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Emergency & Acute > Acute Abdo > Flashcards

Acute Abdo Flashcards

1
Q

What should always be suspected in unexplained abdo pain + hypotension

A

AAA

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2
Q

What are the signs of a ruptured AAA?

A

Sweating, inc HR, absent femoral pulses, mottled skin in lower body, tender pulsative mass, sudden collapse

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3
Q

Abdo signs of ruptured AAA

A

Abdominal bruir

Grey turner’s sign

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4
Q

What is the pathophysiology of AAA?

A

degradation of the elastic lamellae + smooth muscle loss

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5
Q

What is the most common site of AAA?

Where is blood most likely to haemorrhage?

A

Below the renal arteries

Blood into the retroperitoneum

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6
Q

In an unruptured AAA, when would surgery be considered?

A

Aneurysm >5.5cm diameter or expansible of >1cm

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7
Q

How is unruptured AAA monitored?

A

Regular USS (if <4.4cm then every 2 years, if >4.5 then every 3 months) + BP control

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8
Q

ABCDE management of suspected AAA rupture

A
  1. Oxygen
  2. venous access
  3. bloods: including coagulation screen + crossmatch
  4. IV analgesia (morphine)
    IV anti-emetic (cyclizine)
  5. IV fluids
  6. IMMEDIATE BEDSIDE USS
  7. urinary catheter, radial arterial line, ECG
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9
Q

IV fluids in AAA rupture

A

Treat major hypovolaemia until systolic >90 (if passing urine then minimal fluid needed before theatre)

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10
Q

What is the emergency surgical management of AAA?

How can this be done?

A

Stenting!!
Endovascular (through femoral)
Open (expose aorta, clamp + repair)

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11
Q

Describe the classic pattern of appendicitis pain

A

Pain in the epigastric region, worsens in first 24 hours, then migrates to RIF (becomes constant + sharp)

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12
Q

What can make pain in appendicitis worse?

think adults + children

A

Movement (e.g. cough)

Hopping

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13
Q

Abdo exam in appendicitis

A

Tenderness
Guarding at RIF
Rebound tenderness

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14
Q

Where is McBurney’s point?

A

2/3 from umbilicus to ASIS

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15
Q

Presentation of appendicitis

A

Pain!!

Anorexia, N+V, facial flushing, fever, inc HR

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16
Q

What is rovsing’s sign in appendicitis?

A

Palpation of LLQ increases pain over RQ

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17
Q

Signs of perforation in appendicitis

A

Inc HR

Sudden relief of pain

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18
Q

Signs of abscess formation in appendicitis

A

Pyrexia

Palpable abdo mass

19
Q

Signs of peritonitis

A

Vomiting, high fever, severe pain, absent bowel sounds

20
Q

Risk factors for appendicitis

A

Age 10-20
Male
Frequent abx
Smoking

21
Q

Two bedside tests in appendicitis to rule out differentials

A

Pregnancy test

Urinalysis

22
Q

ABCDE for appendicitis

A

IV access
IV opioid + anti-emetic
Pre-op abx: cefuroxime + metronidazole

23
Q

Define the following:
Cholecystitis
Biliary colic
Cholangitis

A

Cholecystitis: gallstone impaction + acute inflammation of the GB

Biliary colic: ‘gallstone attack’, gallstone temporarily blocks the cystic duct

Cholangitis: inflammation of the biliary tract

24
Q

Most common GS problems

A 
Biliary colic (56%)
Cholecystitis (36%)
25
Q

Features of biliary colic

A

Short-lived, recurrent episodes of epigastric/ right hypochondrial pain
RADIATES TO THE BACK

26
Q

Features of cholecystitis

A 
Hypochondrial pain radiating to the RUQ
Vomiting 
Fever
Murphy's sign
Palpable mass?
27
Q

What is murphy’s sign?

A

local peritonism, particularly on inspiration

28
Q

Features of chonalngitis (charcot’s triad)

A

Abdo pain
Jaundice
Fever

29
Q

5 F’s (RFs for gallstones)

A

Female, fair, fat, female + forty

30
Q

Other RFs for gallstones

A

Sudden weight loss
Loss of bile salts (e.g. ileal resection)
OCP
Poor diabetes control

31
Q

RFs specific for cholangitis

A

Pregnancy

Hyperlipidaemia

32
Q

Which imaging is the best way of detecting gallstones?

What may it show?

A

USS

Stones, thickened GB wall, pericholecystic fluid

33
Q

Why isn’t ERCP 1st line?

A

More invasive + v expensive!

34
Q

Management of biliary colic

A

NBM
Analgesia
IV fluids
Elective removal

35
Q

Management of acute cholecystitis

A

NBM
IV analgesia + anti-emetic
IV abx
Laparascopic cholecystectomy

36
Q

What abx are given in acute cholecystitis?

A

IV cefuroxime (1.5g/ 8 hours)

37
Q

Management of cholangitis

A

Abx (cefuroxime + metronidazole)
Prompt treatment - may become septic!!
Definitive: endoscopic biliary decompression
ERCP to clear any obstruction

38
Q

What is diverticulitis?

A

Inflamed + infected diverticula (protrusions of mucosa through muscular wall of the colon)

39
Q

What are uncomplicated and complicated diverticulitis

A

Uncomplicated: localised inflammation, does not extend to peritoneum

Complicated: abscess, peritonitis, fistula, obstruction or perforation

40
Q

Risk factors for diverticulitis

A

Lack of dietary fibre (low stool bulk, slow transit time. high intraluminal pressure)

Smoking, obesity, genetics

41
Q

If diverticulitis is uncomplicated/ mild, how can it be managed?

A

Can be managed in primary care

Co-amoxiclav + metronidazole

Analgesia

42
Q

In emergency diverticulitis, what is the management?

A

Analgesia
IV fluids
Refer to surgeon (NBM)
Broad spec abx (cefuroxime + metronidazole)

43
Q

Emergency diverticulitis: what should you advise re the urge to pass stools

A

Avoid if possible, as may cause another bleed

Emergency & Acute (21 decks)

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