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Emergency medicine: Abdominal pain Flashcards

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1
Q

What are the symptoms of perforation?

A

Acute severe abdominal pain
Rebound tenderness (i.e. peritonitis)
Acute pyrexia
Nausea, vomiting

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2
Q

What are the key investigative findings of perforation?

A
  1. A/CXR =
    - Pneumo-peritoneum (air under diaphragm)
  2. Bloods =
    - Low Hb
    - Raised WCC
    - Raised lactate
    - (Raised amylase)
  3. ABG =
    - Metabolic acidosis
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3
Q

What is the management for perforation? (8 - think RRAPID)

A
  1. ABCDE
  2. Oxygen high flow 15L/min via NRBM
  3. Fluid resuscitation
  4. Morphine with cyclizine
  5. ABx - metronidazole and co-amoxiclav
  6. Cross Match (urgent)
  7. NBM, NGT
  8. Surgery
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4
Q

What are the symptoms of bowel obstruction

A

Acute abdominal pain

  • Colicky and intermittent
  • Severe
  • Distended ± rigid
  • Tender ± peritonitic

Vomiting

  • Bilious
  • Faecal (worrying)

Tinkling bowel sounds

Constipation - partial or complete

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5
Q

What are the key investigations for bowel obstruction?

A
  1. AXR =
    - distended loops of bowel
    - absence of gas distal to obstruction
  2. Contrast enema (for lower obstructions)
  3. Bloods
    - Cross-match
    - FBC
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6
Q

What is the treatment for bowel obstruction

A

DRIP and SUCK

  1. NGT (Rhyles tube to remove GI contents)
  2. NBM
  3. IV fluids
  4. Surgery
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7
Q

In whom is acute appendicitis most common (age range)?

A

10-20 yo

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8
Q

What are the symptomatic sequelae of acute appendicitis?

A

Classic (>60%)

  1. Central colicky abdominal pain
    - worse with movement
    - tender with voluntary guarding
  2. Nausea, vomiting, diarrhoea
  3. Fever + fatigue

Late

  1. Severe pain in RIF (McBurneys)
    - Rigid and tender abdomen
    - Peritonitis
  2. Rovsing sign
  3. Mucous coated faeces
  4. Swinging pyrexia
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9
Q

What is the treatment for appendicitis?

A
  1. ABCDE
  2. NBM, NGT, IV fluids
  3. Abx - IV co-amoxiclav, metronidazole, cefuroxime
  4. Appendectomy
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10
Q

What are the symptoms of AAA?

A
  1. Central abdominal pain
    - Acute (?rupture) or Chronic (developing)
    - Radiates to back, groin, thigh
    - Pulsatile and expansile mass
  2. Fatigue
  3. Absent leg pulses
  4. Acutely unwell, drowsy, confused, low GCS, Cullens and Grey turners (?rupture)
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11
Q

What is the key investigative findings which determines clinical decision regarding treatment in patients with AAA?

A
  1. USS abdomen
    - 3 - 4.4 cm = annual review
    - 4.5 - 5.4 cm = 3 monthly review
    - >5.5 cm = elective surgery
    - Ruptured = urgent surgery
  2. Bloods
    - FBC: Low Hb (may indicate bleed), raised WCC (may indicate infection)
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12
Q

What are the primary causes of acute pancreatitis?

A

Gall stones (majority), Ethanol (alcohol), Trauma

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13
Q

What are the symptoms and signs of acute pancreatitis?

A
  1. Constant epigastric pain
    - radiates to back
    - Worse with alcohol
    - Relieved with leaning forward
    - Tender and rigid
  2. Cullens and Grey turners (late)
  3. RUQ pain - if a/w gall stones
  4. N, V, D, Anorexia
  5. Dehydration
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14
Q

What are the symptoms of acute cholecystitis?

A 
Constant RUQ pain 
- Radiates to right shoulder 
- Worse after eating fatty foods
- Tender RUQ 
- Mass felt RUQ 
Nausea, vomiting, fever, bloating 
Murphys sign (pain in RUQ on palpation during inspiration)
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15
Q

What is acute cholecystitis?

A

Inflammation of the gall bladder due impaction of a gall stone in the neck of the gall bladder

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16
Q

What is cholangitis?

A

Bile statsis causes infection of the gall bladder –> inflammation and Charcot’s triad

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17
Q

What are the symptoms of cholangitis?

A
  1. Fever
  2. Jaundice
  3. Abdominal pain i.e. RUQ pain
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18
Q

What are the symptoms of cholangitis?

A
  1. Fever
  2. Jaundice
  3. Abdominal pain i.e. RUQ pain
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19
Q

What are the symptoms of obstructive jaundice?

A

RUQ pain radiating to R.Shoulder
Dark urine
Pale faeces

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20
Q

What are the symptoms of Peptic Ulcer Disease (PUD)?

Study These Flashcards
A
  1. Epigastric pain
    - Intermittent
    - Epigastric tenderness + bloating
    - Duodenal - relieved with food and milk
    - Gastric - worsened by food
  2. Dyspepsia
  3. Anorexia
  4. Haematemesis or malaena (if ruptures)
21
Q

What are the causes of acute and chronic PUD?

Study These Flashcards
A

Acute - Hyperacidity

Chronic - H.Pylori

22
Q

What are the key investigations for PUD?

Study These Flashcards
A
  1. Upper GI endoscopy with biopsy and Clo test
  2. H.Pylori tests:
    - Urea breath test
    - Serology (detects IgG)
23
Q

What is the treatment for PUD?

