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MedEd acute abdomen Flashcards

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1
Q

who is most likely to get acute appendicits?

A

10-20 y/o

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2
Q

how does appendicits present?

A

periumbilical pain that moves to RIF
nausea and vomiting
low grade fever

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3
Q

what is murphys triad used to diagnose?

A

appendicits

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4
Q

what triad is used to diagnose appendicits?

A

murphys triad

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5
Q

what is murphys triad?

A

abdominal pain that moves from the umbilicus to the RIF
nausea and vomitting
low grade fever

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6
Q

what signs are seen in appendicitis and what do you see?

A

rovsings sign- palpation of the LIF will cause referred pain in the RIF
psoas sign- extension of the hip causes pain
obturator sign- internal rotation of the flexed thigh causes pain
percussion rebound tenderness and guarding
mc burney’s sign- pain at mcburneys point 1/3 of the way from ASIS to umbilicus

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7
Q

how is appendicitis managed?

A

make patient NBM
give fluid if there are signs of shock
abx
laparoscopic appendectomy

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8
Q

what are complications of appendicitis?

A

rupture which can cause peritonitis

abscess which will require drainage

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9
Q

what is diverticular disease?

A

herniation of mucosa and submucosa through muscle layer of the colonic wall

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10
Q

what is the difference between diverticular disease and diverticulosis?

A

diverticulosis= presence of diverticula but asymptomatic

diverticular disease= presence of diverticula but symptomatic

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11
Q

where along the colon does herniation occur in diverticular disease?

A

in between bands of tenia coli

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12
Q

where are diverticula never found?

A

in the rectum

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13
Q

what are RF for diverticular disease?

A

low fibre diet
age over 50
obesity

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14
Q

out of diverticulosis and diverticular disease which is worse? why?

A

diverticular disease because it is symptomatic

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15
Q

how des diverticulitis present?

A

LIF pain
fever
tachycardia
abdo distention

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16
Q

whats the difference between diverticular disease and diverticulosis?

A

both are symptomatic but diverticulosis is severe symptoms due to diverticula getting very inflammed or infected

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17
Q

what imaging is done for diveritcular disease and what do you see?

A

GS: colonoscopy to visualise the diverticula
Barium enema: sawtooth appearance
CT- can confirm diagnosus

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18
Q

how is diverticular disease managed?

A

you can’t reverse growth but you can slow progression- high fibre diet, hydration, reduce weight, stop smoking

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19
Q

what analgesics should you avoid in diverticular disease and why?

A

opioids because it will make them more constipated

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20
Q

what are complications of diverticular disease?

A 
diverticulitis
abscess
perforation
peritonitis 
fistulas and stricture formation
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21
Q

what happens to fluid when there is an intraluminal pressure due to bowel obstruction?

A

third spacing because fluid is squeezed out

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22
Q

what part of the bowel is most likely to get obstructed?

A

small bowel

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23
Q

what is strangulation in bowel obstruction?

A

compromised blood supply which can lead to ischaemia and gangrene

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24
Q

what are the most common causes of small v large bowel obstruction?

