valve

bowel herniation

peritoneal carcinomatosis with 2 obstruction points

Question 24

Rigler’s triad in gallstone ileus

Answer 24

Aerobilia, SBIO, ectopic gallstone

Question 25

Coffee bean sign on XR indicates

Answer 25

sigmoid volvulus

Question 26

Comma sign on XR

Answer 26

caecal volvulus

Question 27

Appendix location

Answer 27

Retrocaecal (75%)
Pelvic, subcaecal, paracaecal

Question 28

Common aetiology of appendicitis in adults & children

Answer 28

Adults - faecoliths
Children - hyperplasia, following viral illness

Both lead to bacterial infection

Question 29

Appendicitis progression

Answer 29

Obstruction -> distension -> thrombosis + occlusion of blood supply -> ischemia -> necrosis -> bacterial overgrowth

Can be suppurative, gangrenous, perforated

Question 30

Pain pattern of appendicitis

Answer 30

Begins with poorly localised pain at umbilicus, after that becomes somatic pain localised to RIF