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Acute abdomen (acute cholecystitis (complications (choledocholithiasis,…
Acute abdomen
acute cholecystitis
pathogenesis
obstruction of the cystic duct, usually by gallstone
obstruction leads to distension of the gall bladder. As the gall bladder becomes distended, blood flow and lymphatic drainage are compromised, leading to mucosal ischaemia and necrosis
Subj
RF
incr oestrogens
overweight
pregnancy
increased risk of gallstones + complications
hx of biliary colic
unwell with fever, nausea and vomitting
Obj
toxic and prefers to lie still
RUQ doesn't move w respiration
rebound and tenderness
murphy's sign
diagnosis
leucocytosis
mild derangement LFTs
USS
treatment
Antibiotics
NBM
cholecystectomy
open
lap
complications
choledocholithiasis
empyema or abscess of gall bladder
GB perforation
cholcystoenteric fistula
Mirizzi syndrome
acute pancreatitis
pathogenesis
?
pancreatic injury results in the process of auto-digestion of the pancreas by the pancreatic enzymes and activation of the inflammatory cascade
Gallstones, ethanol, trauma, steroids, mumps/malignancy, autoimmune, scorpions, hyperlipidaemia, ERCP, drugs
subj
severe epigastric pain radiating to back
profuse vomitting
Hx gallstones/ETOH
Diagnosis
sAmylase raised (X5-10)
sLipase Sp not Sn
USS -->gallstones
CT if unclear
Obj
unwell w signs of shock
significant epigastric tenderness
treatment
NG insertion and suction
IDC fluid output monitoring
IVF
o2
careful observation
daily bloods
CRP
electrolytes
ERCP
complications
pancreatic necrosis
pseudocyst
abscess
acute appendicitis
pathogenesis
obstruction of the appendiceal lumen results in distention of the appendix due to accumulated intraluminal fluid
Ineffective lymphatic and venous drainage allows bacterial invasion causing inflammation initially in the submucosa and subsequently full-thickness
Subj
usually young adult
central abdo pain moves to RIF over hours
nausea
difficult to move due to abdo tenderness
Obj
modest fever
tachycardia
rigidity over R side
tender over McBurney's point
Diagnosis
clinical
treatment
apendicetomy
appendix mass
NG aspiration
Abx
IVfluids
late appendicetomy
perforated duodenal ulcer
pathogenesis
subj
sudden catastrophic upper abdominal pain
significantly unwell and signs of shock
smoker/NSAIDs
obj
marked rigidity of abdo w guarding and tenderness
liver dullness
pelvic tenderness may be elicited on DRI
diagnosis
clinical
free air under diaphragm
treatment
NG
IVAbx
fluid resuscitation
urgent surgery
peritoneal toilet
closure of defect with patch of omentum
H.pylori testing
Small bowel obstruction
pathogenesis
obstruction in the small intestine results in proximal dilatation of the intestine and fluid accumulation within the lumen
causes
adhesions
hernias
other causes are uncommon
history
periumbilical small bowel colic
restless pain
vomitting - often faeculent
abdominal distension
obstipation
examination
abdominal distension
resonance to percussion
BS active and high pitched or 'tinkling'
Rebound tenderness and tachycardia --> strangulation
look for cause - abdo scars, hernias, scars, stomas, and abdo masses
diagnosis
erect or lateral decubitus plain xray
clinical
gastrografin swallow
treatment
operative
exploration
non-operative
NG tube
fluid and electrolyte replacement and pain relief
large bowel obstruction
pathogenesis
mechanical LBO bowel dilation above the obstruction
causes
tumours
strictures
volvulus
subj
hypogastric green apple colic
obstipation
N + V
abdo distension
obj
abdo distension
BS active high pitched
diagnosis
AXR
DRI
sigmoidoscopy
CT
treatment