1.01 - Surgical History Taking Flashcards
What are the differentials for a patient present with acute right lower abdominal pain?
?UTI
?testicular torsion (M only)
?acute appendicitis
?ectopic pregnancy (F only)
Which bedside investigation should always be carried out for a patient presenting with acute right lower abdominal pain?
Urinalysis - will exclude UTI and ectopic pregnancy.
What is the pain character of acute appendicitis?
An acute onset of periumbilical pain (visceral pain) that migrates to the right iliac fossa (somatic pain).
Give the scoring system and the respective criteria used to make a clinical diagnosis of acute appendicitis.
Alvarado score
MANTRELS (see image attached)
A score ≥5 is sufficient to make a clinical diagnosis of acute appendicitis.
Define anorexia.
The loss of appetite and/or loss of interest in food.
This can subsequently lead to weight loss, which is usually the result of reduced energy intake as opposed to increased energy expenditure.
A patient who has zero calorie intake will lose how much weight per week?
Approx. 2kg/wk
What are the differentials for a patient presenting with a ‘painful mouth’?
- inflammatory bowel disease
- gluten enteropathy
- iron deficiency
- vitamin B deficiency
- vitamin C deficiency
Give the characteristics of heart burn.
A retrosternal burning pain / discomfort, which radiates upwards. The patient may also describe a sour taste in their mouth and water brash (hypersalivation).
This is indicative of gastro-oesophageal reflux disease.
What is dyspepsia?
Pain or discomfort centred in the upper abdomen.
Give the characteristics of the following types of dyspesia:
a) reflux-like dyspepsia
b) ulcer-like dyspepsia
c) dysmotility-like dyspepsia
a) heart burn predominant pain in the upper abdomen.
b) epigastric pain relieved by foods or antacids.
c) nausea, belching, bloating and premature satiety.
What is odynophagia?
Pain on swallowing
Odynophagia that is precipitated by drinking hot liquids is suggestive of what diagnosis?
Oesophagitis
A sudden onset of severe and generalised abdominal pain is suggestive of which pathologies?
- bowel perforation
- ruptured abdominal aorta
- mesenteric infarction
Inflammation usually produces:
a) constant
or
b) intermittent
pain?
a) constant
Give the pain characteristics of acute pancreatitis.
Central abdominal pain with back radiation, which is relieved by leaning forwards.
Give the pain characteristics of gall stone disease.
Right hypochondrial pain that radiates to the right shoulder.
Give the differentials for severe vomiting without significant pain.
- gastric outlet obstruction
- proximal small-bowel obstruction
Give the differentials of feculent vomiting.
Late feature of:
- distal small-bowel obstruction
- colonic obstruction
What questions should be asked when exploring past surgical history?
- previous operations
- dates
- complications
What questions should be asked when exploring drug history?
- medications
- indication
- dose
- how long has been taking for
What question can be asked to elicit a full past medical history?
“Have you ever had any medical problem or been to the hospital for anything?”
Give the topics that should be explored in a cardiovascular systematic enquiry.
- chest pain
- effort dyspnoea
- orthopnoea
- nocturnal dyspnoea
- palpitations
- swollen ankles
- claudication
Give the topics that should be explored in a respiratory systematic enquiry.
- dyspnoea
- cough (?sputum ?haemoptysis)
- wheeze
Give the topics that should be explored in a gastro-intestinal systematic enquiry.
- weight loss
- loss of appetite
- nausea or vomiting
- dysphagia
- heart burn
- abdominal pain
- bleeding per rectum
- changes in bowel habit (diarrhoea / constipation)
Give the topics that should be explored in a genito-urinary systematic enquiry.
- abnormal discharge
- last menstrual period
- dysuria
- haematuria
- frequency
- offensive or dark coloured urine
- incontinence
- post-mictruition dribble
Give the topics that should be explored in a social history, that are relevant to surgery.
- at what time did they last eat or drink?
- who will look after the patient following discharge?
- smoking & alcohol history
