Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

core presentations > 1. abdominal pain > Flashcards

1. abdominal pain Flashcards

1
Q

adhesions - history

A

Hx of abdominal or pelvic surgery
intermittent, cramp like abdominal pain
nausea and/or vomiting
constipation
absence of flatus
history of intra-abdominal malignancy (ovarian or colon cancer)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

adhesions - examination

A

high pitched bowel sounds with rushes or absent bowel sounds
distended abdomen
tenderness on palpation
involuntary guarding
pyrexia
tachycardia
tympany on percussion
presence of abdominal scars

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

adhesions - Ix

A

CT abdo pelvis with oral and IV contrast - may see dilated loops of proximal bowel with collapsed loops posterior to site of obstruction
abdo x-ray - dilated loops of bowel
Chest X-ray - may see free air under the diaphragm
ABG - normal or metabolic acidosis; elevated lactate
FBC - elevated WBC, may be normal in early obstruction
CRP - may be elevated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

incarcerated hernia - Hx

A

Hx of hernia, intermittent, cramp like abdominal pain, painful bulge, nausea, vomiting, decreased of absent bowel function, absence of flatus, distended abdo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

incarcerated hernia - O/E

A

high pitched bowel sounds with rushes or absent bowel sounds
distended abdomen
tenderness to abdo palpation
tender bulge in abdominal wall our inguinal/femoral region, involuntary guarding, indirect hernia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

incarcerated hernia - Ix

A

ABG - may be normal or metabolic acidosis, elevated lactate
FBC - may be normal in early obstruction, elevated WBC count as bowel infarction develops
CRP - may be elevated
CT abdo pelvis - dilated loops of proximal bowel with collapsed loops posterior to the site of obstruction
US groin - free fluid in hernia sac, bowel wall sickened, fluid within a herniated bowel loop, dilated intra-abdominal bowel loops

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

cholecystitis - Hx

A

RUQ pain intense lasting more than 30 minutes
HX of cholelithiasis and biliary colic
exacerbated by eating fatty foods
referred right shoulder pain
fever, nausea and/or vomiting
more common in women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

risk factors for cholecystitis

A

women
obesity
age over 50
pregnancy
use of oestrogen
history of liver disease
cirrhosis
pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

cholecystitis O/E

A

fever, tachycardia, rue tenderness
Murphy’s sign - arrest of inhalation during palpation
palpable gallbladder
local guarding
jaundice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

cholecystitis Ix

A

FBC - elevated WBC count
LFTs - may see elevated alkaline phosphatase, bilirubin and aminotransferase
CRP > 30 mg/L
RUQ US: gallstones, thickened gallbladder wall (>4mm), pericholecystic fluid
cholescintigraphy - no contrast filling in gallbladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

cholescintigraphy is cholecystitis

A

no contrast filling gallbladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

perforated gastric ulcer Hx

A

recurrent upper abdominal pain - dyspepsia
nausea, vomiting, anorexia
pain exacerbated by food
weight loss
use of NSAIDs
sudden onset severe upper abdo pain with fever, nausea, vomiting, peritoneal signs
referred pain to shoulder secondary to diaphragmatic irritation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

perforated gastric ulcer O/E

A

fever, peritoneal signs with guarding and rebound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

perforated gastric ulcer Ix

A

ABG - may be normal or metabolic acidosis
blood cultures - may detect bacteraemia
FBC - microcytic anaemia, elevated WBC count
serum electrolytes - may show elevated creatinine and urea
CRP - usually elevated
normal serum lipase or amylase
CT abdo pelvis - pneumoperitonism
abdo x-ray - abdominal free air on erect abdominal film
chest x-ray - may see free air under the diaphragm
helicobacter pylori - may be positive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

perforated gastric ulcer special tests

A

Upper GI series with water soluble contrast - extraversion of contrast from stomach
oesophagogastroduodenoscopy with biopsy - may show helicobacter pylori or malignancy on histology
fasting serum gastrin level - hypergastrinaemia in zolliger-ellison syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

appendicitis Hx

A

sudden onset
constant, severe abdo pain often periumbilical with migration to right lower quadrant, usually worse on movement
nausea, vomiting, anorexia, fever, diarrhoea, more common in children than young adults, pain may improve after appendix rupture.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

appendicitis O/E

A

fever, tachycardia, patient may be lying in right lateral decubitus position with hips flexed; no or decreased bowel sounds; pain commonly originates near the umbilicus or the epigastrium; right lower quadrant (McBurney’s point) tenderness with rigid abdomen; guarding and rebound tenderness; Rovsing’s sign (palpation of left lower quadrant elicits pain in the right lower quadrant), psoas sign (right lower quadrant pain with right thigh extension), pain reproduced by coughing or hopping

