Acute Abdomen 2

Question 1

Common diagnoses

Answer 1

Acute cholecystitis
Perforated peptic ulcer
Appendicitis
Diverticulitis
Pancreatitis
Bowel obstruction
Ischemia

Question 2

Causes of bowel obstruction (small)

Answer 2

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

Question 3

Obstruction in the lumen

Answer 3

Tumor
Food bolus
Gallstone

Question 4

Obstruction in the wall

Answer 4

Crohns stricture

TB

Question 5

Obstruction outside the wall

Answer 5

Adhesion

Hernia

Question 6

Signs of vomiting

Answer 6

Low K

Raised urea and creatinine

Question 7

Adhesions

Answer 7

Fibrous tissue caused by previous surgery / inflammation

Question 8

Treat adhesions

Answer 8

Drip and suck!!!
Nasogastric tube
IV fluid
Catheter

Surgery if strangulating or high WCC
Raised PR
Pain
Tenderness

Question 9

Causes of bowel obstruction (large bowel)

Answer 9

Colorectal cancer
Diverticular stricture
Sigmoid volvulus

Question 10

Causes within lumen (large)

Answer 10

Colorectal cancer

Question 11

Causes within the wall (large

Answer 11

Diverticular stricture

Crohns stricture

Question 12

Causes outside the wall (large)

Answer 12

Volvulus

Question 13

How to investigate the gastric tract?

Answer 13

Gastrografin enema (contrast for X-ray)

Question 14

Management for colorectal cancer, Diverticular disease and volvulus?

Answer 14

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

Question 15

Surgery for each part of the colon?

Answer 15

Right/transverse colon - hemicolectomy

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

Question 16

Sigmoid volvulus?

Answer 16

Twist of elongated sigmoid colon

Causing recurrent large bowel obstruction

Elderly frail

Question 17

Sigmoid volvulus symptoms?

Answer 17

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

Question 18

Sigmoid volvulus management

Answer 18

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

Surgery - if strangulating or recurrent

Question 19

Pseudo obstruction

Answer 19

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

No physical obstruction (ileus)

Question 20

Pseudo obstructive management?

Answer 20

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

Question 21

Causes of Ischemia

Answer 21

Embolus (mi/af/valvular heart disease)

Thrombus
Mnomocclusive mesenteric Ischemia

Question 22

Ischemia signs?

Answer 22

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

Question 23

Ischemia management

Answer 23

Resuscitation - fluid/oxygen/catheter

Mesenteric angiogram +/- anticoagulants)

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