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30 Cards in this Set
- Front
- Back
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What is a typical history for acute appendicitis?
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Nausea
Vomiting Central abdominal pain shifting to the RIG |
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What is present on examination of acute appendicitis?
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Fever
Tenderness Guarding Palpable mass in RIF Pelvic peritonitis |
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What is a typical history for a perforated peptic ulcer?
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Vomiting
Severe acute abdominal pain Previous dyspepsia NSAIDs or corticosteroid use Ulcer disease |
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What is present on examination for perforated peptic ulcer disease?
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Shallow breathing - minimal abdominal wall movement
Abdominal tenderness and guarding Board-like rigidity Abdominal distension Absent bowel sounds |
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What is a typical history of acute pancreatitis?
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Anorexia
Nausea and vomiting Constant severe epigastric pain Previous alcohol abuse |
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What is present in examination for acute pancreatitis?
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Fever
Periumbilical or loin bruising Epigastric tenderness Variable guarding Reduced/absent bowel sounds |
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What is a typical history for ruptured AAA?
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Sudden onset of severe tearing pain radiating to the back
Hypotension Vascular disease High BP |
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What is found on examination of a ruptured AAA?
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Shock and hypotension
Pulsatile, tender abdominal mass Asymmetrical femoral pulse |
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What is a typical history for acute mesenteric ischaemia?
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Anorexia
Nausea and vomiting Bloody diarrhoea Constant abdominal pain Previous vascular disease Hypertension |
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What is found on examination for acute mesenteric ischaemia?
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AF
Heart failure Asymmetrical peripheral pulses Absent bowel sounds variable tenderness and guarding |
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What is a typical history for intestinal obstruction?
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Colicky central abdominal pain
Nausea and vomiting Constipation |
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What is found on examination for intestinal obstruction?
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Surgical scars
Hernias Mass and obstruction Visible peristalsis Increased bowel sounds |
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What is the typical history of a ruptured ectopic pregnancy?
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Premenopausal
Delayed or missed period Hypotension Unilateral iliac fossa pain Pleuritic shoulder tip pain Prune-juice discharge |
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What is found on examination of a ruptured ectopic pregnancy?
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Suprapubic tenderness
Periumbilical bruising Pain and tenderness on PV Swelling/fullness in fornix on PV |
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What is a typical history for pelvic inflammatory disease?
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Sexually active
Previous STI Recent procedure, pregnancy or coil Irregular menstruation Lower or central abdominal pain Backache Pleuritic pain in right upper quadrant |
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What is found on examination for pelvic inflammatory disease?
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Fever
Vaginal discharge change Pelvic peritonitis Right upper quadrant tenderness Pain on PV Swelling/fullness in fornix on PV |
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What could be wrong if bowel sounds are NOT present?
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strangulation
Ileus Ischaemia |
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What investigations are carried out for acute abdomen?
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FBC - increased WBCs
Serum amylase - high = acute pancreatitis Pregnancy test Xray - CXR - air under diaphragm = perforation, AXR - dilation of bowel = obstruction Ultrasound - AAA, acute cholangitis, cholecystitis Laparoscopy |
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What can occur is appendicitis isnt removed?
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Perforates
Becomes gangrenous Leads to localised abscess or generalised peritonitis |
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How can appendicitis be treated?
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IV fluid and IV antibiotics
Laparoscopic removal |
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What are the symptoms of acute salpingitis?
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Bilateral lower abdominal pain
Fever Vaginal discharge |
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What is the pathophysiology of localised and generalised acute peritonitis?
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Localised - Pain and tenderness with a need to treat underlying cause
Generalised - Irritation of peritoneum from infection r chemical irritation from perforation. Infection and acute inflammation occurs with an exudate which spreads throughout the peritoneum. Intestinal dilation and ileus. |
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What is the clinical presentation of peritonitis following perforation?
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Sudden onset of severe, acute abdominal pain
Generalised collapse and shock Patient can improve temporarily and collapse later |
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What is the clinical presentation of peritonitis following inflammation?
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Less rapid onset of severe acute abdominal pain
Features of underlying disease |
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What investigations are carried out for acute peritonitis?
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Erect CXR - air under diaphragm = perforation
Serum amylase = pancreatitis Ultrasound/CT |
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What are causes of small bowel obstruction?
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Adhesions
Hernias Crohns Intussusception Extrinsic cancer Mechanical |
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What are the causes of large bowel obstruction?
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Colon carcinoma
Sigmoid volvulus Diverticular disease |
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What is the clinical presentation of bowel obstruction?
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Colic pain
Vomiting Constipation No flatus |
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What is present on examination in bowel obstruction?
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Distension
Increased bowel sounds Tenderness |
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How is a volvulus managed?
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Pass a sigmoidascope or rectal tube to un-knit the bowel
If recurrent it will need resection |