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

appendicits Ix

A

FBC - elevated WBC count
CRP elevated
CT scan of abdomen and pelvis wth intravenous contrast - abnormal appendix (diameter >6mm) identified or calcified appendicolith seen in association with peri-appendiceal inflammation
RLQ US: non-compressible appendix of >7mm in anteroposterior diameter appendicolith, interruption of continuity of the echogenic submucosa, peri appendices fluid or mass
MRI abdo - findings may include diffuse or segmental enlargement of the pancreas with irregular contour and obliteration of the peri pancreatic fat, necrosis or pseudocysts.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

ectopic pregnancy Hx

A

vaginal bleeding with severe, usually unilateral pelvic pain, amenorrhoea or painless vaginal bleeding, history of recent early pregnancy or missed last menstrual period

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

ectopic pregnancy risk factors

A

history of ectopic
tubal surgery
PID
infertility treatment and pregnancy with an IUD in situ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

ectopic pregnancy O/E

A

may have palpable adrenal mass with or without tenderness, rigid abdomen, guarding and rebound tenderness with ruptured ectopic leading to haemorperitoneum, tachycardia, and hypotension, vaginal bleeding on speculum examination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

ectopic pregnancy Ix

A

hCG - positive
FBC - possible anaemia
pelvic ultrasound - no intrauterine pregnancy detected, ectopic pregnancy visualised
diagnostic laparoscopy - ectopic pregnancy or complex mass seen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

PID Hx

A

sexually active, unprotected sexual intercourse
prior infection with chlamydia of gonorrhoea; history of PID; use of intrauterine device, lower abdominal or pelvic pain of recent onset or relatively short duration that may have begun after intercourse, abnormal vaginal discharge , fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

PID O/E

A

abdominal tenderness, abnormal vaginl discharge, cervical motion tenderness and adnexal tenderness will be present, bimanual examination may reveal a tube-ovarian abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

PID O/E

A

FBC - elevated WBC count
erythrocyte sedimentation rate/CRP - elevated
wet mount of vaginal secretions - polymorphonuclear cells present
nucleic acid amplification test or culture of vaginal secretions - may confirm infection with chlamydia trichromatic or neisseria gonorrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

PID US

A

tubal wall thickness >5mm, incomplete septa within the tube, fluid in the cup-de-sac, and a cog-wheel appearance on the cross section of the tubal vein, may see complex adnexal mass, which could be indicative off a tubo-ovarian abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

acute pancreatitis

A

acute-onset, constant, severe mid-abdominal/epigastric pain that often radiates to the back; nausea, vomiting; anorexia; history of biliary colic, alcohol misuse, use of specific medicines (e.g., sulphonamides, tetracycline, oestrogens, corticosteroids), trauma, or surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

acute pancreatitis O/E

A

varying degrees of abdominal tenderness, usually worse in the epigastric region; guarding, abdominal distension, and reduced or absent bowel sounds; ecchymoses in the skin of one or both flanks (Grey-Turner’s sign) and/or the periumbilical area (Cullen’s sign)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

acute pancreatitis Ix

A

serum lipase of amylase - elevated (3x the upper limit)
FBC - elevated WBC
LFTs - normal or elevated ALT
urea and creatinine - normal or elevated
serum glucose - normal or elevated
serum calcium - may be elevated
serum triglycerides - may be elevated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

acute pancreatitis imaging

A

abdo US - ascites, gallstones, dilated common bile duct, enlarged pancreas
CT abdo with oral and IV contrast - may show pancreatic inflammation, peri-pancreatic stranding, calcifications, fluid collections, confirms or excludes gallstones.
magnetic resonance cholangiopancreatography - findings may include stones, diffuse or segmental enlargement of the pancreas with irregular contour and obliteration od the peri pancreatic fat, necrosis or pseudocysts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

acute diverticulitis Hx

A

perisistant LLQ pain, fever, anorexia, nausea, vomtiing, abdominal distension (with ileum), patient may have a history of diverticulosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

