Week 2: Adominal Pain Flashcards
(20 cards)
Appendicitis: special tests
Rovsings test.
Psoas sign.
Cope sign.
Rovsings: pain more in RIF than LIF when LIF is pressed.
Psoas: pain on extending hip if retrocaecal appendix.
Cope: pain on hip flexion and rotation. If appendix close to obiturator internus.
Clinical features of appendicitis (7)
Abdominal pain Nausea Fever Anorexia RLQ tenderness Diminished bowel sounds Vomiting (uncommon)
Acute appendicitis
Investigations: 5
Management: 1
Complications: 3
FBC. CT abdo/pelvis. Urinalysis. Pregnancy test. Abdo US.
Appendectomy.
Perforation. Peritonitis. Surgical wound infection.
List hypothesis for the causes of acute abdominal pain (8)
Acute appendicitis Mesenteric adenitis (URTI) UTI Gastroenteritis Trauma Cholethiasis Meckels dicerticulum Crohns/ulcerative colitis
Abdominal organ anatomy
RUQ
LUQ
RUQ: Liver. Gallbladder. Duodenum. Xiphoid process (midline). Abdominal aorta.
LUQ: Spleen (behind the stomach). Left kidney (midaxillary line). Pancreas (not palpable).
Abdominal organ anatomy
LLQ
RLQ
LLQ: Sigmoid colon.
Descending colon.
Bladder. Sacral promontory. Uterus. Ovaries.
RLQ: Bowel loops. Appendix. Caecum.
Appendix pain.
Early.
Later.
Peri umbilical pain may signify early acute appendicitis: distension of an inflamed appendix.
Changes to parietal pain, RLQ, inflammation of adjacent peritoneum.
Appendix
Where does it lie? McBurney’s point.
Mesentery.
Appendix lies deep to McBurney’s point.
One third of the way between ASIS -> umbilicus.
Short mesenteric (mesoappendix) may lie extraperitoneally.
Appendix
Blood vessels: superior mesenteric artery –> _ –> _
Lymph drainage: 2
Nerve supply
Ileocolic artery –> appendicular artery
Drainage: ileocolic vein
Lymph: superior mesenteric and ileocolic (ileocolic artery)
Nerve: Sympathetic: lower thoracic. Parasympathetic (vagus)
Caecum
Which part of the large intestine?
Guarded by which valve?
Continuous with?
Caecum is the first part of the large intestine.
Ileocaecal valve.
Caecum is continuous with the ascending colon.
Ascending colon
First part of the?
Extends from, to?
It is?
Ascending colon is the first part of the colon.
It runs from the ileocaecal junction to the hepatic flexure.
It is retroperitoneal.
Transverse colon:
Extends from, to?
It is what? (2 parts)
Hangs freely on mobile mesenteric, called?
This part of the colon is completely invested it?
Extends from the hepatic flexure to the splenic flexure.
Largest and most mobile part of the large intestine.
Mesentery: transverse mesocolon.
Invested in peritoneum.
Descending colon:
From where, to?
Continuous with.
Splenic flexure to the left iliac fossa.
Continuous with the sigmoid colon.
Sigmoid colon:
Extends from where to the beginning of?
What shape is it?
Covered by?
Hangs in mesenteric called?
Sigmoid extends from the descending colon at the pelvic brim to the beginning of the rectum.
S-shaped loop.
Covered by mesentery: sigmoid mesocolon.
Anatomical terms:
Anterior Posterior Ventral Dorsal Superior Inferior Cranial Caudal
Front Back Front Back Upper Lower Above or near the head Away from the head
Anatomical terms Medial Lateral Superficial Deep Proximal Distal Palmar: dorsal Plantar: ventral
Towards the midline Away from the midline Surface: shallow Away from the surface Nearest Furthest Hand (dorsal. Back of the hand) Foot (ventral. Sole)
Appendix
What is it?
What does it join?
It is usually?
Appendix is a vermiform blind tube.
It joins the caecum inferior to the ileocaecal junction.
It is usually retrocaecal.
Dehydration Signs
Early:
Moderate: Percentage:
4 signs
CRT
Severe: Percentage:
5 signs
CRT
Breathing:
Early: no signs or symptoms.
Mod: 4-6%
4: thirst, sunken eyes, irritable, decreased skin elasticity.
CRT: >2s
Severe: =>7%
5: shock, lack of urine output, rapid feeble pulse, low BP, pallor
CRT: >3s
Deep acidotic breathing
Gross estimate of fluid loss in 10kg child with 5% dehydration.
What is the water deficit in mls?
How should this be replaced?
10kg child who is 5% dehydrated will weigh 9.5kg.
They have a water deficit of 500ml.
Normal 0.9% saline may be sufficient.
Clinical features of mesenteric adenitis:
Usually presents in children with a recent Hx of:
Abdo may be localised to?
What also may be present?
Generalised what may be noted?
Is there a specific test?
WBC?
Scans?
Hx of URTI.
Diffuse pain, may be localised to the right lower quadrant.
Guarding may be present.
Generalised lymphadenopathy.
No specific test.
Relative lymphocytes in WBC is suggestive.
US/CT may exclude other diagnosis.
