Test by Abdominal surgery. Autumn semester.

In the differential diagnosis of appendicitis in an infant it is important to consider

• ileo-ilial intussception.
• Basal pneumonia.
• Henoch-Schoenlein purpura.
• Torsion of ovarian cyst.
• Testicular torsion.
• All coirect.
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Recognised causes of acute pancreatitis include
• Mumps and Coxsackie B viral infections.
• Hypothermia and hyperlipidemia.
• Gallstones in the common bile duct.
• Azathioprine therapy.
• Alcohol abuse.
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Acute pancreatitis is typically characterized by
• Abdominal guarding, developing soon after the onset of pain.
• Normal serum amylase concentration in the first 4 hours after unset.
• Persistent serum hyperamylaseamia suggests a developing pseudocyst.
• Hypercalcaemia develops 5-7 days after onset of the disease.
• Hyperactive loud bowel sounds.
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Acute appendicitis
• Is cimiinoner in females.
• Presents with pain around the umbilicus.
• Is commonest under the age of 15 years.
• Is usually accompanied by microscopic haematuria.
• Is commonly associated with a mild pyrexia.
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Vomiting in the morning is a typical feature of
• Pyloric obstruction.
• Alcohol abuse.
• Raised intracranial pressure.
• Gallstones.
• Pregnancy.
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Typical features of acute pancreatitis include
• Colicky pain recurring every 2 5 minutes.
• Pain lessened by sitting forwards.
• Hyperactive loud bowel sounds.
• Nausea and vomiting.
• Back pain radiating to the groins.
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In a patient with severe acute abdominal pain
• Analgesics should be with held pending cofirmation of the diagnosis.
• Visible peristalsis suggests intestinal obstruction.
• Peritonitis is characterized by hyperactive loud bowel sounds.
• Lower lobe pneumonia should be considered among possible diagnosis.
• Perforation is likely if vomiting and restlessness are marked.
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The treatment of acute pancreatitis
• Is largely nonspecific and supportive.
• Should include a laparotomy in the majority of cases.
• Should routinely include the administration of calcium.
• Should routinely include the administration of antibiotics.
• Is more effective when peritoneal lavage is performed.
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Investigation of a case of acute appendicitis
• Will usually reveal a polymorphonuclear leucocytosis.
• Often shows microscopic haematuria.
• Usually reveals haemoconcentration.
• Often reveals fluid levels in the right iliac fossa on an direct radiograph of the abdomen.
• Often do not prevent thoracic injuries.
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Typical features of biliary colic include
• Pain radiating to the right shoulder tip or scapula.
• Colicky pain recurring every 2-5 minutes.
• Nausea and vomiting.
• Restlessness and sweating.
• Pain relieved by bland food.
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Biliary colic typically
• Occurs 3 to 4 hours after meals.
• Lasts 5 to 20 minutes.
• Radiates from the upper abdomen to the right subscapular region.
• Is made worse by deep inspiration.
• Is followed by jaundice.
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In the management of acute pancreatitis
• Early laparotomy is advisable to exclude diagnosis.
• Opiates should be avoided because of the sphincter of Oddi.
• Intravenous fluids are unnecessary in the absence of a tachycardia.
• The PaO2 and central venous pressure should be monitored.
• Nasogastric aspiration is required since an ileus is inevitable.
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 Acute appendicitis
• Typically is associated with right iliac fossa pain.
• Is often associated with luminal obstruction of the appendix.
• Produces urinary symptoms simulating acute pyelonephritis.
• Typically produces constipation and persistent vomiting.
• Is usually associated with a temperature 39 degrees C.
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Appendectomy should be performed
• After laparotomy reveals a diagnosis ol mesenteric adenitis.
• Immediately in adult patients with an appendix abscess.
• In patients with a gangrenous appendix.
• In patients with chronic appendicitis.
• If it inflammation is the result of neighbouring Crohn's disease.
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Appendicitis
• Is more common in females.
• Is distributed evenly throughout the world population.
• Is more likely to occur it the appendix is in the retrocaecal position
• Is commonly the result of appendicular obstruction.
• is frequently recurrent.
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Acute cholecystitis should be typically treated by
• Nasogastric suction and intravenous fluids.
• Antibiotic therapy.
• Low fat diet.
• Urgent cholecystectomy.
• Cholecystostomy.
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Typical features of acute pancreatitis include
• Peripheral circulatory failure.
• Persistent diarrhea.
• Pain radiating to the back.
• Pain relieved by vomiting.
• Obstructive jaundice.
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The following statements about intra-abdominal abscess are
• Pelvic abscess typically presents with urinary retention.
• Constipation is a typically early feature of pelvic abscess.
• Lower posterior chest tenderness suggests subphrenic abscess.
• Abscesses are best localised by abdominal ultrasonography.
• Antibiotic therapy alone should resolve a subphrenic abscess.
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 Patients with early appendicitis
• Usually present with central abdominal pain.
• Rarely present with anorexia.
• Have usually vomited on one or two occasions.
• Usually complain of similar attacks of pain in the previous few weeks.
• Usually have no premonitory signs or symptoms.
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Acute pancreatitis
• Presents with diffuse epigastric pain.
• Produces exaggerated bowel sounds.
• May be diagnosed by an elevated urinary diastase.
• May be complicated by hypoxia.
• May be complicated by renal failure.
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Acute appendicitis
• Is most common in t he 30 to 10 year age group.
• Characteristically presents with a high temperature.
• Is often associated wit h painful extension of the right hip.
• May produce haematuria and pyuria.
• Can be excluded if the patient has diarrhoea.
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The physical signs of early appendicitis
• Are generally of more diagnostic value than the patient's history.
• Usually include muscle guarding in the right iliac fossa.
• Usually include a pyrexia above 38,5 C.
• Include rectal tenderness.
• Usually include a palpable mass in the right iliac fossa.
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Likely differential diagnosis in a young woman with appendicitis include
• Ovulatory pain.
• Ruptured ectopic pregnancy
• Colonic diverticulitis.
• Caecal carcinoma.
• Torted ovarian cyst.
• All correct.
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Obstruction of the lumen of the appendix may lead to
• Mucosal ulceration.
• Gangrenous appendicit is
• A perforated appendix.
• Intissusception of the appendix.
• Athrophy in the appendix.
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 A ruptured ectopic pregnancy
• Usually occurs in the first month of pregnancy.
• Usually presents with severe lower abdominal pain.
• Frequently presents with hypovolaemic shock.
• Can usually be diagnosed by pelvic examination.
• May demonstrate a lower abdominal mass.
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Acute cholecystitis
• Is almost invariably related to the presence of gallstones.
• Usually presents with biliary colic.
• Is often associated with jaundice.
• Is characterised by pyrexia in the early hours of the disease.
• Usually requires urgent surgery.
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Acute pancreatitis frequently
• Is accompanied by hypercalcaemia.
• Produces paralytic ileus.
• Is associated with a pleural effusion.
• Produces pyloric stenosis.
• Produces hypoxaemia.
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Acute pancreatitis
• Is commonly associated with the presence of gallstones.
• Has a high incidence in alcoholics.
• Occurs most commonly in diabetics.
• May have a viral origin.
• Pain relieved by vomiting.
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