September 24, 2015 - Acute Abdomen Flashcards Preview

COURSE 1 > September 24, 2015 - Acute Abdomen > Flashcards

Flashcards in September 24, 2015 - Acute Abdomen Deck (19):
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Acute Abdomen

A condition of the abdomen which requires urgen diagnosis and treatment. Almost always involves abdominal pain, and often requires surgery.

Some examples can be... pancreatitis, bowel obstruction, Crohn's, UC, appendicitis, etc.

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Types of Abdominal Pain

1. Visercal

2. Somatic (parietal)

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Visceral Abdominal Pain

Derives from the visceral peritoneum. This is often sensitive to stretching, pulling, contraction. Mediated by the autonomic nervous system.

The pain is often poorly localized, dull, crampy, and not made worse with movement. May come and go in waves and can be very severe.

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Somatic (Parietal) Abdominak Pain

Derives from the parietal peritoneum and is mediated by somatic nerves. This is sensitive to cutting, burning, and imflammation.

Pain is often sharp, well-localized, severe, persistent, and made worse with movement. Patients typically like to stay still.

Eg. peritonitis, appendicitis, diverticulitis.

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High CBC and Dehydration

CBC can appear artificially high in the presence of dehydration. This is because there is less plasma volume to dilute it.

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Appendectomy

The removal of the appendix.

Can be performed openly or laparoscopically.

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McBurney's Point

2/3 along the line between ASIS and umbilicus.

 

A image thumb
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Pathophysiology of Appendicitis

1. Obstruction of the appendiceal lumen

2. Increased lumen pressure and spasm (visceral pain)

3. Impaired circulation to the wall of the appendix (ischemia)

4. Bacterial invasion of wall with inflammation and eventual necrosis of the wall (somatic pain)

5. Perforation with peritontis or abscess

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Causes of Appendiceal Obstruction

Fecalith (inspissated stool)

Lymphoid hyperplasia

Fibrosis, foreign bodies, parasites

Neoplasia

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Appendicitis: Patient History

Classic is non-specific periumbilical pain (visceral), followed by nausea and shark RLQ pain (somatic) 12-36 hours later.

The migration of pain to the RLQ is classic.

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Rovsing's Sign

RLQ pain with the palpation of the LLQ.

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Obturator Sign

RLQ pain with the rotation of the hip.

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Psoas Sign

RLQ pain with the hyper-extension of the hip.

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DDx of Appendicitis

Could also be...

Pelvic inflammatory disease

Ruptured ovarian cyst (women in child-bearing age)

Ruptured follicular cyst

Mesenteric adenitis (children)

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Imaging for Appendicitis

US or CT

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Meckel's Diverticulum

Is a true congeinital diverticulum. It is a slight bulge in the small intestine that is present at birth and is the most common malformation of the GI tract and is present in about 2% of the population.

May cause issues by being different cells and secreting products such as alkaline pancreatic juice or acid.

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Etiology of Diverticulosis

A low fibre diet.

Low fibre diets lead to longer transit times, harder and smaller stools, increased intra-colonic pressure, segmentation and narrowing of the colon.

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Acute Diverticulitis

Microperforation with surrounding infection.

Presents with LLQ pain, fever, a history of constipation and bowel complaints, altered bowel habit.

Need a CT scan.

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Complications of Diverticulitis

Abscess

Colovesicular fistula

Fistula to other organs

Stricture

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