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Abdominal pain Flashcards

1
Q

An international study involving referral to 26
surgical departments in 17 countries revealed nonspecific
1
2
3
the most common conditions.

A 
abdominal pain (34%),
 acute appendicitis (28%) 
and cholecystitis (10%)
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2
Q

T or F

As a general rule, upper abdominal pain is caused
by lesions of the upper GIT and lower abdominal
pain by lesions of the lower GIT

A

T

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3
Q

Colicky midline umbilical abdominal pain

(severe) → vomiting → distension = ______

A

small bowel

obstruction (SBO).

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4
Q

Midline lower abdominal pain → distension →

vomiting = _______

A

large bowel obstruction (LBO).

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5
Q

If cases of acute abdomen have a surgical cause,

the pain nearly always precedes the _____

A

vomiting

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6
Q

________ must be considered in
an elderly person with arteriosclerotic disease or
in patients with atrial fibrillation presenting with
severe abdominal pain or following myocardial
infarction

A

Mesenteric artery occlusion

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7
Q

Up to ________of presentations of abdominal pain
are considered to be non-specific, whereby no
specific cause is found

A

one-third

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8
Q 
A study on chronic abdominal pain 4 showed that the
commonest reasons (approximate percentages) were
A 
no discoverable causes (50%), 
minor causes including muscle strains (16%),
 irritable bowel syndrome (12%), 
gynaecological causes (8%), 
peptic ulcers and hiatus hernia (8%).
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9
Q

Red flag pointers for acute abdominal pain

History
1
2
3
4
5
6
A
  1. Collapse at toilet
  2. Lightheadedness
  3. Ischaemic heart disease
  4. Progressive-vomiting pain, distension
  5. Menstrual abnormalities
  6. Malignancy
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10
Q

Red flag pointers for acute abdominal pain

Signs
1
2
3
4
5
6
A
  1. Hypotension
  2. Atrial fibrillation or tachycardia
  3. Fever
  4. Prostration
  5. Rebound tenderness and guarding
  6. Decreased urine output
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11
Q 
Dangers of misdiagnosis
• \_\_\_\_\_\_\_\_ → rapid hypovolaemic shock
• \_\_\_\_\_\_\_\_ → rapid hypovolaemic shock
• \_\_\_\_\_\_\_\_ → peritonitis/pelvic abscess
• \_\_\_\_\_\_\_\_ → peritonitis
• \_\_\_\_\_\_\_\_ → gangrene
A 
Ectopic pregnancy
Ruptured AAA
Gangrenous appendix
Perforated ulcer
Obstructed bowel
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12
Q

Early appendicitis
presents typically with ___________some 4 to 6
hours later.

A

central abdominal pain

that shifts to the right iliac fossa (RIF)

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13
Q

Disaccharidase deficiencies, such as _______ are associated with cramping abdominal pain,
which may be severe

A

lactase

deficiency,

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14
Q

Specific pitfalls in the dx

Failing to examine _______ in a patient
with intestinal obstruction

A

hernial orifices

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15
Q

Misleading temporary improvement (easing of

pain) in _____ or ______

A

perforation of gangrenous appendix or

perforated peptic ulcer

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16
Q

Spinal dysfunction of the _____ or _______ can cause referred pain
to the abdomen

A

lower thoracic spine

and thoracolumbar junction

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17
Q

________ can be most relevant, especially
in recurrent or chronic abdominal pain where no
specific cause can be identified in most cases.