acute diverticulitis O/E

A

fever, LLQ tenderness, frank blood in stool, diffuse tenderness with peritoneal signs (guarding, rebound tenderness, rigid abdomen) with perforation or ruptures abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

acute diverticulitis Ix

A

elevated WBC count

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

acute diverticulitis imaging

A

water soluble contract enema - may see diverticula along with extraversion of contrast material into an abscess cavity or into the peritoneum
abdo US - may see fluid collections around the colon or a thickened hypoechoic bowell wall
endoscopy - may ee inflamed diverticulum, abscess or perforation
laparoscopy in diverticulitis allows direct visualisation of bowel if diagnosis is unclear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

ulcerative colitis Hx

A

bloody much diarrhoea and/or frank blood, fever, abdominal pain, weight los, growth retardation, back and joint pain and stiffness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

UC O/E

A

abdominal tenderness; fevers; skin rash; episcleritis; pallor; guaiac-positive stools or frank blood on rectal examination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

UC labs

A

FBC:
variable degree of anaemia, leukocytosis, or thrombocytosis
comprehensive metabolic panel (including LFTs):
hypokalaemic metabolic acidosis; elevated sodium and urea; elevated alkaline phosphatase, bilirubin, aspartate aminotransferase, and alanine aminotransferase; hypoalbuminaemia
CRP and erythrocyte sedimentation rate:
elevated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

UC stool studies

A

negative culture, Clostridium difficile toxins A and B negative; WBCs present; elevated faecal calprotectin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

UC abdo X ray

A

dilated loops with air-fluid level secondary to ileus; free air is consistent with perforation; in toxic megacolon, the transverse colon is dilated to ≥6 cm in diameter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

UC colonoscopy/sigmoidoscopy

A

rectal involvement, continuous uniform involvement, loss of vascular marking, diffuse erythema, mucosal granularity, fistulas (rarely seen), normal terminal ileum (or mild ‘backwash’ ileitis in pancolitis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

UC biopsy

A

continuous distal disease, mucin depletion, basal plasmacytosis, diffuse mucosal atrophy, absence of granulomata, and anal sparing; only mucosal/submucosal involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

UC in double contrast barium enema

A

results range from a fine granular appearance of the bowel wall to diffuse ulceration, thumbprinting (due to mucosal oedema), and narrowing and shortening of the bowel, depending on the severity of the disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

UC CT abdo pelvis with oral and IV contrast

A

may show thickening, inflammation, abscess, fistulisation, obstruction of the bowel; biliary dilation suggests primary sclerosing cholangitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

churns disease Hx

A

family history of Crohn’s disease; typical age range 15-40 or 60-80 years; fevers, abdominal pain, prolonged intermittent bloody or non-bloody diarrhoea; fatigue; anal discharge and abscess; weight loss; faltering growth in children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

churns disease O/E

A

abdominal tenderness often periumbilical or right lower quadrant if terminal ileum inflamed, mimicking appendicitis; peri-anal disease with fissures, skin tags fistulae, sinuses, and abscesses; aphthous ulcers; blood on rectal examination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

churns disease labs

A

FBC:
anaemia; leukocytosis; may be thrombocytosis
comprehensive metabolic panel:
hypoalbuminaemia, hypocholesterolaemia, hypocalcaemia
CRP and erythrocyte sedimentation rate:
elevated
iron studies:
normal, or may demonstrate changes consistent with iron deficiency
serum vitamin B12:
may be normal or low
serum folate:
may be normal or low

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

churns disease stool studies

A

absence of infectious elements seen on microscopy or culture; faecal calprotectin may be elevated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

churns disease imaging

A

abdo x ray:
small bowel or colonic dilation; calcification; sacroiliitis; intra-abdominal abscesses
CT abdomen:
skip lesions, bowel wall thickening, surrounding inflammation, abscess, fistulae
MRI abdomen/pelvis:
skip lesions, bowel wall thickening, surrounding inflammation, abscess, fistulae
abdominal and pelvic ultrasonography:
bowel wall thickening, surrounding inflammation, abscess; tubo-ovarian abscess
colonoscopy:
aphthous ulcers, hyperaemia, oedema, cobblestoning, skip lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

churns disease tissue biopsy

A

tissue biopsy:
mucosal bowel biopsies demonstrate transmural involvement with non-caseating granulomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

cholelithiasis Hx

A

right upper quadrant or epigastric pain (lasting more than 30 minutes) sometimes associated with food

