Colorectal surgery: Acute abdomen

Question 1

Define what is meant by acute abdomen? [1]

Answer 1

Abdominal pain of non-traumatic origin with a maximation duration of 5 days

Question 2

Name 3 pathologies that might cause pain the upper right abdomen [3]

Answer 2

• inflammation of gallbladder
• enlargement of liver
• hepatitis
• liver abscesses
• perforated duodenal ulcer

Question 3

Name 3 pathologies that might cause pain the lower right abdomen [3]

Answer 3

• appendicitis
• diverticulitis
• meckel diverticulitis
• crohns disease}

Question 4

Name three pathologies that could be causing pain the upper left abdomen [3]

Answer 4

• gastritis
• gastric ulcer
• abscess in spleen
• ruptured spleen

Question 5

State a pathology that would be indicated by pain in lower left abdomen [1]

Answer 5

diverticulitis

Question 6

How would Meckel’s diverticulitis present? [5]

Answer 6

• most common: painless rectal bleeding
• age < 2 years
• passage of bright red blood per rectum (haematochezia)
• intractable constipation (obstipation)
• It is clinically indistinguishable from appendicitis: Right sided pain

Question 7

Describe the pathophysiology of Meckel’s diverticulum

Answer 7

Meckel’s diverticulum is a small outpouching extending from the wall of the intestine and located in the lower portion of the small intestine.

Question 8

Name 4 causes of bleeding that may cause acute abdominal pain [4]

Answer 8

Bleeding:
- AAA
- Ulcer
- Ectopic
- Trauma

Question 9

Name 4 causes of perforation that may cause acute abdominal pain [4]

Answer 9

Perforation:
- ulcer
- obstruction
- IBD
- diverticulitis

Question 10

Name 2 causes of ischaemia that may cause acute abdominal pain [2]

Answer 10

• Mesenteric ischaemia
• Cardiac ischaemia}

Question 11

Basic investigations for ptx with acute abdomen pain? [3]

Answer 11

• ECG: if cardiac issues considered
• Urine dip
• Pregnancy

Question 12

Asides from standard testing, name two tests that are good indicator for urgent intrabdominal patholgies [2]

Answer 12

CRP
Amylase / lipase

Question 13

Imaging used to investigate acute abdominal pain [3]

Answer 13

Plain radiographs (clinical effectiveness is queried)
- Erect chest XR: pneumonia
- Supine abdomen XR: small bowel obstruction

CT (investigation of choice)

Ultrasound
- Highly sensitive & first line for biliary pathology
- Good for gynaecological
- Bad for appendicitis

Question 14

You suspect a patient has a biliary pathology, what is the first line of imaging used to diagnose this? [1]

Answer 14

Ultrasound

Question 15

What imaging modality should be preffered for investigating pregnant populations? [2]

Answer 15

US or MRI

Question 17

What is rebound tenderness? [1]
What does positive sign for rebound tenderness suggest? [1]

Answer 17

Rebound tenderness:

• said to be present when the abdominal wall, having been compressed slowly, is released rapidly resulting in a sudden stab of pain
• Suggests peritonitis: e.g. caused by appendicitis

Question 18

What is ascending cholangitis? [1]
What is it most commonly caused by? [1]
What is a classic triad of symptoms? [3]

Answer 18

Ascending cholangitis:
- is a bacterial infection of the biliary tree
- common predisposing factor is gallstones
- Charcots triad: RUQ; fever & jaundice

Question 19

Epigastric pain relieved by eating is indicates which type of ulcer? [1]

Epigastric pain worsened by eating is indicates which type of ulcer? [1]

Answer 19

Eating relieves duodenal ulcers

Eating worsens gastric ulcers

Question 20

‘Tinkling’ bowel sounds & central bowel pain would suggest which pathology? [1]

Answer 20

Intestinal obstruction

Question 21

Describe the character of the pain described in aortic dissection [1]

Answer 21

tearing pain

Question 22

Describe the character of the pain described in a inflammation [1]

Answer 22

Constant dull pain: think appendicitis, diverticulitis

Question 23

Describe the character of the pain described in peritonitis [1]

Answer 23

Constant sharp pain

Question 24

Bowel sounds are helpful in suspected obstruction. Describe how this can be helpful [2]

Answer 24

High pitched (tinkling): obstruction

Absent: ileus (non-mechanical obstruction)

Question 25

Describe how you would take a CXR for investigating perforation [1]

Answer 25

Erect chest x-ray: to look for free air under the diaphragm that suggests perforation of a hollow abdominal viscus

Question 26

Describe how you would take a CXR for investigating pneumonia [1]

Answer 26

PA chest x-ray: look for lower lobe pneumonia

Question 27

Describe how you would take a CXR for investigating obstruction? [1]

Answer 27

Abdominal x-ray: can look for signs of bowel obstruction, volvulus or even bowel wall thickening (e.g. colitis)