A

Psychogenic factors

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18
Q

_______ is hospital admission by
deception, often with severe abdominal pain without
convincing clinical signs or abnormal investigation

A

Munchausen syndrome

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19
Q

special clinical tests for abdominal pain:

_______ (a sign of peritoneal tenderness with acute cholecystitis); iliopsoas and obturator signs

A

Murphy sign

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20
Q

_______ occur through
defects in transversus abdominal muscle lateral
to the rectus sheath—usually below the level of
the umbilicus

A

Spigelian hernias

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21
Q

PE:

Palpation: palpate with gentleness—note any
guarding or rebound tenderness: guarding
indicates _______

rebound tenderness indicates _____ (bacterial peritonitis, blood)

A

peritonitis;

peritoneal irritation

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22
Q

Patient pain indicator:

the ______indicates focal peritoneal irritation;

the_______indicates visceral pain

A

finger pointing sign

spread palm sign

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23
Q

Atrial fibrillation: consider ____

A

mesenteric artery

obstruction

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24
Q
  • ______ sepsis and volume depletion
  • _______: sepsis, pneumonia, acidosis
  • Pallor and ‘shock’: _______
A

Tachycardia:
Tachypnoea
acute blood loss

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25
Q

Auscultation: note bowel activity or a_______ (best before palpation and percussion)

A

succussion

splash

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26
Q

Causes of a ‘silent abdomen’:
1
2
3

A 
diffuse sepsis, ileus,
mechanical obstruction (advanced
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27
Q

Hypertympany indicates _____

A

mechanical obstruction

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28
Q

_______if
raised to greater than three times normal upper
level acute pancreatitis is most likely

A

serum amylase and/or lipase (preferable

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29
Q

What can you see in a plain abdominal xray

— \_\_\_\_\_\_\_—70% opaque 
— \_\_\_\_\_\_\_—only 10–30% opaque
— air in biliary tree
— calcified aortic aneurysm
— marked distension sigmoid →\_\_\_\_\_
— distended bowel with fluid level → \_\_\_\_\_\_\_\_\_\_
— enlarged caecum with large bowel obstruction
— blurred right psoas shadow →\_\_\_\_\_\_\_
A

kidney/ureteric stones
biliary stones

sigmoid volvulus
bowel obstruction

appendicitis

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30
Q

What can you see in a plain abdominal xray

sentinel loop of gas in left upper quadrant
(LUQ) → _________

A

acute pancreatitis

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31
Q

chest X-ray: air under diaphragm → _______

A

perforated ulcer

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32
Q

Dxtics

________ good for hepatobiliary system,
kidneys and female pelvis

A

ultrasound:

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33
Q

T or F

UTZ can be affected by shadows

A

T

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34
Q

_________—diagnosis of acute

cholecystitis

A

HIDA or DIDA nuclear scan

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35
Q

__________: gives excellent survey of abdominal

organs including masses and fluid collection

A

CT scan

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36
Q

________: shows bile duct obstruction and pancreatic

disease

A

ERCP

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37
Q

______ is a rhythmic pain with regular spasms
of recurring pain building to a climax and fading. It
is virtually pathognomonic of_____

A

Colicky pain

intestinal obstruction

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38
Q

______ is a true colicky abdominal pain, but
so-called biliary colic and kidney colic are not true
colics at all

A

Ureteric colic

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39
Q

________ usually arises from disorders of the
embryologic foregut, such as the oesophagus, stomach
and duodenum, hepatobiliary structures, pancreas
and spleen

A

Epigastric pain

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40
Q

_______ usually arises from disorders of structures of

the embryologic midgut

A

Periumbilical

pain

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41
Q

structures from the
_______ tend to refer pain to the lower abdomen or
suprapubic region

A

hindgut

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42
Q

The intra-abdominal sensory receptors can
be considered as innervating______ or ________
peritoneum.

A

visceral or parietal

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43
Q

Visceral _________ are triggered
by intestinal distension or tension on mesentery
or blood vessels while _______ are triggered by
mechanical, thermal and chemical stimuli

A

mechanoreceptors

nociceptors

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44
Q

The pain
from viscera is felt as __________localised while
stimulation of parietal peritoneal nociceptors gives a
pain that is experienced directly at the site of insult.

