16. Right Iliac Fossa Pain

Question 1

What are the main differentials for RIF pain?

Answer 1

Appendicitis, gastroenteritic, ureteric colic, inguinal hernia

Question 2

What other diagnoses must you consider in a female with RIF pain?

Answer 2

Gyanecological pathology like ectopic pregnancy, pelvic inflammatory disease, torsion, rupture of ovarian tumour or cyst, mittelschmerz

Question 3

What will you be looking for on examination in someone with RIF pain?

Answer 3

Scars, abdominal distension, cervical lymphadenopathy, masses, bowel sounds, hernias

Question 4

What kind of amylase and lipase levels would you expect in pancreatitis?

Answer 4

Amylase >1000U/L and lipase >300U/L

Question 5

Describe some of the features of mesenteric adenitis?

Answer 5

Typically follows an URTI, which is why cervical lymphadenopathy may be present. It is most common is children under 15.

Question 6

How may mesenteric adenitis rpesent differently to appendicitis?

Answer 6

Mesenteric adenitis pain may be more diffuse, not have signs of peritonitis and rectal tenderness like appendicitis

Question 7

What is the sepsis six?

Answer 7

1. Administer high flow O2
2. Take blood cultures
3. Give broad spectrum Abx
4. Give IV fluid challenge
5. Measure lactate and Hb
6. Measure hourly urine output
   (Give 3, Take 3)