Abdomen Flashcards by Kevin Jones

What is jaundice?

High level of bilirubin causing yellowing of the skin/sclera and dark urine

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What pathology causes jaundice?

Causes include:

Hepatitis

Liver Cirrhosis

Biliary Obstruction (e.g. due to gallstones or pancreatic cancer)

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What is Aphthous Ulceration?

Round or Oval ulcers occurring in the mucous membranes in the mouth.

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What causes Aphthous Ulceration?

Causes typically benign, but include:

Stress

Mechanical trauma

Can be associated with:

Iron and B12 deficiency

Crohn’s Disease

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What is Haematemesis?

The vomiting of blood which can be:

Fresh red in colour

Coffee ground in appearance.

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What causes haematemesis?

Mallory-Weiss tear or Oesophageal Varaceal Rupture (FRESH RED APPEARANCE)

Gastric or Duodenal Ulcer (COFFEE GROUND APPEARANCE)

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What is gastro-oesophageal reflux and how does it present?

Back flow of stomach contents into oesophagus.

Secondary to lower oesophageal sphincter incompetence.

Presents as:

Epigastric discomfort – burning in nature.

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What is Odynophagia and list two potential causes?

Pain during swallowing.

Can be caused by:

Oesophageal obstruction

Infection

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What is a Mallory-Weiss Tear?

A tear or laceration of the mucous membrane

Most common at point where oesophagus and stomach meet.

(Gastroesophageal Junction)

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What are the Signs and Symptoms of Mallory-Weiss Tear?

Abdominal pain

History of severe vomiting

Haematemesis

Involuntary effort to vomit (retching)

Coffee Grounds vomit

Malena

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Common Causes of Mallory-Weiss tear?

In most instances – severe vomiting

Can be associated with:

Chronic alcoholism

Severe chest or abdomen trauma

Chronic Hiccups

Intense Snoring

Lifting and straining

Gastritis

Hiatus hernia

Complication of chemotherapy

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Causes of abdominal distension.

Ascites

Constipation

Bowel obstruction

Organomegaly

Malignancy

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Causes of Constipation.

Dehydration

Reduction in bowel motility

Medications ( opiates, ondansetron and iron supplements)

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Causes of Diarrhoea

Infection

Irritable bowel syndrome

Inflammatory bowel disease

Medications (laxatives)

Constipation (with overflow)

Malignancy

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What is Steatorrhoea and what are the causes?

Presence of fat in faeces, causing pale appearance and difficulty in flushing.

Causes:

Pancreatitis

Pancreatic cancer

Biliary obstruction

Celiac disease

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What is Haematochezia?

Fresh red blood passed per rectum.

Caused by:

Haemorrhoids

Anal Fissures

Lower Gastrointestinal Malignancy

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What is Ascites? List the causes.

Build up of fluid within the abdomen

Caused by:

Liver Cirrhosis – 75 percent of cases

Cancer – 15 percent

Other causes:

Heart failure

Inflammation of the pancreas

Infection

Kidney problems

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What are the symptoms of Ascites?

Symptoms incluide:

Weight Gain

Reduced Appetite, Constipation and Indigestion

Nausea and Vomiting

Shortness of breath due to, increased pressure on lungs and build up of fluid in lungs

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Complications of Ascites?

Infection within fluid

Medications used to reduce fluid can cause changes to salt and potassium levels

Can affect cardiac and kidney function

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What are systemic gastrointestinal symptoms ?

Anorexia

Weight loss

Nausea

Fatigue

Pyrexia

Pruritus

Confusion

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What is Acute Abdomen?

Rapid onset of:

Severe symptoms

That may indicate potentially life threatening intracranial-abdominal pathology

That requires urgent surgical intervention.

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How does Acute Abdomen Present?

Sudden onset of abdominal pain

Associated nausea or vomiting

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Obstructive causes of Acute Abdomen

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Adhesions

Incarceration of hernias

Volvulus

Gallstones

Intussusception

Congenital anatomical abnormalities

Gastrointestinal Neoplasm

Inflammatory bowel disease

Inflammatory causes of Acute Abdomen

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Cholecystitis

Appendicitis

Acute pancreatitis

Acute diverticulitis

Merkel’s diverticulitis

Ulcerative Colitis

Crohn’s Disease

Gynaecological causes of Acute Abdomen

Ectopic Pregnancy Ruptured Ovarian Cyst Ovarian Torsion Pelvic Inflammatory Disease Endometriosis

Infectious causes of Acute Abdomen

Hepatic abscess or Hepititis Gastroenteritis Infectious colitis Typhilitis Psoas abscess