A

diffuse and poorly

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45
Q

Acute abdominal pain in children

Common causes/probability diagnosis:

1
2
3

A
  • infant colic
  • gastroenteritis (all ages)
  • mesenteric adenitis
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46
Q

Acute abdominal pain in children

Serious causes, not to be missed:

  • ________ (peaks at 6–9 months)
  • ________ (mainly 5–15 years)
  • bowel obstruction
A

intussusception

acute appendicitis

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47
Q

Acute abdominal pain in children:

Rarities:
1
2
3
4
A
  • Meckel diverticulitis
  • Henoch–Schönlein purpura
  • sickle crisis
  • lead poisoning
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48
Q

This is the occurrence in a well baby of regular,
unexplained periods of inconsolable crying and
fretfulness, usually in the late afternoon and evening,
especially between 2 weeks and 16 weeks of a

A

Infant ‘colic’ (period of infant distress)

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49
Q

Infant ‘colic’ (period of infant distress)

Crying worst at around ______ weeks of age

A

10

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50
Q

Infant ‘colic’ (period of infant distress)

Drugs are not generally recommended, but for very
severe problems some preparations can be very
helpful (e.g. _________

A

simethicone

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51
Q

__________is the diagnosis that should be
foremost in one’s mind with a child aged between
3 months and 2 years presenting with sudden onset
of severe colicky abdominal pain, coming at intervals
of about 15 minutes and lasting for 2–3 minutes

A

Intussusception

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52
Q

What is the pathophysiology of Intussusception?

A 
It is due to the
telescoping of a segment of bowel into the adjoining
distal segment (e.g. ileocaecal segment), resulting
in intestinal obstruction.
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53
Q

What is the cause of Intussusception?

A

It is usually idiopathic but
can have a pathological lead point (4–12 years) (e.g.
polyp, Meckel diverticulum)

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54
Q

Sign of Intussusception?

A

Sausage-shaped mass in right upper quadrant
(RUQ) anywhere between the line of colon and
umbilicus, especially during attacks (difficult to
feel)

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55
Q

Signs of Intussusception

• _________ (i.e. emptiness in RIF to palpation)
• Alternating high-pitched active bowel sounds
with absent sounds
• Rectal examination: _______

A

Signe de dance

± blood

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56
Q

Diagnosis of Intussusception

• Ultrasound
•___________ (with caution) also
used for diagnosis and treatment

A

Oxygen or barium enema

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57
Q

Treatment of Intussusception

• _______ by air or oxygen from the
‘wall’ supply (preferred) or barium enema
• Surgical intervention may be necessary

A

Hydrostatic reduction

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58
Q

In any child complaining of acute abdominal pain,

enquiry should be made into ______

A

drug ingestion

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59
Q

A common cause of colicky abdominal pain in children

is _______

A

cigarette smoking (nicotine)

60
Q

AA in children

This may occur at any age, being more common
in children of_________ and in
adolescence, and uncommon in children under
3 years of age

A

school age (10–12 years)

61
Q

A serious point of confusion can occur between ________, causing diarrhoea and vomiting, and acute
gastroenteritis

A

pelvic

appendicitis

62
Q

This presents a difficult problem in differential
diagnosis with acute appendicitis because the history
can be very similar. At times the distinction may
be almost impossible

A

Mesenteric adenitis

63
Q

T or F

with mesenteric adenitis localisation of pain and tenderness is definite, rigidity is less of a feature, the temperature is higher, and anorexia, nausea and vomiting are also lesser features

A

F

pain and tenderness not as definite

64
Q

Mesenteric adenitis can sometimes present an
anaesthetic risk and patients are usually quite ill in
the immediate _______ period. Treatment is
symptomatic and includes ample fluids and paracetamol.

A

postoperative

65
Q

__________—three distinct
episodes of abdominal pain over 3 or more months—
occurs in 10% of school-aged children

A

Recurrent abdominal pain (RAP)

66
Q

How many percent of RAP can organic cause be found?

