Acute abdomen

Question 1

What are the causes of small and large intestinal ischemia ?

Answer 1

• Thrombosis 25%
• Embolism 50%
• Non-occlusive Dz 20%
• Venous thrombosis <10%

Question 2

What is the pathophysiology of bowel ischemia ?

Answer 2

necrosis of the bowel wall results in bacterial proliferation in bowel wall causing pneumatosis intestinalis. The gas goes through mesenteric vessels
into the portal vein causing pneumatosis portalis. Leading to sepsis and/or intestinal perforation and death.

Question 3

What are the risk factors for bowel ischemia ?

Answer 3

• Smoking, hyperlipidaemia,
  HTN are most common
• Afib (embolic)

Question 4

What is the clinical presentation of bowel ischemia ?

Answer 4

generalised abdominal pain out of proportion to clinical findings. It can also be diffuse constant pain.

Question 5

What are the investigations in bowel ischemia?

Answer 5

• ABG (lactate, acidosis)
• Hb
• Coag
• Group and X-match
• Scans
• CT angiogram

Question 6

What is the management of bowel ischaemia ?

Answer 6

• ATLS resuscitation
• IV Abx
• Resection of necrotic bowel
• Revascularization (IR)
• embolectomy

Question 7

What are intra-abdominal abscess and their complications ?

Answer 7

It is pus collection within the abdomen commonly occurs post -surgically and prsents with fever, pain and N/V. The main complication is rupture causing spillage of f purulent material into abdominal cavity leading to peritonitis.

Question 8

What is peritonitis ?

Answer 8

Inflammation of the peritoneum caused by Rupture (perforation) within the abdominal cavity, and Spontaneous peritonitis (much less common).

Question 9

What are the risk factors for peritonitis ?

Answer 9

*Trauma +/- from medical procedures
*As a complication of gastrointestinal surgery / perforated viscus
* From the use of feeding tubes
* Following colonoscopy or other endoscopic procedure

Question 10

What are the medical conditions linked to peritonitis ?

Answer 10

cirrhosis, appendicitis, Crohn’s disease,
stomach ulcers, diverticulitis and pancreatitis

Question 11

What is the management of peritonitis ?

Answer 11

• Resuscitation (ATLS)
• 2 large bore IVCs fluids,electrolytes and abx
• Wide bore NG Tube
• Urinary catheter
• Analgesia
• Blood cultures if septic commence IV abx.
• Erect CXR
• CT-AP
• Surgical management – dictated by source
• Likely to need ICU / HDU management post-op

Question 12

What are the risk factors for diverticultis ?

Answer 12

SMoking, obesity, low fiber high fat diet.

Question 13

What are the work-ups in acute pancreatitis ?

Answer 13

US, MRCP