Abdominal Flashcards
Sentinel loop = loss of movement in small intestine
If high up = pancreatitis
If RLQ = appendicitis
Older women with tummy pain. Never experienced this before. Drank 2 glasses of wine per night and took something for hypercholesterolaemia. HR 100 irregular (AF). Generalised abdominal tenderness. History of open cholecystectomy 20 years ago and CABG 10 years ago. BP 140/90 (high), 30 pack year smoking history. Dx?
a) Pancreatitis
b) Mesenteric Ischaemia
c) Adhesion SBO obstruction
d) AAA rupture
e) Perforated peptic ulcer
Mesenteric Ischaemia
pain out of proportion
Hx of recent laparotomy for fistula and appendicitis. Was on cef and metronidazole and gentamicin for 3 days but now isn’t. Had diarrhea on day 4 post-op but settled now. C diff growing on stool sample, what are you going to do?
a) 5dayIVmet
b) 5 day PO metronidazole
c) 5 day vancomycin
d) 2 week vancomycin
e) No further tx required
e) No further tx required
Someone with fever and rigors, RUQ pain, jaundice and hypotensive. Dx?
a) Acute cholangitis
b) Acute appendicitis
c) Acute cholecystitis
d) Pancreatitis
Acute cholangitis
Charcot’s triad - fever, jaundice and RUQ pain
Asian man with acute epigastric pain. Past history of alcohol and smoking, recurrent upper abdominal pain over the last few months which is somewhat relieved by the use of antacids/PPI. He has also been stressed at work. On examination abdomen was rigid, guarded and distended. What investigation would you do next?
a) Erect CXR
b) Abdo XR
c) CT Abdo
d) CRP,FBC
e) Blood alcohol levels
Hx of peptic ulcer –> perf?
Erect xray to look for free gas
60 year old man has acute LIF pain on background of getting more constipated for the last 5 years and sometimes blood in bowel motion that coats the outside of the stool and is on the toilet paper. On examination there was a palpable mass in LIF. Dx?
a) Acute diverticulitis
b) Diverticular disease
c) Pseudo obstruction
Acute diverticulitis more severe than this - fever, severe pain, airrhea
Left iliac fossa pain with fever. Dx?
a) Acute diverticulitis
b) Diverticular disease
c) Pseudo obstruction
Acute diverticulitis
Elderly woman who presented with nausea and vomiting for 2 days. Has Parkinson’s disease and had previous appendicectomy 30 years ago. Abdomen distended and no bowel sounds, otherwise normal exam. BNO for 5/7, nil flatus 2/7. What investigation?
a) Abdo x-ray
b) Small bowel series
c) 3 phase CT abdomen
d) Gastrografin enema
e) CT scan with oral contrast
Obstruction.
Abdominal xray = first line investigation
A CT scan with intravenous contrast of the abdomen = gold standard. IV not oral.
67 year old male with severe abdo pain. Hx of MI 7 years ago, has had AF since then. Said today’s pain was even worse than the MI. Has a 15 year Hx of DM, which is diet and hypoglycaemic controlled, and HTN. Meds: warfarin, enalapril, atorvastatin, gliclazide, metformin and metoprolol.
Temp 39.0, HR 100, BP 140/80, JVP normal. Chest and HS normal. Bloods: increased glucose (12.1), urinary ketones negative, INR 2.0 and WCC 22. Metabolic acidosis (pH 7.1) with respiratory compensation. Mildly tender abdomen with no bowel sounds. Had an appendectomy at 20yo. Diagnosis?
a) Ischaemic bowel
b) DKA
c) Perforated colon
d) Aortic aneurysm
e) Rectus sheath haematoma
No bowel sounds, obstruction –> ischaemic bowel
I think a perf would start to have signs of shock, very tender abdo (peritonism)
18yr old dude uni student gets kicked in the L/RUQ at football. Abdo ultrasound is normal. Vitals normal. What is next part of management?
a) Abdo CT
b) Abdo angiogram CT
c) Chest xray
d) Abdo X-ray
?Class thinks abdo CT but id d/c him lol
Guy with pancreatitis after drinking binge. BP 110/60, pulse 130. No bowel sounds + very distended abdomen. Lipase 750. What should we add to his care
a) IV fluids
b) IV antibiotics
c) NG tube for decompression
d) CT abdomen
Sounds like a bowel obstruction.//? CT abdo?
What would make an inguinal hernia need urgent surgical treatment?
a) Pain
b) Unable to be reduced
c) Recent change in bowel habit
d) New onset dysuria
e) Firm
PAIN = necrosis
Unable to reduce = incarceration
A patient has suspected cholecystitis, severe abdominal pain. What pain relief should be used while she waits for surgical review?
a) NSAID
b) Panadol c) Morphine d) Codeine e) Pethidine
f) Wait for surgical review
NSAID
Patient with fever 5 days after appendectomy, wound is warm and swollen, what is best initial treatment?
a) IV fluclox
b) IV gentamicin
c) Drainage
d) Aspiration
e) CT abdo
Drainage
Lady with femoral hernia presenting with bowel obstruction and bilious vomiting. What do you do for her after resuscitation?
a) Reduce hernia
b) Refer for surgery
c) Biopsy or aspiration of lump d) Ultrasound lump
Surgery
3 or more air fluid levels = obstruction
Type 1 = GOJ moves up above hiatus, most common
Type 2 = GOJ still at level of diaphragm, fundus pulled up