Toxic causes of Acute Abdomen

Heavy metal poisoning (mercury, lead and arsenic) Narcotic withdrawal from opioids

Ischaemic causes of Acute Abdomen

Acute mesenteric ischaemia and infarction Ischaemic colitis Splenic infarction Sickle cell crisis Budd-Chiari syndrome Abdominal wall haematoma

Metabolic causes of Acute Abdomen

Uraemia Diabetic Ketoacidosis Addisonian crisis Inherited metabolic disorders Allergy/Anaphylaxis

Vascular causes of Acute Abdomen

Abdominal Aortic Dissection Ruptured Aortic Aneurysm Ruptured Splenic artery aneurysm

Urological causes of Acute Abdomen

Testicular Torsion Kidney Stones Pyelonephritis

Acute Appendicitis Symptoms

Acute abdominal pain starting in mid abdomen, later localising to the right lower quadrant Associated with fever, anorexia, nausea and vomiting.

Tests to assess for Appendicitis

Rosving’s Psoas Obturator

What is Mesenteric Adenitis?

Swelling of the lymphatic tissue of the mesentery, secondarily caused by viral or bacterial infection.

What population group does Mesenteric Adenitis most commonly affect?

Children

How does Mesenteric Adenitis present?

LLQ and LRQ abdominal pain. Will not present with true green bile vomiting.

Symptoms of Acute Diverticulitis

Pyrexia Tachycardia Malaise Lower Iliac Fossa Pain Abdominal Distension Palpable Mass

In RARE cases Diverticulitis can progress to?

Fistula Abscess Peritonitis Perforation Haemorrhage Bowel obstruction

Crohns Disease affects?

Any part of the gastrointestinal tract Causing discontinuous patchy inflammation Transmural (affects the full thickness of the bowel wall)

Ulcerative Colitis affects?

The large intestine only. Causing continuous inflammation Mucosal and submucosal layers are affected

What is the Ruptured Aortic Aneurysm Triad?

Abdominal/Back pain Pulsatile Abdominal Mass (only sensitive in thin patients with AAA >5CM) Hypotension

What is Acute Cholecyctitis?

Acute Gallbladder Inflammation – major complication of gallstones. Caused by obstruction or passage of gallstones into neck or cystic duct, causing acute inflammation of gallbladder wall. Impacted gallstone causes bile to become trapped, causing irritation and increases in pressure in gallbladder.

Fill in the blank | Patients with Peritonitis are usually_______ with or without shock.

Septic

What are the complications of a perforated viscus?

Bowel contents, bile, urine, exudate and blood can irritate the peritoneum and lead to peritonitis.

Your patient is still, reluctant to be examined due to pain, guarding their abdomen, with rigidity and rebound tenderness present. What is your impression ?

Peritonitis

What tissue does Merkel’s Diverticulum consist of and where does it reside?

Pancreatic and stomach tissue inside the small intestine.

What can Merkel’s Diverticulum Cause?

Hydrochloride acid release Volvulus

What is a Volvulus?

The bowel twisting on itself causing an obstruction

Symptoms of a Volvulus?

Abdominal pain Distension Vomiting – look out for green bile Blood in stool Constipation/overflow diarrhoea Haemodynamic instability

Most common age group for a Volvulus?

Age >70 years But can occur in utero, through to adulthood.

What is Intussusception?

Telescoping action where part of intestine slides into adjacent part of intestine. Often blocking food or fluid from passing through. Can also cut off blood supply to affected part of intestine.

What age group most likely to get an Intussusception?

Occurs at any age but: Most common in 2-24 months

Intussusception – classic symptoms triad in paediatric patients?

Palpable mass Intermittent abdominal pain Red currant coloured stools.

Symptoms associated with Intussusception?

Pallor Lethargy Diarrhoea Shock Vomiting (look out for green bile)

Cause of Peptic Ulcer Disease

Epigastric pain Nausea Vomiting (rarely, may relieve pain) Lethargy due to anaemia Weight Loss Can be asymptomatic.

Presentation of Acute Pancreatitis

Sudden onset of Abdominal pain Nausea and vomiting are often present History of Gallstones or excessive alcohol intake Signs include: Epigastric Tenderness Pyrexia Tachycardia

List treatment plan for Acute Abdo presenting with Hypotension and Tachycardia ?

- suggestive of fluid loss, hypovolaemia or sepsis. - require prompt, aggressive fluid resuscitation with adequate large bore IV access. - Tranexamic acid indicated for AAA. Priority Call - broad spectrum antibiotics, administered promptly due to infection peritoneal spoilage or sepsis differentials. Adequate pain relief using opioids and use of anti-emetics

Abdomen Flashcards

(57 cards)