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

cholelithiasis O/E

A

right upper quadrant or epigastric tenderness; jaundice

52
Q

cholelithiasis labs

A

LFTs:
may be normal or elevated alkaline phosphatase and elevated bilirubin
serum lipase and amylase:
elevated (>3 times upper limit of normal) in acute pancreatitis

53
Q

cholelithiasis imaging

A

abdominal ultrasound:
demonstrates stones in the gallbladder
endoscopic ultrasound (EUS):
stones in gallbladder or bile duct

54
Q

GI malignancy Hx

A

nausea, vomiting, abdominal pain and distension (especially with distal obstruction); little or no flatus or bowel function; weight loss; black stools

55
Q

GI malignancy O/E

A

may have palpable mass, pallor, or cachexia; if obstruction present, distended abdomen, high-pitched (hyperactive) bowel sounds with rushes, or absent bowel sounds; tenderness to abdominal palpation, involuntary guarding; tachycardia

56
Q

GI malignancy labs

A

FBC:
variable level of anaemia
renal function:
normal, except if advanced pelvic disease is compressing ureters
LFTs:
normal, except if liver metastases present
faecal occult blood testing:
positive

57
Q

GI malignancy imaging

A

CXR:
normal or evidence of metastatic disease
oesophagogastroduodenoscopy with biopsy:
may show upper gastrointestinal ulcer, mass, or mucosal changes and provide histological confirmation
colonoscopy with biopsy:
ulcerating exophytic mucosal lesion that may narrow the bowel lumen; histological confirmation
CT thorax/abdomen/pelvis with oral and intravenous contrast:
hypodense lesions around tumour site or at distant metastatic sites (e.g. liver); colonic wall thickening, enlarged lymph nodes, liver metastases, ascites, lung secondaries; invasion of mesorectal fascia
CT colonography:
appearances similar to conventional colonoscopy, with an ulcerating exophytic mucosal lesion that may narrow the bowel lumen
upper gastrointestinal endoscopic ultrasound:
determines clinical tumour (T) and node (N) stage of upper gastrointestinal tumours
transrectal endoscopic ultrasound:
determines clinical tumour (T) and node (N) stage of rectal tumours

58
Q

mallory-weiss tear Hx

A

vomiting or coughing with subsequent haematemesis; retrosternal, epigastric, or back pain; melena; presyncope/syncope; dysphagia, odynophagia

59
Q

mallory weiss tear O/E

A

postural/orthostatic hypotension; pallor, tachycardia

60
Q

mallory weiss tear imaging

A

erect CXR:
may show free air
oesophagogastroduodenoscopy:
bleeding, adherent clot, or fibrous rind over an area of mucosal split at or near the gastro-oesophageal junction

61
Q

diabetic ketoacidosis Hx

A

inadequate or inappropriate insulin therapy, infection (pneumonia and urinary tract infections are the most common), myocardial infarction; anorexia, nausea, vomiting, polyuria, thirst; abdominal pain; fever; dizziness, weakness, mental status change

62
Q

diabetic ketoacidosis O/E

A

acetone breath; deep, laboured, gasping breathing (Kussmaul’s breathing); signs of hypovolaemia (tachycardia, hypotension, poor capillary refill, sunken eyes); abdominal tenderness; altered mental status

63
Q

diabetic ketoacidosis labs

A

plasma glucose:
elevated
serum electrolytes and urea:
usually sodium low, potassium elevated, chloride low, magnesium low, calcium low, phosphate normal or elevated, urea elevated, creatinine elevated
arterial blood gases:
pH varies from 7.00 to 7.30 in diabetic ketoacidosis (DKA); arterial bicarbonate ranges from <10 mmol/L (<10 mEq/L) in severe DKA to >15 mmol/L (>15 mEq/L) in mild DKA
urinalysis:
positive for glucose and ketones; positive for leukocytes and nitrites in the presence of infection
serum ketones:
elevated
FBC:
elevated WBC count

64
Q

plasma glucose in diabetic ketoacidosis

A

elevated

65
Q

urinalysis in diabetic ketoacidosis

A

positive for glucose and ketones; positive for leukocytes and nitrites in the presence of infection

66
Q

serum ketones in diabetic ketoacidosis

A

elevated

67
Q

opiod withdrawal Hx

A

history of drug use/misuse; fever, chills, nausea, vomiting; crampy abdominal pain; change of bowel habit; sweating, tremors, confusion, agitation, anxiety, muscular aches, increased salivation, dilated pupils