A

In only 5–10%

of children will an organic cause be found

67
Q

Possible causes of RAP

• Constipation
•\_\_\_\_\_\_\_\_\_ (pain with
extreme pallor)
•\_\_\_\_\_\_\_\_\_ (symptoms related to milk
ingestion)
• \_\_\_\_\_\_\_\_\_ (may disturb child about 60
minutes after falling asleep)
A

Childhood migraine equivalent

Lactose intolerance

Intestinal parasites

68
Q

Non-organic RAP

Clinical features

  • __________ abdominal pain
  • pain localised to or just above_______
A

acute and frequent colicky

umbilicus

69
Q

Non-organic RAP

  • no radiation of pain
  • pain lasts less than _____
  • nausea frequent and vomiting rare
A

60 minutes

70
Q

Non-organic RAP

• \_\_\_\_\_\_(never wakes the child at night)
• minimal umbilical tenderness
• anxious child
• \_\_\_\_\_\_\_\_\_\_ personality
• one or both parents intense about child’s health
and progress
A

diurnal

obsessive or perfectionist

71
Q

Psychogenic factors

Some children will have
obvious psychological problems or even be school
avoidant, a common factor being ______

A

family disruption

72
Q

Abdominal pain in the elderly

Problems arise with management because the ________
and there is _________so
that fever and leucocytosis can be absent

A

pain threshold is raised (colic in particular is less severe)

an attenuated response to infection

73
Q

An ______ may be asymptomatic until it ruptures
or may present with abdominal discomfort and a
pulsatile mass noted by the patient

A

AAA

74
Q

AAA

_______ is advisable in first-degree relatives over 50 years

A

Ultrasound screening

75
Q

The
normal diameter of the abdominal aorta, which is
palpated just above the umbilicus, is 10–30 mm,
being 20 mm on average in the adult; an aneurysm is
greater than _____ in diameter.

A

30 mm

76
Q

Greater than _____
is significantly enlarged and is chosen as the arbitrary
reference point to operate because of the exponential
rise in risk of rupture with an increasing diameter

A

50 mm

77
Q

AAA TX

The patency of a _____after
5 years is approximately 95% (

A

Dacron graft

78
Q

AAA

Investigations

• ______ (good for screening) in relatives
>50 years (obesity a problem)
• CT scan (clearer imaging). ________ scan is
investigation of choice.
• MRI scan (best definition)

A

Ultrasound

Helical/spiral

79
Q

This is a real surgical emergency in an elderly person
who presents with acute abdominal and perhaps
back pain with associated circulatory collapse

A

Rupture of aneurysm

80
Q

intense pain + pale and ‘shocked ±

back pain ______

A

ruptured AAA

81
Q

Acute intestinal ischaemia arises from ________occlusion from either an embolus
or a thrombosis in an atherosclerotic artery

A

superior mesenteric artery

82
Q

Clinical features of aute mesenteric ischemia

1
2
3
4

A

• Abdominal pain—gradually becomes intense (see
FIG. 34.7 )
• Profuse vomiting
• Watery diarrhoea—blood in one-third of patients
(later) (refer CHAPTER 44)
• Patient becomes confused

83
Q 
Signs  of aute mesenteric ischemia
1
2
3
4
A

• Localised tenderness, rigidity and rebound over
infarcted bowel (later finding)
• Absent bowel sounds (later)
• Shock develops later
• Tachycardia (may be atrial fibrillation and other
signs of atheroma

84
Q

Dx of aute mesenteric ischemia.

X-ray (plain) shows _____ due to
mucosal oedema on gas-filled bowel.

_______ gives the best definition while

______ is performed if embolus is
suspected.

However, it is commonly only diagnosed at______

A

‘thumb printing’

CT scanning

mesenteric arteriography

laparotomy

85
Q

Management of aute mesenteric ischemia.

Early surgery may prevent gut necrosis but massive
______may be required as a lifesaving
procedure.

