8 - Abdominal catastrophes Flashcards
(34 cards)
What is the cause and consequence of a bowel obstruction?
Caused by strangulated hernias
Results in hypovolemic shock due to fluid loss
What is blood loss into retroperitoneum caused by?
Ruptured abdominal aortic aneurysm
What is cholangitis?
Infection of the billary tract caused by gallstones or stents
Why does parietal peritoneum/diaphragm pain radiate to the shoulder tip?
Diaphragm supplied by phrenic nerve which has its roots at c3-5 at shoulder tip
What is visceral referred pain?
Visceral pain fibres follow sympathetic fibres back to spinal cord that gave preganglionic sympathetic fibres
CNS perceives visceral pain as coming from area supplied by spinal cord segment
What causes visceral pain?
Inflammation
Ischaemia
Abnormal muscle contraction - colic
Where is gastric and duodenal pain referred to?
Foregut structures so pain felt in epigastric
Where is gall bladder pain referred to?
Foregut structure so pain felt in epigastric
Irritates parietal peritoneum, referring pain to tip of scapula
Where is splenic pain reffered to?
Left lumbar region, anterior and posterior
Where is appendicitis pain referred to?
Early: Midgut structure so pain in umbilicus
Later: Inflammation irritates parietal
Where is pancreatic and abdominal aorta pain referred to?
Hindgut structures so pain in suprapubic area
Where is small intestine colic pain referred to?
Hindgut structure so pain in suprapubic area
Where is large intestine colic pain referred to?
Hindgut structure so pain in suprapubic area
Where is ureteric colic pain referred to?
Right ASIS to pubic symphysis and right iliac region (back)
Patients roll around on floor in pain
Where is peritonitis pain referred to?
Pain all over abdomen and shoulder tips
How does bowel obstruction lead to hypovolaemic shock?
Increased secretion into small intestine
Decreased reabsorption
Accumulation of fluid as isotonic water removed from ECF
Vomit up, more space for fluid to be sequestered
Check for raised haematocrit
What causes bleeding into the gut?
Vom blood and melaena:
Oesophageal varices (dilated veins)
Peptic ulcer
Bright red bleed from rectum: Diverticular disease
What has occured in a bleeding peptic ulcer?
Posterior duodenal ulcer has eroded into gastroduodenal artery
What causes melaena?
Alteration of blood by digestive enzymes, usually due to oesophageal varices or peptic ulcer
Why does urea rise in oesophageal and gastric bleeds?
Bleed means large protein ends up in small intestine
Liver converts protein to urea, while creatinine levels stay normal
What causes retroperitoneal bleeding?
Ruptured abdominal aortic anuerysm
Anticoagulated patients tearing retroperitoneal veins
Describe the typical presentation of AAA
Sudden onset severe abdominal and back or loin pain
Shock symptoms
Describe the typical presentation of ruptured ectopic pregnancy
Reproductive age
Lower abdominal pain and left shoulder tip pain on lying down
Vaginal bleeding
Collapse
What happens in a posterior perforation of a gastric ulcer?
Allows gastric contents to enter lesser sac, so fluid can enter greater sac via epiploic foramen
Leads to chemical peritonitis