68
Q

opiod withdrawal O/E

A

diffuse abdominal pain and tenderness; abdomen usually not distended; dilated pupils, confusion, sweating, copious salivation

69
Q

opioid withdrawal labs

A

urine drug screen:
positive
gas chromatography-mass spectroscopy:
positive

70
Q

hepatitis Hx

A

perinatal exposure, family history of hepatitis B virus infection, blood transfusions, high-risk activities (e.g., multiple sexual partners, men who have sex with men, injection drug users, intravenous drug use); right upper quadrant pain; fever, chills, fatigue, myalgia/arthralgia; nausea, vomiting; jaundice

71
Q

hepatitis O/E

A

right upper quadrant tenderness; hepatosplenomegaly; jaundice; ascites; maculopapular or urticarial rash

72
Q

hepatitis labs

A

FBC:
elevated; non-specific
LFTs:
elevated transaminases (alanine aminotransferase/aspartate aminotransferase), alkaline phosphatase, and bilirubin
serum electrolytes, urea, and creatinine:
usually normal
hepatitis serology and antigens:
positive

73
Q

hepatitis imaging

A

ultrasound right upper quadrant:
poorly defined margins and coarse, irregular internal echoes in hepatitis B
prothrombin time:
prolonged

74
Q

gastroenteritis Hx

A

nausea, vomiting, diarrhoea, crampy abdominal pain; history of sick contacts with similar symptoms; ingestion of questionable food or water; recent travel to places with insanitary conditions

75
Q

gastroenteritis O/E

A

dehydration; tachycardia; soft, non-distended abdomen; diffuse abdominal tenderness

76
Q

gastroenteritis labs

A

FBC:
elevated WBC count
serum electrolytes and urea:
variable, may show dehydration
stool for culture, ova and parasites:
may identify infectious agent

77
Q

gastroenteritis imaging

A

stool leukocytes:
positive
CT abdomen/pelvis with oral and intravenous contrast:
may show non-specific thickening of affected bowel

78
Q

infectious colitis Hx

A

fever, chills, nausea, vomiting, diarrhoea (may be bloody), abdominal pain; abdominal distention, malaise, and anorexia; may have been recent travel, community outbreak or close contact with people with similar symptoms, recent use of antibiotics or hospitalisation; immunocompromise

79
Q

infectious colitis O/E

A

pyrexia, abdominal pain and tenderness; variable signs from mild dehydration to hypovolaemic shock/septic shock (hypotension, tachycardia); peritonitis; possible abdominal distention

80
Q

infectious colitis labs

A

FBC:
elevated WBC count and/or anaemia
serum electrolytes and urea:
variable, may show dehydration
stool culture:
may identify infectious agent
faecal occult blood:
positive

81
Q

infectious colitis imaging

A

abdominal x-ray:
may show distended colon
CT abdomen/pelvis with contrast:
may show thickened and inflamed segments of colon or all of colon affected; may show pneumatosis or localised perforation or perforation with phlegmon/abscess in severe cases

82
Q

sickle cell crisis Hx

A

history of sickle cell anaemia; diffuse bodily pain which can include abdominal pain, bone pain, chest pain; may also have fatigue, fever, jaundice, tachycardia, delayed growth and puberty; skin ulcers

83
Q

sickle cell O/E

A

diffuse acute abdominal pain and tenderness on palpation; patient is uncomfortable in any position; abdomen is usually not distended; fever

84
Q

sickle cell labs

A

FBC with reticulocyte count:
some degree of anaemia occurs in most patients with sickle cell disease; leukocytosis common in acute pain crises
peripheral blood smear:
presence of nucleated red blood cells, sickle-shaped cells, and Howell-Jolly bodies
urea and creatinine:
normal or elevated
LFTs:
variable
bacterial cultures:
pathogen detected

85
Q

sickle cell crisis imaging

A

abdominal ultrasound:
may show enlarged spleen or presence of gallstones; hepatomegaly
CT abdomen/pelvis:
may show enlarged spleen or presence of gallstones; hepatic or renal infarction
haemoglobinopathy testing:
sickle cell haemoglobin mutation
CXR:
presence of pulmonary infiltrate(s) may be an indication of acute chest syndrome

86
Q

endometriosis Hx

A

dysmenorrhoea; cyclical lower abdominal/pelvic/back pain, often 1-2 weeks before menstruation and during menstruation; pain during bowel movements; dyspareunia; sub-fertility; urinary or bowel obstruction; depression