A

resection of necrosed gut

86
Q

In pts with mesenteric ischemia:

• _______ can occur but
usually in patients with circulatory failure.
• _________ occlusion is less severe
and survival more likely

A

Mesenteric venous thrombosis

Inferior mesenteric artery

87
Q

_______ usually causes severe lower
abdominal pain, which may not be apparent in a
senile or demented person.

A

Acute retention of urine

88
Q

Causes of Acute retention of urine

  1. 2
    3
A

enlarged prostate or prostatitis
bladder neck obstruction by faecal loading
or other pelvic masses
or anticholinergic drugs

89
Q

Mx of Acute retention of urine

• Perform a _______and empty rectum
of any impacted faecal material.
• _________to relieve
obstruction and drain (give antibiotic cover).
• Have the catheter in situ and seek a urological
opinion. Send specimen for MCU.

A

rectal examination

Catheterise with size 14 Foley catheter

90
Q

_____ is encountered typically in the aged,
bedridden, debilitated patient. It may closely resemble
malignant obstruction in its clinical presentation.

Spurious diarrhoea can occur, which is known as
_____

A

Faecal impaction

‘faecal incontinence’

91
Q

localised RIF pain + a/n/v + guarding

A

acute appendicitis

92
Q

AA signs

pain on resisted flexion of right leg,
on hip extension or on elevating right leg (due
to irritation of psoas especially with retrocaecal
appendix)

A

± Psoas sign:

93
Q

AA signs

_________pain on flexing patient’s right
thigh at the hip with the knee bent and then
internally rotating the hip (due to irritation of
internal obturator muscle)

A

± Obturator sign:

94
Q

AA signs

_______ tenderness in RIF while palpating
in LIF

A

Rovsing sign:

95
Q

Variations and cautions in AA

• _________ → localised mass and
tenderness
• _________: pain and rigidity less and
may be no rebound tenderness; loin tenderness;
positive psoas test
• _________: no abdominal rigidity; urinary
frequency; diarrhoea and tenesmus; very tender
PR; obturator tests usually positive

A

Abscess formation

Retrocaecal appendix

Pelvic appendix

96
Q

Variations and cautions in AA

• ________: pain often minimal and
eventually manifests as peritonitis; can simulate
intestinal obstruction
• Pregnancy (occurs mainly during second
trimester): pain is higher and more lateral; harder
to diagnose; peritonitis more common

• Perforation more likely in the ____, ________, ______

A

Elderly patients

very young, the
aged and the diabetic

97
Q

AA

plain X-ray findings

A

may show local distension, blurred

psoas shadow and fluid level in caecum

98
Q

Management of AA

Immediate referral for surgical removal. If perforated,
cover with ____ or _______

A

cefotaxime and metronidazole

99
Q

SBO

The more _____ the obstruction,
the more severe the pain.

A

proximal

100
Q

colicky central pain + vomiting +

distension

A

SBO

101
Q

Signs of SBO

• Patient weak and \_\_\_\_\_
• Visible peristalsis,\_\_\_\_\_\_
• Abdomen soft (except with \_\_\_\_\_)
• Tender when distended
• Increased sharp, tinkling bowel sounds
• Dehydration rapidly follows, especially in
children and elderly
A

sitting forward in distress

loud borborygmi

strangulation

102
Q

LBO

The cause is commonly________r (75% of
cases), especially on the left side, but it can occur in
______ or _______ of the sigmoid colon (10%
of cases) and caecum

A

colon cancer

diverticulitis or in volvulus

103
Q

LBO

_____is more common in older men and has a sudden and severe onset. The pain is less severe than in SBO

A

Sigmoid volvulus

104
Q

ddx of LBO

pseudo-obstruction of the colon or ______

A

(Ogilvie syndrome

105
Q

Clinical features of LBO

  • __________ pain (even with cancer)
  • Each spasm lasts less than 1 minute
  • Usually hypogastric midline pain (see FIG. 34.11 )
  • Vomiting may be absent (or late)
  • Constipation, no flatus
A