Study These Flashcards
A
  1. ABCDE
  2. Fluid rests if required
  3. Analgesia for pain - avoid NSAIDs as this can exacerbate
  4. PPI (lansoperazole or omeprazole) to reduce damage
  5. H.Pylori treatment (ACL):
    - Amoxicillin
    - Clarithromycin
    - Lansoperazole
  6. Repeat endoscopy in 6 weeks - ensure it has gone
24
Q

What symptoms would worry you of gastric cancer in a patient with PUD?

Study These Flashcards
A

ALARMS

  • Acute onset
  • LoA
  • Anaemia
  • Reduced weight
  • Malaena
  • Swallowing difficulty
25
What are the symptoms of diverticulitis?
1. Acute onset 2. Left (common) or Right lower quadrant pain - Constant or intermittent - Relieved with defecation - Localised tenderness and palpable mass 3. PR Bleeding 4. Fever, tachycardia, nausea, vomiting, diarrhoea
26
What are the key investigative findings for diverticulitis?
1. AXR - look for any sign of ileus, perforation 2. Colonoscopy - diagnostic 3. Bloods - Raised WCC, ESR, CRP
27
What are the signs of haemorrhage during diverticulitis?
PR Bleeding - acute and often painless Abdominal pain and or urge to defecate Blood clots
28
What are the common locations to find renal stones?
PUJ VUJ Pelvic Brim
29
What are the symptoms associated with renal stones?
1. Renal colic - Intermittent spasming pain - Loin to groin - Worse when moving or when drinking - Tender flank 2. Nausea, vomiting, anorexia 3. Sweating and restless 4. Fever and systemically unwell (if infection present)
30
What are the key investigative findings for renal stones?
1. Urine dip - +Blood, + Nitrates (if inf) 2. Bloods - raised Urea, Creatinine, K+; Low Na+ 3. KUB - detects 60% 4. CTKUB - detects 99%
31
What is the treatment for renal colic? (7)
1. ABCDE 2. Fluids - encourage plenty of oral; give IV if required 3. Analgesia - NSAIDs effective (Diclofenac or Ibuprofen) 4. Tamsulosin (a blocker dilates SM of prostate and bladder to help pass stone) 5. Shock wave lithotripsy 6. Metoclopramide (A/E) 7. Nephrostomy if pyelonephritis develops
32
What are the symptoms of ectopic pregnancy?
``` Abdominal pelvic pain U/L usual - Vague --> colicky --> constant - Adnexal mass - Localised tenderness Cervical os small Uterus small Cervical excitation Vaginal bleeding (small) Amenorrhoea (6-8 wks) Nausea and vomiting --> dehydration, dizzy, syncope ```
33
What are the investigative findings for ectopic?
1. Pregnancy test - +Ve --> USS 2. HCG - if > 1000 = likely IUP - if <1000 but increases > 66% in 48 hours = likely IUP - if slow rising or declining = ectopic or MisC 3. USS - determine if IUP, adnexal mass, free fluid
34
What is the treatment for an ectopic?
1. ABCDE - Oxygen, fluids if required 2. Methotrexate single dose --> r/v HCG at 4 and 7 d 3. Salpingostomy --> r/v HCG at 7 d
35
What are the primary causes of pelvic inflammatory disease (PID)?
Chlamydia | Gonorrhoea
36
What are the symptoms of PID?
``` Pelvic pain Deep dyspareunia Vaginal discharge and dysuria (due to concomitant infection) Erratic, irregular, painful menses Cervical motion pain Adnexal mass + tenderness Fever Previous Hx of STIs ```
37
What are the key investigations of PID?
1. Transurethral or vulvovaginal swab with NAATS - if C. Trahamotis --> Tx - if N. Gonorrhoea --> CS 2. FBC - Raised WCC 3. USS - exclude ovarian abscess
38
What are the treatment options for PID?
High gonorrhoea risk - Ceftriaxone IM, metronidazole, doxycline (14 d) or - Olfloxacin and metronidazole or - Ceftriaxone and azithromycin Low gonorrhoea risk - Ceftriaxone IM, metrondiazle, doxycycline (14 d)
39
What are the risk factors for PID?
Age < 25yo, sexually active women, past history of STIs, multiple partners
40
What is the definition of a miscarriage?
Spontaneous abortion of child by < 24wks (often occurs at 12 wks)
41
What are the symptoms of miscarriage?
Pelvic pain Offensive vaginal loss PV bleeding Uterine contractions
42
What are the types of ovarian cyst and in whom are they common?
Benign epithelial neoplastic ovarian cyst 1. Mucinous cystadenoma (20-40) 2. Serous cystadenoma (40-50)
43
What are the symptoms and signs of ovarian cyst?
``` Pelvic pain - radiates to back - dull ache Dyspareunia Bleeding (if rupture): abdominal --> peritonitis; pelvic --> discharge and bleeding ```
44
What are the symptoms and signs of ovarian cyst?
``` Pelvic pain - radiates to back - dull ache Dyspareunia Bleeding (if rupture): abdominal --> peritonitis; pelvic --> discharge and bleeding ```
45
What are the key investigations for ovarian cyst?
1. Preg test = -ve 2. HCG = -ve 3. USS (diagnostic) 4. CA125 (ovarian Ca tumour marker)
46
What are the key investigations for MisC?
1. B-HCG = slowly rising or declining | 2. USS = determine if IUP or ectopic etc.
47
What is the treatment for ovarian cyst?
1. Expectant - watch and wait, most resolves spontaneously 2. Analgesia and Anti-emetic 3. Laprocystectomy if cyst > 5cm 4. Laproscopy
48
What is the treatment for Miscarriage?
1. ABCDE - oxygen and fluid if req 2. IM Oxytocin - reduce any bleeding 3. Analgesia and Anti-emetics 4. Anti-D for mothers 5. Wait for it to spontaneously come out

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