Theme 7:
Potential life-
threatening
conditions
Summary
1
,Inhoud
Week 5: Acute abdominal pain ............................................................................................................... 9
Introduction......................................................................................................................................... 9
Sepsis ................................................................................................................................................. 11
Meet the expert ................................................................................................................................ 14
Anatomy: Abdominal viscera ............................................................................................................ 16
Abdominal wall .............................................................................................................................. 17
Peritoneal cavity ............................................................................................................................ 19
Small intestine ............................................................................................................................... 22
Large intestine ............................................................................................................................... 25
Liver ............................................................................................................................................... 26
Gallbladder .................................................................................................................................... 28
Pancreas ........................................................................................................................................ 29
Spleen ............................................................................................................................................ 31
Arterial supply to the abdominal viscera ...................................................................................... 32
Venous drainage ............................................................................................................................ 35
Anatomy: Embryology ....................................................................................................................... 38
The acute abdomen and acute GI haemorrhage .............................................................................. 41
Intestinal obstruction .................................................................................................................... 41
Bowel strangulation ...................................................................................................................... 43
Peritonitis ...................................................................................................................................... 43
Intraabdominal abscess ................................................................................................................. 44
Perforation of an abdominal viscus ............................................................................................... 45
Acute bowel ischaemia.................................................................................................................. 46
Major gastrointestinal haemorrhage ............................................................................................ 46
Gallstone diseases and related disorders.......................................................................................... 50
Structure and function of the biliary system................................................................................. 50
Pathophysiology of the biliary system .......................................................................................... 50
Investigation of gall bladder pathology ......................................................................................... 51
Clinical presentations of gallstone disease ................................................................................... 52
Management of gallstone disease ................................................................................................ 54
Peptic ulceration and related disorders ............................................................................................ 57
Pathophysiology of peptic disorders ............................................................................................. 57
Epidemiology and aetiology of peptic ulcer disease ..................................................................... 57
Investigation and clinical features of peptic disorders ................................................................. 59
Presenting features of peptic ulcer disease .................................................................................. 59
2
, Pancreatitis ........................................................................................................................................ 65
Acute pancreatitis ......................................................................................................................... 65
Recurrent and chronic pancreatitis ............................................................................................... 69
Appendicitis ....................................................................................................................................... 70
Anatomy of the appendix .............................................................................................................. 70
Pathophysiology of appendicitis ................................................................................................... 70
Making the diagnosis of appendicitis ............................................................................................ 72
Appendicectomy............................................................................................................................ 75
Chronic inflammatory disorders of the bowel .................................................................................. 78
Week 6: Acute abdominal pain Pt.2 ...................................................................................................... 80
Introduction....................................................................................................................................... 80
Meet the expert ................................................................................................................................ 82
Small bowel obstruction ................................................................................................................ 82
Colorectal obstruction ................................................................................................................... 83
Diagnostics..................................................................................................................................... 84
Main operative causes .................................................................................................................. 85
Disorders of the large bowel motility, structure and perfusion........................................................ 87
Modern diet and disease ............................................................................................................... 87
Irritable bowel syndrome .............................................................................................................. 88
Constipation .................................................................................................................................. 89
Sigmoid volvulus ............................................................................................................................ 91
Diverticular disease ....................................................................................................................... 91
Colonic angiodysplasias ................................................................................................................. 94
Ischaemic colitis............................................................................................................................. 94
Hernias and other groin problems .................................................................................................... 96
Lumps in the groin ......................................................................................................................... 96
Inguinal hernia ............................................................................................................................... 99
Femoral hernia ............................................................................................................................ 102
Abdominal emergencies in children ................................................................................................ 104
Abdominal emergencies in infants and young children .............................................................. 104
Abdominal emergencies in older children .................................................................................. 106
Physiology of pain............................................................................................................................ 108
Referred pain ............................................................................................................................... 108
Visceral pain ................................................................................................................................ 108
Gynaecology .................................................................................................................................... 110
Pelvic inflammatory disease ........................................................................................................ 110
3