Sudden-onset colick

106
Q

colicky pain + distension ± vomiting

A

LBO

107
Q

X-ray of LBO:

distension of large bowel with separation
of haustral markings, especially caecal distension
— sigmoid volvulus shows a ______
— ________ confirms diagnosis

A

distended loop

gastrografin enema

108
Q

T or F

perforated duodenal ulcer is more common than a gastric ulcer

A

T

109
Q

3 stages of perforated peptic ulcer

1
2
3

A 
1 prostration
2 reaction (after 2–6 hours)—symptoms improve
3 peritonitis (after 6–12 hours
110
Q

sudden severe pain + anxious, still,

‘grey’, sweaty + deceptive improvement

A

perforated peptic ulcer

111
Q

presents as
severe true colicky pain due to stone movement and
ureteric spasm

A

ureteric colic

112
Q

________is not a true colic but a constant
pain due to blood clots or a stone lodged at the pelvic–
ureteric junction

A

Kidney renal colic

113
Q

Features of ureteral colic

  • _____—stone in kidney
  • ______—ureteric stone
  • ______—stone in bladder
A

loin pain

kidney/ureteric colic

strangury

114
Q

Clinical features of ureteral colic

• Maximum incidence ______ years (M > F)

• Intense _____: in waves, each lasting
30 seconds with 1–2 minutes respite

• Begins in_______ (see FIG. 34.13 )

  • Usually lasts <8 hours
  • ± Vomiting
A

30–50

colicky pain

loin and radiates around the flank to
the groin, thigh, testicle or labia

115
Q

Dxtics of ureteral colic

______microscopy; blood testing strip (negative
does not exclude calculus)

• Plain X-ray: most stones—kidney, ureter, bladder
(75%)—are ______ (calcium oxalate and
phosphate)

________ confirms opacity, level of obstruction,
kidney function and any anatomical
abnormalities

A

Urine:

radio-opaque

• IVP:

116
Q

Dxtics of ureteral colic

• Ultrasound: may locate calculus but will exclude
obstruction

• ________ is the ‘gold standard’
(sensitivity 97%, specificity 96%) (will show
easily missed radiolucent 11 uric acid stones

A

Non-contrast spiral CT

117
Q

In ureteral colic:

Further pain can be alleviated by __________ but should be limited to two a
day.

A

indomethacin

suppositories

118
Q

The calculus is likely to pass spontaneously if

______ (90%) <4 mm pass spontaneously

A

<5 mm

119
Q

If calculus ______ intervention will usually be required
by extracorporeal shock wave lithotripsy or
surgery

A

> 5 mm

120
Q

A repeat IVP may be necessary if there is evidence

of obstruction for more than _____

A

3 weeks

121
Q

Facts about urinary tract calculi

• The prevalence is _______ population per
year
• The lifelong incidence is _____
• The recurrence is up to ______ (most within
2 years)
• The typical age range is 20 to 50 years (peaks at
28 years)

A

1 to 3 per 1000

10%

75%

122
Q

Some patients who present with typical colic may be
feigning their pain mainly because they are opioid
dependent and seeking drugs by deception. What is this called?

A

Phony colic

123
Q

the stereotyped patient is female, 40,
fat, fair and fertile it can occur from adolescence to
old age and in both sexes

A

Biliary pain

124
Q

Features of Biliary pain

  • acute onset severe pain
  • _______or at night (often wakes 2–3 am)
  • constant pain (not colicky)
  • lasts 20 minutes to 2–6 hours
  • maximal______
A

post-prandial

RUQ or epigastrium

125
Q

Biliary pain:

• may radiate to ____
• painful episode builds to a crescendo for about
20 minutes; may recede or last for hours
• some relief by assuming_________
• ± nausea and vomiting with considerable retching
• often a history of biliary pain (may be mild) or
jaundice

