17. Left Iliac Fossa Pain Flashcards
What are the main differentials for LIF pain in a 76yo female?
Acute diverticulitis Constipation IBD Ischaemic colitis Leaking AAA Pseudomembranous colitis Locally perforated sigmoid carcinoma
Describe the pain experienced in Acute diverticulitis?
Pain initially poorly localised, midline + colicky
Migrates to LIF + becomes constant
After characterising the LIF pain what other symptoms should you ask about?
Nausea + vomiting: Acute diverticulitis + PID Fever: Acute diverticulitis Change of bowel habit Rectal bleeding: colitis Bloating: IBS Weight Loss Gynaecological problems
What examinations are important to consider in someone with LIF pain?
Abdo exam, DRE + vaginal examination
How would you manage diverticulitis in the acute phase?
Analgesia Bowel rest IV fluid Antibiotics VTE prophylaxis Monitor
What may be offered 2-6 weeks after resolution of acute diverticulitis?
Colonoscopy to confirm the diagnosis + assess the extent of diverticulosis + exclude cancer
What is diverticulosis?
Presence of diverticula in the bowel
What is diverticular disease?
Symptomatic diverticulosis: painless bleeding, altered bowel habit
What is diverticulitis?
Painful inflammation in patients with diverticular disease
What is pseudomembranous colitis? What is used to treat this?
Acute inflammatory condition of the bowel usually caused by Clostridium difficile
Oral vancomycin
In younger adults, what other causes of LIF must be considered?
F: gynae pathologies e.g. ectopic pregnancy
M: Testicular torsion/ tumour
What drugs can dampen the inflammatory response, thus masking how ill a patient truly is?
Steroids
What drugs predispose patients to pseudomembranous colitis?
Antibiotics
PPIs
What is the imaging modality of choice for diagnosing Acute diverticulitis?
Abdominal CT with contrast
What investigations are contraindicated in patients with Acute diverticulitis?
Colonoscopy
Barium enema
