Acute Abdomen 2 Flashcards Preview

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Flashcards in Acute Abdomen 2 Deck (23):
1

Common diagnoses

Acute cholecystitis
Perforated peptic ulcer
Appendicitis
Diverticulitis
Pancreatitis
Bowel obstruction
Ischemia

2

Causes of bowel obstruction (small)

Adhesion
Hernia
Tumor
Stricture (crohns)
Luminal (food/gallstone)

3

Obstruction in the lumen

Tumor
Food bolus
Gallstone

4

Obstruction in the wall

Crohns stricture
TB

5

Obstruction outside the wall

Adhesion
Hernia

6

Signs of vomiting

Low K
Raised urea and creatinine

7

Adhesions

Fibrous tissue caused by previous surgery / inflammation

8

Treat adhesions

Drip and suck!!!
Nasogastric tube
IV fluid
Catheter

Surgery if strangulating or high WCC
Raised PR
Pain
Tenderness

9

Causes of bowel obstruction (large bowel)

Colorectal cancer
Diverticular stricture
Sigmoid volvulus

10

Causes within lumen (large)

Colorectal cancer

11

Causes within the wall (large

Diverticular stricture
Crohns stricture

12

Causes outside the wall (large)

Volvulus

13

How to investigate the gastric tract?

Gastrografin enema (contrast for X-ray)

14

Management for colorectal cancer, Diverticular disease and volvulus?

Colorectal - surgery (stent)
Diverticular - surgery
Volvulus - endoscopic decompression (surgery)

15

Surgery for each part of the colon?

Right/transverse colon - hemicolectomy

Left - hartmann's procedure (stoma)
Subtotal colectomy and small bowel colonic anatomosis
Left hemicolectomy following bowel washout (on table lavage)

16

Sigmoid volvulus?

Twist of elongated sigmoid colon

Causing recurrent large bowel obstruction

Elderly frail

17

Sigmoid volvulus symptoms?

Abdominal distension
Painless, non-tender
Beware If pain - strangulation

18

Sigmoid volvulus management

Conservative - tube decompression via rigid sigmoidoscopy
- or flexible sigmoidoscopy and decompression

Surgery - if strangulating or recurrent

19

Pseudo obstruction

Seen in patients with other problems. E.g resp, renal, post orthopaedic surgery

No physical obstruction (ileus)

20

Pseudo obstructive management?

Exclude mechanical obstruction
Correct electrolytes
Decompress with colonoscopyrarely pro kinetic drugs e.g neostigmine
V rarely surgery if caecal Ischemia/perforation

21

Causes of Ischemia

Embolus (mi/af/valvular heart disease)

Thrombus
Mnomocclusive mesenteric Ischemia

22

Ischemia signs?

FBC - WCC raised

Amylase raised
Lactate raised
Arterial blood gases - metabolic acidosis, negative base excess

Thumb printing on colon wall

Lack of contrast in mesenteric vessels and bowel wall

23

Ischemia management

Resuscitation - fluid/oxygen/catheter

Mesenteric angiogram +/- anticoagulants)

Surgery - as soon as diagnosed, segment bowel resection, embolectomy