A

tip of right shoulder or scapula

flexed posture

126
Q

Signs of Biliary colic

• Patient anxious and restless, usually in a flexed
position or rolling in agony
• Localised tenderness\_\_\_\_\_\_\_over fundus
of gall bladder (on transpyloric plane)
• Slight rigidity
A

(Murphy sign)

127
Q

Diagnosis of biliary obstruction

• Abdominal ultrasound/DIDA
• Helical CT
• \_\_\_\_\_\_\_\_\_ if previous
cholecystectomy
• LFTs may show elevated \_\_\_\_ and \_\_\_\_\_
A

Intravenous cholangiography

bilirubin and alkaline
phosphatase

128
Q

Tx of biliary obstruction

• Gallstone dissolution or _______ (in those
unable to have surgery)
• ____________ (main procedure)

A

lithotripsy

Cholecystectomy

129
Q

Types of gallstones:

A

Two main types—cholesterol and pigment

bilirubin

130
Q

70% of people with gall bladder stones are
asymptomatic, but risk of developing symptoms
is about _____ over 20 years

A

15%

131
Q

______ is associated with gallstones in over 90%
of cases and there is usually a past history of biliary
pain. It

A

Cholecystitis

132
Q

The causative

organisms of acute cholecystitis are usually aerobic bowel flora (e.g. _____ and _____

A

E. coli,

Klebsiella species and Enterococcus faecalis).

133
Q

With acute pancreatitis there may be a past history
of ________ or a past history of ______
(35%) or gallstone disease (40–50%).

A

previous attacks

alcoholism

134
Q

severe pain + nausea and vomiting

+ relative lack of abdominal signs

A

acute

pancreatitis

135
Q

acute pancreatitis dx

WCC—\_\_\_\_\_\_
• Serum \_\_\_\_\_\_\_\_\_ (preferred as more sensitive and
specific) or serum amylase
• CRP—elevated
• Serum glucose ↑, calcium ↓
A

leucocytosis

136
Q

In comparison to acute pancreatitis, the pain of

chronic pancreatitis is _______

A

milder but more persistent.

137
Q

____ and _______may result from
pancreatitis and weight loss and steatorrhoea become
prominent features

A

Malabsorption and diabetes

138
Q

Pain associated with _________ is
indistinguishable from that of chronic pancreatitis
but generally tends to be more severe and more
prominent in the back

A

pancreatic cancer

139
Q

Chronic Panc

Give pancreatic enzyme supplements (e.g.
pancrelipase) for________

A

steatorrhoea

140
Q

The patient with __________ is usually over
40 years of age, with long-standing, grumbling, leftsided
abdominal pain and constipation, but can have
irregular bowel habit

A

acute diverticulitis

141
Q

Typical clinical features of acute diverticulitis are:

  • acute onset of pain in the_________
  • pain increased with walking and ______
  • usually associated with constipation
A

left iliac fossa

change of
position

142
Q

Can be generalised due to intra-abdominal sepsis
following perforation of a viscus e.g. peptic ulcer,
appendix, diverticulum

A

Peritonitis

143
Q

abx for peritonitis

A

Usual antibiotic
treatment is IV cephalosporins or amoxy/ampicillin +
gentamicin + metronidazole. 1

144
Q

Spontaneous bacterial

peritonitis can occur in any patient with _______

A

ascites.

145
Q

What to do in abdominal stitch

A

• stop and rest, then walk—don’t run
• apply deep massage to the area with the palps
(fleshy tips) of the middle three fingers
• perform slow or deep breathing

146
Q

___________—this may allow the identification
of chronic adhesive obstruction, small bowel
tumours or inflammation, or intra-abdominal
malignancy

A

laparoscopy

147
Q

T or F

It is possible to have recurrent episodes of subacute
inflammation of the appendi

A

t

MC (90 decks)

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