THEME II: ACUTE ABDOMEN
1. What is the definition of “acute abdomen”?
- Clinical presentations that usually requires emergency surgical therapy.
- It refers to signs and symptoms of abdominal pain and tenderness. Sudden onset !! due to Inflamm, Irritation, Ischemia, obstruction of Peritoneum
2. Which are the most common surgical acute abdominal conditions, presented with acute abdomen? X5
- Intra-abdominal hemorrhage → Spontaneous rupture of spleen
- → Ruptured ectopic pregnancy
- → Hemorrhagic pancreatitis
- → Leaking or ruptured arterial aneurysm
- Infection → Appendicitis, Cholecystitis, Mekell’s diverticulitis, Hepatic abscess
- Perforation → Perforated gastrointestinal ulcers, perforated gastrointestinal cancer
- Ileus → adhesive, obstruction, incarcerated hernia, intussusception
- Ischemia → Burger’s disease, strangulated hernias. Ischemic colitis
3. An expeditious workup is necessary to established ‘acute abdomen’, what is the usual order
- Medical history - anamnesis
- Physical examination
- Laboratory tests
- Imaging tests
4. Which is the most common general surgical emergency?
- Acute appendicitis is the most common general surgical emergency.
5. What is the definition of ‘Acute appendicitis’?
- Acute inflammatory process of appendix
6. What are the positions of appendix in relation to caecum?
- Medial
- Retrocecal
- Laterocecal
- Subhepatic
- Tip close to left colon
- Pelvic
- Clinical features of acute appendicitis are modified according to the position of appendix.
Kocher's Sign - starts in epigastrium/periumbilical → Migrates to RLQ (McBurney's Point)
7. How does history of acute appendicitis begin?
- The history begins with central abdominal pain of a visceral pain carried by T8-T10 !! visceral type (ill-localised) usually around umbilicus or epigastrium
8. What are the most sensitive signs of acute appendicitis accompanying with local peritoneal irritation?
- Lower abdominal quadrant pain is the most sensitive signs of acute appendicitis accompanying with local irritation – somatic phase of the pain
- 1. McBurney's Point Tenderness
- 2. Gaurding
- 3. Rebound tenderness
- 4. Rovsing
- 5. obturator
- 6. Psoas
9. Which is the most common abdominal physical findings in acute appendicitis?
- Local tenderness and guarding in the RLQ.
10. Which is the hallmark in the diagnosis “acute appendicitis”?
- RLQ Pain
- Rebound Tender
- Gaurding
- Fever, Nausea, leukocytosis.
- Tenderness over the site of appendix is the hallmark in the diagnosis of acute appendicitis.
11. What is the management of acute appendicitis?
- Appendectomy – Surgical removal of the appendix at McBurney's point: 2/3 distance from umbilicus to ASIS
-NPO, IV crystalloid fluids, Analgesia, IV Abx - Ceftriaxone or carbapenem
12. What does ‘periappendicular infiltrate’ mean?
- Periappendicular infiltrate is a host defense reaction against spreading of inflammation from appendix into peritoneal activity