, Ectopic pregnancy ....................................................................................................................... 111
Ovarian torsion ............................................................................................................................ 113
Evaluation of acute pelvic pain in women ...................................................................................... 114
Differential diagnosis................................................................................................................... 114
Diagnostics................................................................................................................................... 115
Week 7: Acute coma ........................................................................................................................... 118
Introduction..................................................................................................................................... 118
Examination of the comatose patient ............................................................................................. 121
Altered consciousness ..................................................................................................................... 123
Impaired consciousness .............................................................................................................. 123
Treating comatose patients......................................................................................................... 124
Herniation syndromes ................................................................................................................. 124
Metabolic coma ........................................................................................................................... 126
Non-convulsive status epilepticus ............................................................................................... 127
Altered but not lowered consciousness ...................................................................................... 127
Vegetative state........................................................................................................................... 127
Brain death .................................................................................................................................. 128
Head and brain injuries ................................................................................................................... 129
Initial assessment and care for head traumas ............................................................................ 129
Severity of brain injuries.............................................................................................................. 129
Initial assessment and treatment ................................................................................................ 131
Skull fractures .............................................................................................................................. 132
Post-traumatic intracranial complications .................................................................................. 133
The prognosis after head injury .................................................................................................. 136
Water balance, fluids and electrolytes ............................................................................................ 138
Assessing acid-base disturbance ................................................................................................. 138
Disorders of sodium concentration ............................................................................................. 138
Disorders of magnesium concentration ...................................................................................... 141
Acid base disorders ..................................................................................................................... 142
Myxoedema coma ........................................................................................................................... 150
Diabetes mellitus ............................................................................................................................. 151
Diabetic emergencies .................................................................................................................. 151
Management of hypoglycaemia .................................................................................................. 153
Psychiatry ........................................................................................................................................ 154
Somatoform disorders................................................................................................................. 154
Suicide and self harm .................................................................................................................. 155
4
Potential life-
threatening
conditions
Summary
1
,Inhoud
Week 5: Acute abdominal pain ............................................................................................................... 9
Introduction......................................................................................................................................... 9
Sepsis ................................................................................................................................................. 11
Meet the expert ................................................................................................................................ 14
Anatomy: Abdominal viscera ............................................................................................................ 16
Abdominal wall .............................................................................................................................. 17
Peritoneal cavity ............................................................................................................................ 19
Small intestine ............................................................................................................................... 22
Large intestine ............................................................................................................................... 25
Liver ............................................................................................................................................... 26
Gallbladder .................................................................................................................................... 28
Pancreas ........................................................................................................................................ 29
Spleen ............................................................................................................................................ 31
Arterial supply to the abdominal viscera ...................................................................................... 32
Venous drainage ............................................................................................................................ 35
Anatomy: Embryology ....................................................................................................................... 38
The acute abdomen and acute GI haemorrhage .............................................................................. 41
Intestinal obstruction .................................................................................................................... 41
Bowel strangulation ...................................................................................................................... 43
Peritonitis ...................................................................................................................................... 43
Intraabdominal abscess ................................................................................................................. 44
Perforation of an abdominal viscus ............................................................................................... 45
Acute bowel ischaemia.................................................................................................................. 46
Major gastrointestinal haemorrhage ............................................................................................ 46
Gallstone diseases and related disorders.......................................................................................... 50
Structure and function of the biliary system................................................................................. 50
Pathophysiology of the biliary system .......................................................................................... 50
Investigation of gall bladder pathology ......................................................................................... 51
Clinical presentations of gallstone disease ................................................................................... 52
Management of gallstone disease ................................................................................................ 54
Peptic ulceration and related disorders ............................................................................................ 57
Pathophysiology of peptic disorders ............................................................................................. 57
Epidemiology and aetiology of peptic ulcer disease ..................................................................... 57
Investigation and clinical features of peptic disorders ................................................................. 59
Presenting features of peptic ulcer disease .................................................................................. 59
2
