Acute Abdominal Pain Flashcards
Grey Turners Sign
Blue discolouration and bruising of flanks
Murphy’s Sign
Pain in deep inhalation when fingers are places on right upper quadrant
Psoas sign
Sign of appendicitis due to irritation of psoas
Pain when asking patient to push right knee against force or raising right leg when lying on left side
Rosvings sign
Pain in right upper quadrant due to pressure on left upper quadrant
McBurney’s point
2 inches from anterior superior point if ileum along line of umbilicus
Localised tenderness here indicates appendicitis
Acute Appendicitis
Pathogenesis, signs and symptoms
Organisms from gut can invade appendix wall leading to inflammation, necrosis and perforation
Peri umbilical pain moving to RIF, anorexia and constipation
Acute appendicitis
Investigations and treatment snd complications
Rosvings sign, psoas sign and cope sign
Elevated Crp and leukocytes, abdominal CT, ULTRASOUNd,
Appendicectomy
Metronidazole and cefuroxime
Perforation, appendix mass and appendix abscess
Laparoscopy
Bowel obstruction
Key features and causes
Features: vomitting, colicky pain, constipation and distension
Small bowel causes: adhesions and hernias
Large bowel causes : colon carcinoma, constipation, diverticular stricture, volvulus
Can also be chrohns, gallstone ileus or tb or foreign body
Need to know if bowel obstruction is small or large, ileus or mechanical and if bowel is simple, closed loop or strangulated
Bowel obstruction management
Fluids to rehydrate and restore electrolyte balance
Analgesia
Imaging:
Abdominal x Ray, erect chest x Ray, monitor fluid status
Early ct scans
Large bowel colonoscopy
Surgery:
Emergency surgery for strangulation
Stents for malignancies
Acute Pancreatitis
Causes, signs, symptoms and investigations
Think GET SMASHED for causes
Gradual or sudden/ severe epigastric pain or central abdominal pain which radiates to backs and is relieved by sitting forward
Cullen’s signs, grey turners sign, generalised tenderness, jaundice, ileus, tachycardia, fever, ridgid abdomen
Investigations: serum amylase, serum lipase, ABG , erect chest x ray, Crp, ultrasound
Acute Pancreatitis
Management and complications
Analgesia- pethidine or morphine
Hourly pulse, Bp and urine output
Ercp and gallstone removal
Complications: shock, renal failure, pancreatic necrosis, pseudo cyst, accesses, thrombosis
Cullen’s sign
Yellow blue discolouration of skin around umbilicus
Acute cholecystitis
Definition, features, investigations and management
Stone in cystic duct or neck of gall bladder
Severe pain in RUQ
Fever, tenderness and muscle guarding
Wcc, LFTS and abdominal ultrasound
Nil by mouth, iv fluids, anti-biotics and analgesics
Cholecystectomy within 48 hours
Acute Peritonitis
Definition, causes and clinical features
Inflammation of the abdominal cavity which can be localised or generalised
Causes of local: acute appendicitis,cholecystitis
Generalised: bacterial infection, secondary is spread of bacteria or spillage of blood/ acid
Clinical features: localised will have rebound tenderness and involuntary guarding
Generalised has general us wellness, systemic signs of illness, rigid Abdomen, absent bowel sounds
Acute Peritonitis
Investigations and management
Bloods: fbc, u and Es, LFTS and Crp
Imaging: erected cxr, abdominal x Ray, ultrasound, CT of abdomen
Germ stain culture if ascites is present
Management:
Iv fluids, iv antibiotics, fluid line, nag tube, catheter
