Acute Abdo

Question 1

4 signs that suggest appendicitis

Answer 1

Rovsings
Copes
Psoas
Rebound tenderness

Question 2

What is Rovsings sign

Answer 2

Pain is greater in RIF than LIF when LIF is pressed

Question 3

What is Copes sign

Answer 3

Pain on passive flexion and internal rotation of the hip

Question 4

What is Psoas sign

Answer 4

Pain on extending hip (only with retrocaecal appendix)

Question 5

What sign is:

Pain on extending hip (only with retrocaecal appendix)

Answer 5

Psoas Sign

Question 6

“What sign is:

Pain on passive flexion and internal rotation of the hip”

Answer 6

Cope’s Sign

Question 7

What sign is:

Pain is greater in RIF than LIF when LIF is pressed

Answer 7

Rovsing’s Sign

Question 8

Which Abx in the Mx of appendicitis

Answer 8

Cef and met

Cefotaxime and metronidazole

Question 9

Appendicitis complications (3)

Answer 9

Perforation
Appendix mass
Appendix abscess

Question 10

Define diverticular disease

Answer 10

the complications from diverticulosis

Question 11

Define diverticulitis

Answer 11

acute inflammation and infection of diverticulae

Question 12

Define diverticulosis

Answer 12

presence of diverticulae outpouchings of the colonic mucosa and submucosa throughout the large bowel

Question 13

What are the Hinchley stages of Diverticular disease

Answer 13

• Ia: phlegmon
• Ib and II: localised abscesses
• III: perforation with purulent peritonitis
• IV: faecal peritonitis

Question 14

Presenting complaints of diverticular disease (4)

Answer 14

Bloody stool
LIF pain
Fever
Urinary symptoms from fistulation

Question 15

Ix for diverticular disease (4)

Answer 15

“Bloods – FBC, clotting

Barium enema (CHRONIC) * - never acute as could perforate

Flexible sigmoidoscopy ± colonoscopy

CT (ACUTE) and erect AXR (?perf)”

Question 16

Mx of acute symptomatic diverticular disease

Answer 16

IV hydration
Bowel rest
Surgery - Hartmann’s / primary anastamosis

Question 17

Mx of chronic diverticular disease

Answer 17

Soluble, high-fibre diet

Anti-inflammatories (e.g. Mesalazine)
Surgery (may be required with recurrent attacks or complications)

Question 18

What is a Hartmanns procedure and what is the indication

Answer 18

“Removal of the diseased bowel and an end-colostomy formation with an anorectal stump

This is used when a primary anastomosis (immediate joining) is not possible (e.g. inflammation)”

Question 19

Diverticular disease complications (6)

Answer 19

Diverticulitis 
Faecal peritonitis
Fistulas
Peri-colic abscess
Colonic obstruction
Perforation

Question 20

What is the position of a femoral hernia in relation to the pubic tubercle

Answer 20

Lateral & inferior to pubic tubercle

Question 21

What is the position of an inguinal hernia in relation to the pubic tubercle

Answer 21

Superior & medial to public tubercle

Question 22

What do femoral hernias often contain

Answer 22

Omentum

Question 23

What do inguinal hernias often contain

Answer 23

Bowel

Question 24

Which type of hernia is more commonly strangulated

Answer 24

Femoral

Question 25

How to determine whether the hernia is direct of indirect

Answer 25

1. Reduce the hernia 2. Place a finger over the deep inguinal ring (just above the midpoint of the inguinal ligament) 3. Ask the patient to cough and if the hernia re-appears, it cannot be an indirect hernia (must be direct)

Question 26

What can cause pancreatitis (10)

Answer 26

GET SMASHED – Gall stones, Ethanol, Trauma, Scorpion Venom (Trinidad scorpion), Mumps/Malignancy, Autoimmune, Steroids, Hyperlipidaemia/Hypercalcaemia/Hyperparathyroidism, ERCP, Drugs (e.g. Thiazides)

Question 27

What are the domains of the Glagow score (8)

Answer 27

``` PaO2 Age Neutrophils Ca Renal function Enzymes Albumin Sugar ```

Question 28

Medical and surgical Mx of acute pancreatitis

Answer 28

Medical: Fluid balance, catheter and NG tube if vomiting, analgesia, glucose control Surgical ERCP Further surgery if complications are serious (most management for pancreatitis is passive or medical though)

Question 29

Which signs of bleeding in Pancreatitis is which

Answer 29

Cullens is periumbilical Grey-Turners is on the sides

Question 30

Diagnostic test for acute pancreatitis

Answer 30

Amylase

Question 31

PC of chronic pancreatitis (4)

Answer 31

Recurrent epigastric pain Pain relieved on sitting forward WL, bloating, steatorrhoea Pain worst on movement

Question 32

Key blood test for chronic pancreatitis

Answer 32

Faecal elastase

Question 33

Local complications of chronic pancreatitis (3)

Answer 33

pseudocysts, duodenal obstruction, pancreatic ascites

Question 34

Systemic complications of chronic pancreatitis (3)

Answer 34

diabetes, steatorrhea, reduced quality of life

Question 35

Mx of chronic pancreatitis

Answer 35

ERCP to remove gallstone if it is the problem

Question 36

PC of intestinal obstruction (4)

Answer 36

Diffuse pain Constipation Vomiting if higher obstruction Abdominal distension

Question 37

Causes of small bowel obstruction (2)

Answer 37

Adhesions from prior operations (most common cause in western world) Malignancy

Question 38

Causes of large bowel obstruction (3)

Answer 38

Colorectal malignancies Sigmoid/caecal volvulus Paralytic Ileus Postoperative ileus

Question 39

What is heard on auscultation of intestinal obstruction (2)

Answer 39

High-pitched, tinkling bowel sounds | Absent bowel sounds…

Question 40

Medical and surgical Mx of intestinal obstruction

Answer 40

Medical “Drip & suck” (Drip + NG tube) Conservative if volvulus decompresses Surgical Laparotomy (esp. if peritonitic)

Question 41

PC of acute intestinal ischaemia

Answer 41

Sudden onset diffuse pain

Question 42

RF of acute intestinal ischaemia (4)

Answer 42

Old age Cardiovascular disease AF Hypotensive state Car accidents

Question 43

What is seen on examination of acute intestinal ischaemia (3)

Answer 43

Diffuse abdominal pain Shock signs Normal exam

Question 44

Ix for acute intestinal ischaemia (3)

Answer 44

AXR – perforation, megacolon Angiography – show blockages ECG – look for MI or AF

Question 45

RF of chronic intestinal ischaemia (3)

Answer 45

Old age Cardiovascular disease Heart failure hx

Question 46

PC of chronic intestinal ischaemia (4)

Answer 46

Intermittent gut claudication Post-prandial pain PR bleeding Weight loss

Question 47

Ix for intestinal ischaemia (3)

Answer 47

AXR Angiography – show blockages ECG – look for MI or AF