, Pancreatitis ........................................................................................................................................ 65
Acute pancreatitis ......................................................................................................................... 65
Recurrent and chronic pancreatitis ............................................................................................... 69
Appendicitis ....................................................................................................................................... 70
Anatomy of the appendix .............................................................................................................. 70
Pathophysiology of appendicitis ................................................................................................... 70
Making the diagnosis of appendicitis ............................................................................................ 72
Appendicectomy............................................................................................................................ 75
Chronic inflammatory disorders of the bowel .................................................................................. 78
Week 6: Acute abdominal pain Pt.2 ...................................................................................................... 80
Introduction....................................................................................................................................... 80
Meet the expert ................................................................................................................................ 82
Small bowel obstruction ................................................................................................................ 82
Colorectal obstruction ................................................................................................................... 83
Diagnostics..................................................................................................................................... 84
Main operative causes .................................................................................................................. 85
Disorders of the large bowel motility, structure and perfusion........................................................ 87
Modern diet and disease ............................................................................................................... 87
Irritable bowel syndrome .............................................................................................................. 88
Constipation .................................................................................................................................. 89
Sigmoid volvulus ............................................................................................................................ 91
Diverticular disease ....................................................................................................................... 91
Colonic angiodysplasias ................................................................................................................. 94
Ischaemic colitis............................................................................................................................. 94
Hernias and other groin problems .................................................................................................... 96
Lumps in the groin ......................................................................................................................... 96
Inguinal hernia ............................................................................................................................... 99
Femoral hernia ............................................................................................................................ 102
Abdominal emergencies in children ................................................................................................ 104
Abdominal emergencies in infants and young children .............................................................. 104
Abdominal emergencies in older children .................................................................................. 106
Physiology of pain............................................................................................................................ 108
Referred pain ............................................................................................................................... 108
Visceral pain ................................................................................................................................ 108
Gynaecology .................................................................................................................................... 110
Pelvic inflammatory disease ........................................................................................................ 110
3
, Ectopic pregnancy ....................................................................................................................... 111
Ovarian torsion ............................................................................................................................ 113
Evaluation of acute pelvic pain in women ...................................................................................... 114
Differential diagnosis................................................................................................................... 114
Diagnostics................................................................................................................................... 115
Week 7: Acute coma ........................................................................................................................... 118
Introduction..................................................................................................................................... 118
Examination of the comatose patient ............................................................................................. 121
Altered consciousness ..................................................................................................................... 123
Impaired consciousness .............................................................................................................. 123
Treating comatose patients......................................................................................................... 124
Herniation syndromes ................................................................................................................. 124
Metabolic coma ........................................................................................................................... 126
Non-convulsive status epilepticus ............................................................................................... 127
Altered but not lowered consciousness ...................................................................................... 127
Vegetative state........................................................................................................................... 127
Brain death .................................................................................................................................. 128
Head and brain injuries ................................................................................................................... 129
Initial assessment and care for head traumas ............................................................................ 129
Severity of brain injuries.............................................................................................................. 129
Initial assessment and treatment ................................................................................................ 131
Skull fractures .............................................................................................................................. 132
Post-traumatic intracranial complications .................................................................................. 133
The prognosis after head injury .................................................................................................. 136
Water balance, fluids and electrolytes ............................................................................................ 138
Assessing acid-base disturbance ................................................................................................. 138
Disorders of sodium concentration ............................................................................................. 138
Disorders of magnesium concentration ...................................................................................... 141
Acid base disorders ..................................................................................................................... 142
Myxoedema coma ........................................................................................................................... 150
Diabetes mellitus ............................................................................................................................. 151
Diabetic emergencies .................................................................................................................. 151
Management of hypoglycaemia .................................................................................................. 153
Psychiatry ........................................................................................................................................ 154
Somatoform disorders................................................................................................................. 154
Suicide and self harm .................................................................................................................. 155
4