A

small bowel obstruction= mainly from adhesions from surgery

large bowel obstruction= mainly from malignancy

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25
what is the most common cause of small bowel obstruction?
adhesions from surgery
26
what is the most common cause of large bowel obstruction?
malignancy
27
what are signs and symptoms of bowel obstruction?
``` severe colicky pain abdo distention tinkling bowel sounds bilious vomitting constipation ```
28
what is the main imaging for bowel obstruction?
supine abdominla x ray
29
on abdo x ray how do you differentiate between small and large bowel obstruction?
small bowel= vulvae coniventae are seen which are lines that go all the way across the bowel large bowel= haustra which go halfway across the bowel
30
what are vulvae coniventae, how do you spot them and in what are they seen?
they are lines that go all the way across the bowel and help identify small bowel obstruction
31
what is the difference between vulvae coniventae and haustra and where is each seen on an abdo x ray?
vulvae coniventae= lines on the small bowel that go all the way across haustra= lines on the large bowel that only go halfway across
32
how is bowel obstruction managed?
conservative: NDM, NG tube to decompress bowels, IV fluids, urinary catheter and analgesia if acute and theres evidence of strangulation/ichaemia then do a laparotomy
33
how is bowel obstruction secondary to adhesions managed?
conservatively- NMD, NG tube to decompress bowel | then check in 24 hrs
34
what is volvulus?
rotation of a loop of bowel around the axis of its mesentery that results in obstruction and ischaemia
35
what part of the bowel is most commonly affected in volvulus?
most commonly the sigmoid colon | sometimes the caecum
36
what are RF for volvulus?
``` long sigmoid colon long mesentery mobile caecum chronic constipation adhesions ```
37
what are signs and symptoms of volvulus?
``` severe colicky pain constipation absent or tinkling bowel sounds vomitting abdo distention and tenderness signs of dehydration ```
38
what is seen on abdo x ray in volvulus?
coffee bean sign
39
how is volvulus managed?
if sigmoid colon then sigmoidoscopy and detorsion, there is a high rate of recurrence and if so surgery may be needed if caecum them colonoscopy cannot be done due to risk of detorsion so surgery is done
40
describe how acute pancreatitis arises
when a apcnreas is inflammed calcium build up in it this causes release of enzymes like lipase and amylase this damages local structures and causes systemic signs
41
what is the most common cause of pancreatitis in women vs men?
``` women= gallstones men= alcohol ```
42
what electrolyte imbalance can cause pancreatitis?
hypercalcaemia
43
what drugs can cause pancreatitis?
sodium valproate, steroids, thiazides and azathioprine
44
what are signs and symptoms of acute pacreatitis?
severe epigastric pain that radiates to the back- relieved by sitting forward and worse when lying down nausea and vomitting fever hypovolemia
45
what are the 2 signs of acute pancreatitis and where are they found?
cullens sign= periumbilical bruising | grey turners sign= flank bruising
46
how do you remember which way around grey turners and cullens sign is?
cullens= bella cullen from twilight had a really fucked up baby and a baby is in the tummy so cullens sign= tummy/perumbilical bruising grey turners sign= flank bruising
47
what are grey turners and cullens signs a sign of?
acute pancreatitis
48
what ix are done for acute pancreatitis? what will you see
amylase lipase- 3x higher than normal CT abdo GS to confirm diagnosis ALP +bilirubin to check for gallstones Ca/triglyceride levels
49
what is GS imaging for acute pancreatitis?
CT abdomen
50
how high are amylase and lipase in acute pancreatitis? what must you be careful to remember?
3x normal | the level of enzyme does not correspond to the severity of the pancreatitis
51
out of amylase and lipase which is more sensitive for pancreatitis?
lipase
52
describe glasgow/ PANCREAS score
``` PaO2= <8kpa/60 mmHg Age >55 Neutrophils- high WBC Calcium <2 mmol/L Renal function- urea >16 mmol/L Enzymes- high AST/ALT or LDH Albumin <32g/L Sugar- glucose >10 mmol/L ```
53
how is acute pancreatitis managed?
``` analgesia IV fluids NG tube Control blood sugar abx if infected treat cause ```
54
if acute pancreatitis is caused by gallstones how is this managed?
ERCP with sphincterotomy cholecystectomy remove nectrotic tissue
55
what is a predictor of pancreatitis severity? what is not
heamatocrit is a good indicator of severity | enzymes (amylase/lipase) ARE NOT good severity predictors
56
what is peritonitis?
inflammation of the peritoneal lining of the abdominal cavity
57
what is the difference between primary and secondary generalised peritonitis?
primary is due to bacterial infection without an obvious source secondary is due to a pre existing abdominal condition
58
what are signs and symptoms of peritonitis?
nausea and vomitting acute onset severe abdomen pain that is generalised at first and then becomes localised reduced bowel sounds (due to paralytic ileus) signs of sepsis gaurding and rebound tenderness washboard rigidity
59
what is seen on ascitic tap in SBP?
neutrophil count over 250
60
what is seen on erect CXR in peritonitis?
air under the diaphragm
61
what is SBP?
spontaneous infection of ascitic fluid not originating from an obvious place in the abdomen eg hole in intestines or collection of pus
62
how is peritonitis managed?
conservative: IV fluids, abx, NG tube primary generalised/septic= broad spectrum abx localised/secondary generalised= treat cause, may need surgery (necrosectomy and peritoneal lavage)
63
what is a hernia and what are the 2 common types?
usually inguinal or femoral it is a protrusion of contents through areas of weakness in the wall that contains them
64
what are the causes of hernia?
``` anything that increases intra abdominal pressure eg pregnancy chronic cough constipation weakened abdo muscles ```
65
where are femoral vs inguinal hernias located? how do you remember this
femoral= inferior and lateral to the pubic tubercle (remember because the femoral vein goes below/inferior and is lateral to the pubic tubercle) inguinal= superior and medial to the pubic tubercle
66
what are the borders of hesselbach's triangle?
lateral border of rectus abdominis inferior epigastric vessels inguinal ligament
67
what type of hernia is related to hesselbach's triangle and how?
direct inguinal hernia
68
what anatomical triangle does a direct inguinal hernia protrude through?
hesselbach's triangle
69
in what gender are inguinal hernias more common?
males
70
describe anatomically where an direct vs indirect inguinal hernia starts and ends
``` direct= in through a hole in the back of the inguinal canal and out through superficial inguinal ring indirect= in through deep inguinal ring and out through superficial inguinal ring ```
71
in what gender is femoral hernia more common in and how do you remember?
females because femoral and female both start with an f
72
how do you remember the positioning of inguinal v femoral hernia?
femoral artery is below and lateral to pubic tubercle and so is the hernia inguinal= intimate to it extends towards the genitalia therefore it is superficial and medial to the pubic tubercle
73
what is an incarcerated hernia?
when the contents of a hernia are stuck inside by adhesions
74
what is a strangulated hernia?
when the blood supply to the hernia is cut off
75
how are inguinal or femoral hernias managed?
conservative- weight loss elective repair- mesh repair where stent is placed over the defect where the hernia protruded from obstructed/strangulated- emergency laparotomy
76
how are incarcerated/strangulated hernias repaired?
via emergency laparotomy
77
how dies intestinal ischaemia arise?
obstruction of a mesenteric vessel leading to bowel ischaemia and necrosis
78
what are RF for intestinal ischaemia?
increasing age AF other causes of emboli eg endocarditis, malignancy cardiovascular disease RF eg hypertension, diabetes, hyperlipidaemia

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