87
Q

endometriosis O/E

A

discomfort and uterosacral ligament nodularity during bimanual/rectovaginal examination; tenderness on palpation in lower abdomen; fixed retroverted uterus in late stages; pelvic mass (ovarian endometriomas)

88
Q

endometriosis imaging

A

transvaginal ultrasound:
may show ovarian endometrioma (homogeneous, low-level echoes) or evidence of deep pelvic endometriosis such as uterosacral ligament involvement (hypoechoic linear thickening)
diagnostic laparoscopy:
direct visualisation of endometrial implants and histological confirmation of biopsies
rectal endoscopic ultrasound:
hypoechoic nodule or mass
MRI pelvis:
hypointense, irregular thickening or mass of uterosacral ligament; replacement of fat tissue plane between uterus and rectum/sigmoid with tissue mass

89
Q

testicular torsion Hx

A

history of previous on-off testicular pain; sudden-onset testicular pain with nausea and vomiting; scrotal oedema/swelling/erythema; abdominal pain also often present

90
Q

testicular torsion O/E

A

severe testicular pain and tenderness on affected side; may be swollen; affected testicle is located higher than the non-affected testicle, often in horizontal position; reduced or absent cremasteric reflex

91
Q

testicular torsion imaging

A

surgical exploration of the scrotum:
testicular torsion
grey-scale ultrasound:
presence of fluid and the whirlpool sign (the swirling appearance of the spermatic cord from torsion as the ultrasound probe scans downwards perpendicular to the spermatic cord)
FBC:
normal
power Doppler ultrasound:
absent or decreased blood flow in the affected testicle; decreased flow velocity in the intratesticular arteries, increased resistive indices in the intratesticular arteries
colour Doppler ultrasound:
absent or decreased blood flow in the affected testicle; decreased flow velocity in the intratesticular arteries, increased resistive indices in the intratesticular arteries
spectral Doppler:
non-homogeneous and/or asymmetric vascular perfusion compared with the unaffected testis
scintigraphy:
decreased uptake of radioactive technetium-99m to the affected testicle in patients with testicular torsion

92
Q

scintigraphy in testicular torsion

A

decreased uptake of radioactive technetium-99m to the affected testicle in patients with testicular torsion

93
Q

kidney stones Hx

A

previous history of kidney stones; may be asymptomatic to severe abdominal flank pain radiating to the groin; other symptoms include nausea, vomiting, diaphoresis, haematuria; urinary frequency/urgency; occupations in hot conditions (e.g., chefs, steel workers); family history of stones

94
Q

kidney stones O/E

A

often obese; abdomen soft; when in pain, may be severe, unable to find comfortable position; tender to palpation/percussion of costovertebral angle/flank; if urosepsis also present may be tachycardic, hypotensive, pyrexial

95
Q

kidney stones labs

A

urinalysis:
dipstick positive for leukocytes, nitrates, blood; microscopic analysis positive for WBCs, red blood cells, or bacteria; may be normal
FBC:
normal or raised WBC count
serum electrolytes, urea, and creatinine:
normal or deranged
uric acid level:
normal or elevated

96
Q

kidney stones imaging

A

non-contrast helical CT abdomen/pelvis (stone protocol):
calcification seen in renal collecting system or ureter
renal ultrasound:
calcification seen within urinary tract
retrograde urethrogram:
calcification seen within urinary tract or a filling defect seen
intravenous pyelogram:
calcification seen within urinary tract or a filling defect seen when dye is passing through the kidney and down the ureter

97
Q

pyelonephritis Hx

A

family history of kidney stones; history of urinary tract infection, stress incontinence, or frequent sexual intercourse; fever with chills; dysuria, frequency, urgency; flank pain; nausea, vomiting, diaphoresis, haematuria

98
Q

pyelonephritis O/E

A

pyrexia; flushed looking; flank pain and/or costovertebral angle tenderness on palpation/percussion

99
Q

pyelonephritis labs

A

urinalysis:
pyuria (>10 WBCs per high-power field [HPF]), red blood cells ≥5/HPF, leukocyte esterase, nitrites, WBC casts, proteinuria up to 20 g/L (2 g/dL)
Gram stain:
typically gram-negative rods; less typically gram-positive cocci
urine culture:
positive
FBC:
leukocytosis
CRP:
elevated

