16. Right Iliac Fossa Pain Flashcards
What are the 4 main differentials for RIF pain?
Appendicitis
Gastroenteritis
Ureteric colic
Inguinal hernia
What 5 other diagnoses must you consider in a female with RIF pain?
Gyane pathology: ectopic pregnancy pelvic inflammatory disease torsion/ haemorrhage/ rupture of ovarian tumour or cyst Mittelschmerz
What will you be looking for on examination in someone with RIF pain?
Scars Abdominal distension Cervical lymphadenopathy Masses Bowel sounds Hernias DRE External genitalia (testicular torsion)
What kind of amylase and lipase levels would you expect in pancreatitis?
Amylase >1000U/L
Lipase >300U/L
Describe some of the features of mesenteric adenitis? In which age group is this most common?
Typically follows an URTI, which is why cervical lymphadenopathy may be present.
Most common is children < 15.
How may mesenteric adenitis present differently to appendicitis?
Mesenteric adenitis pain may be more diffuse, not have signs of peritonitis + rectal tenderness like appendicitis
What is the sepsis six?
- Administer high flow O2
- Take blood cultures
- Give broad spectrum Abx
- Give IV fluid challenge
- Measure lactate + Hb
- Measure hourly urine output
(Give 3, Take 3)
What is SIRS?
Body's response to proinflammatory processes. 2 or more of: Temp >38 or <36 HR >90 bpm RR > 20/ min WCC >12 or <4
What is sepsis?
SIRS caused by a suspected or proven infection
What is severe sepsis?
Sepsis causing hypotension + end organ hypo perfusion
What is septic shock?
Severe sepsis that is refractory to fluid resus + therefore needs vasopressors
What is multi organ dysfunction syndrome?
Evidence of >, 2 organs failing
Why is lactate measured?
Tissue hypoperfusion +/or hypoxia causes pyruvic acid to be preferentially converted to lactate during anaerobic respiration.
Raised lactate indicates tissue ischaemia + severity of sepsis
