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CONTENT
The Acute abdomen
General Principles
Conditions causing acute abdominal pain
BREAK
Gastritis, splenic
disorders, LUQ
pneumonia
Cholecystitis, biliary
colic, hepatitis, RUQ
pneumonia
Renal colic
Sigmoid
diverticulitis,gynae
Appendicitis,
caecal diverticulitis,
meckels, mesenteric
adenitis, gynae
General principles
Colicky pain: spasms of pain due to peristaltic waves trying to overcome
blockage of hollow viscus e.g. ureter, appendix, bowel, gall bladder
then parietal
Peritonitis: features
T : Tenderness (and tachycardia)
P : Pyrexia
P : Percussion pain (better than rebound)
Acute appendicitis
Anatomy: Vermiform appendix
Acute appendicitis
Epidemiology
Acute appendicitis
CLINICAL PRESENTATION
SYMPTOMS:
- Pain: (general becomes localised acute), dull colicky)
- Systemic upset: Anorexia, malaise, lethargy, vomiting
SIGNS:
- Rebound, guarding, McBurneys point
- Rovsings Sign, Psoas Sign, Obturator sign
Acute Appendicitis
OBTURATOR SIGN
Acute Appendicitis
INVESTIGATIONS
Laparoscopy
MANAGEMENT
SURGICAL (Open/laparoscopic)
LANZ / GRID IRON incision
Pancreatitis
Foregut structure
Acute or chronic
GET SMASHED
Gallstones
Steroids
Ethanol
Mumps
Trauma
Autoimmune
Scorpion bite
Acute Pancreatitis
COMPLICATIONS
CLINICAL PRESENTATION
Acute pancreatitis
Cullens sign
Acute pancreatitis
Investigations
Acute Pancreatitis
MANAGEMENT
-
Essentially supportive: analgesia, rest pancreas, remove cause and allow it to recover
P - pO2 <8kPa
A - Age > 55
--
Chronic pancreatitis
Diabetes
Steatorrhea
INVESTIGATIONS:
MANAGEMENT:
Contracts by CCK
Bile emulsifies fat
Blood supply to gall bladder
= cystic artery
Gallstones
Types: cholesterol (70%), pigment (30% cholesterol mainly bilirubin and calcium salts),
mixed
BILIARY COLIC
Abdo pain: General epigastric pain localises to RUQ, can
radiate to shoulder tip, exacerbated by fatty foods
ACUTE CHOLECYSTITIS
Blockage with superimposed infection
CLINICAL
Cholecystectomy
Laparoscopic or open (Kochers incision)
Acute (<72hrs) = hot or interval (>6 wks)
Complications of procedure: bile leak, bile duct injury, bleed
(liver bed/cystic artery), abscess
Cholecystectomy
Identify calots triangle
Diverticulitis
DEFINITIONS
Complications of diverticular
disease
Obstruction
Perforation / peritonitis
Bleeding
Diverticulitis
Diverticular abscess
Fistula (e.g. pneumaturia)
Strictures
Diverticulitis
SIGNS AND SYMPTOMS:
INVESTIGATIONS:
Diverticulitis
MANAGEMENT
Bowel Obstruction
Small v large bowel
Ulcerative colitis
1. typically Colon only (can affect
terminal ileum)
2. Continuous inflammation
3. Transmural inflammation
3. Shallow, mucosal
4. Perianal rare
LOCAL
- Crohns: adhesions, strictures, SBO, fistulae, abscesses
3 phases
1. Hyperactive: abdo pain and PR bleed (reversible)
2. Paralytic: increased pain, decreased motility causing ileus
3. Shock: fluid loss through damaged colon (metabolic acidosis)
Ischaemic bowel
MANAGEMENT
Renal colic
Types: calcium oxalate (75%) and uric acid (5-10%)
HERNIAS
GROIN LUMPS
SCROTAL LUMPS
NECK LUMPS
STOMAS
Definition: Greek for mouth
COMPLICATIONS OF
STOMAS
Differences between
colostomy and ileostomy
Ileostomy
Colostomy
1. Small calibre
1. Large calibre
2. Spouted
3. Semi-solid/faecal contents
4. Continuous output
4. Intermittent output
5. Site- RIF
5. Site- LIF
HERNIAS
Definition: protrusion of viscus and coverings through defect
in abdo wall from containing compartment to another
HERNIAS
AETIOLOGY: congenital and acquired
Symptoms and signs: pain, lump on coughing, complications (severe pain, fever,
nausea and vomiting)
INGUINAL HERNIAS
75% of abdominal hernias
Inguinal hernias
Direct
Indirect
2. Caused by PPV
deep ring
Scrotal Lumps
1. Inguinoscrotal hernia
2. Testicular tumour
3. Hydrocele
4. Varicocele
5. Epididymal cyst
Key Qs:
Neck Lumps
Neck Lumps
Midline
Lateral
1. Sebaceous cysts
1. Sebaceous cysts
2. Lipomas
2. Lipomas
3. Lymph nodes
3. Lymph nodes
4. Goitre
4. Multinodular goitre
cyst
6. Pharyngeal pouch
7. Nerve: neurofibroma
Case 1
What is the diagnosis?
Case 2
How would you manage this?
Case 3
What are the causes of this?
Case 4
What is the main x-ray
finding?
What does it indicate?
How do you manage it?
Case 5
What is the main CT finding?
Case 6
What is the diagnosis?
How would you manage it?
What is a life-threatening
complication of this?
- Surgical sieve
- Present the x ray not just the finding!
Dont memorise, learn basic principles so can work things out
Jaundice
Interpretation
ABG, fluid balance chart, ECG
SHOCK
DEFINITION
TYPES
Hypovolaemic
Cardiogenic
SHOCK
Physiological terms explained:
SHOCK
Classification of hypovolaemic shock