100
Q

pyelonephritis imaging

A

CT abdomen/pelvis with intravenous contrast:
altered renal parenchymal perfusion; altered excretion of contrast; perinephric fluid; non-renal disease; may show abscess formation
renal ultrasound:
gross structural abnormalities; hydronephrosis; stones; perirenal fluid collections
99mTc-dimercaptosuccinic acid scintigraphy:
inflammation or scarring of the renal cortex; unequal distribution of renal function between the kidneys
MRI:
structural anomalies of the genitourinary system (prenatal); renal inflammation or masses; abnormal renal vasculature; urinary obstruction

101
Q

volvulus Hx

A

steady abdominal pain that may have colicky characteristics varying from vague discomfort to excruciating (severe unremitting pain suggests gangrenous bowel); history of abdominal surgery, abdominal or inguinal hernia; nausea, vomiting, emesis may be absent in patients with sigmoid volvulus (more common in older or debilitated patients); periumbilical or hypogastric pain, diarrhoea or constipation (depending on the degree and location of the obstruction)

102
Q

volvulus O/E

A

often diffuse abdominal distension and tenderness; faint or no bowel sounds, rigid abdomen, guarding, rebound tenderness, fever, or haematochezia

103
Q

volvulus labs

A

ABG:
may be normal; metabolic acidosis; elevated lactate
CXR:
may see free air under the diaphragm
FBC:
elevated WBC count
serum electrolytes:
may be normal in early obstruction; may confirm hypochloraemia and hypokalaemia; urea and creatinine may be elevated
CRP:
may be elevated

104
Q

volvulus imaging

A

plain abdominal x-rays:
partial or complete obstruction; dilated bowel loops; air-fluid levels; abdominal free air with perforation
CT of abdomen:
bowel obstruction with whirl pattern of mesentery

105
Q

intussusception Hx

A

more common in children than in adults; classic presentation of severe, colicky pain alternating with lethargy; may also present with vague abdominal complaints; severe, cramp-like abdominal pain; children may be inconsolable; vomiting

106
Q

intussusception O/E

A

occult or frank blood mixed with mucus giving currant-jelly appearance, abdominal tenderness, and palpable mass

107
Q

intussusception labs

A

FBC:
elevated WBC count
serum electrolytes:
may be normal in early obstruction; may confirm hypochloraemia and hypokalaemia; urea and creatinine may be elevatedMore
CRP:
may be elevated

108
Q

intussusception imaging

A

ultrasound:
tubular mass in longitudinal view; target lesion in transverse view
CT of abdomen and pelvis:
target lesion: intraluminal soft-tissue density mass with an eccentrically placed fatty area; reniform mass: high attenuation peripherally and lower attenuation centrally; sausage-shaped mass: alternating areas of low and high attenuation representing closely spaced bowel wall, mesenteric fat, and/or intestinal fluid and gas

109
Q

perforated duodenal ulcer Hx

A

acute onset of severe epigastric pain, nausea, vomiting, and loss of appetite; more common in men than women; history of melaena or bright red blood from rectum, episodic epigastric pain relieved by eating; use of non-steroidal anti-inflammatory drugs; may have latent period with symptom improvement that may last several hours, followed by peritonitis with fever, nausea, vomiting, and peritoneal signs; referred pain to shoulders secondary to diaphragmatic irritation

110
Q

perforated duodenal ulcer O/E

A

tachycardia, fever, epigastric tenderness, rigid abdomen, guarding, rebound tenderness, and occult or frank blood in stool

111
Q

perforated duodenal ulcer labs

A

ABG:
may be normal; metabolic acidosis; elevated lactateMore
blood cultures:
may detect bacteraemia
FBC:
elevated WBC count
serum electrolytes:
may show elevated creatinine and ureaMore
CRP:
usually elevated
serum lipase or amylase:
normal
may be positive for helicobacter pylori

112
Q

perforated duodenal ulcer imaging

A

CT of abdomen and pelvis:
pneumoperitoneumMore
plain abdominal x-rays:
abdominal free air on erect abdominal film
CXR:
may see free air under the diaphragm

113
Q

ruptured ovarian cyst Hx

A

often days 20 and 26 of a normal menstrual cycle; often follows intercourse, exercise, or pelvic examination; sudden-onset lower abdominal pain, may be lateralised to left or right; light vaginal bleeding; postural dizziness if marked haemorrhage (associated with rupture of corpus luteum cyst, specifically among patients on anticoagulants or with bleeding disorders)

114
Q

ruptured ovarian cyst O/E

A

light vaginal bleeding; vital signs usually normal, but may be low-grade fever; may have tachycardia/hypotension if severe bleeding in association with coagulopathy or anticoagulant use; signs of peritonitis if haemoperitoneum present

115
Q

ruptured ovarian cyst imaging

A

transvaginal ultrasound:
enlarged ovary or portion of ovarian tissue; may be cystic, solid, or mixed; free pelvic fluid
positive or negative pregnancy test

116
Q

abdominal aortic dissection Hx

A

severe, sharp, or tearing pain in thorax or abdomen, pain radiates to neck or back, history of hypertension, increased risk in Marfan’s syndrome and Ehlers-Danlos syndrome or other collagen vascular disorders, painless dissection is rare

117
Q

abdominal aortic dissection O/E

A

hypertension in distal dissection; lower extremity pulse deficit, sensory or motor deficits (including numbness, tingling, or transient paraplegia); ischaemia and, if mesenteric arteries involved, bowel ischaemia with rigid abdomen, guarding and rebound tenderness

118
Q

abdominal aortic dissection labs

A

serum urea and electrolytes:
elevated urea

119
Q

Abdominal aortic dissection imaging

A

plain abdominal x-rays:
aortic wall calcification consistent with abdominal aortic aneurysm; loss of psoas shadow in presence of rupture
CT angiography of chest and abdomen:
two aortic lumina separated by intimal flap or displaying different rates of contrast opacification
magnetic resonance angiography of chest and abdomen:
two aortic lumina separated by intimal flap; branch vessel involvement; aortic regurgitation
CXR:
widened aortic silhouette; widened mediastinum
contrast aortography:
two aortic lumina separated by intimal flap; branch vessel involvement; aortic regurgitation

120
Q

ischaemic colitis Hx

A

fever, vomiting, diarrhoea, abdominal pain, and bloody stools; history of vascular disease, recent abdominal aortic aneurysm repair, sepsis, myocardial infarct, or atrial fibrillation

121
Q

ischaemic colitis O/E

A

diffuse abdominal pain or localised to area of colon affected with little or no distension

122
Q

ischaemic colitis labs

A

FBC:
elevated WBC count
serum lactate:
elevated if tissue hypoxia

123
Q

ischaemic colitis imaging

A

CT abdomen/pelvis with oral and intravenous contrast:
may show thickened and inflamed segments of colon; pneumatosis or gas in mesenteric veins suggestive of ischaemia
colonoscopy:
pale or bluish mucosa with haemorrhagic lesions
obstruction series:
pneumatosis or gas in mesenteric or portal vein but not specific to ischaemic colitis
MRI abdomen with contrast:
may show thickened and inflamed segments of colon; pneumatosis or gas in mesenteric veins suggestive of ischaemia
diagnostic laparoscopy:
full thickness ischaemia may be seen; ischaemia restricted to mucosa will not be seen

124
Q

meckel’s diverticulitis Hx

A

sudden-onset severe abdominal pain, often starts periumbilical with migration to right lower quadrant; nausea, vomiting, anorexia, fever, diarrhoea

125
Q

mocker’s diverticulitis O/E

A

fever, tachycardia, patient may be lying in right lateral decubitus position with hips flexed; no or decreased bowel sounds; pain commonly originates near the umbilicus or the epigastrium; right lower quadrant (McBurney’s point) tenderness with rigid abdomen; guarding and rebound tenderness; psoas sign (right lower quadrant pain with right thigh extension)

126
Q

meckel’s diverticulitis labs

A

FBC:
low haemoglobin and haematocrit; leukocytosis with left shift

127
Q

meckel’s diverticulitis imaging

A

technetium-99m pertechnetate scan (‘Meckel scan’):
ectopic focus or ‘hot spot’; enhancement of diverticulum
plain abdominal radiography:
dilated bowel loops with air-fluid levels and paucity of distal gas suggests bowel obstruction; free air on upright film suggests a perforation; a density in the right side of the abdomen suggests an intussusception
CT scan of the abdomen and pelvis:
blind-ending fluid-filled and/or gas-filled structure in continuity with distal ileum
ultrasound of the abdomen:
tubular mass in longitudinal views and a doughnut or target appearance in transverse views suggests intussusception

core presentations (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions