3- investigations of lower abdominal symptoms Flashcards
what are GI symptoms?
- pain
- change in bowel habit →frequency, stool consistency, associated with blood or mucous
- bloating/distension
- rectal bleeding
- anal pain on defecation
- peri-anal itch
what are causes of abdominal pain in right hypochondrium region of abdomen?
- hepatitis
- gallstones
- cholangitis
- cholecystitis
- liver abscess
what are causes of abdominal pain in left hypochondrium region of abdomen?
- splenic abscess
- splenic rupture
- splenic infarct
what are causes of abdominal pain in epigastric region of abdomen?
- peptic ulcer
- oesophagitis
- pancreatitis
- gastric cancer
what are causes of abdominal pain in right lumbar region of abdomen?
- renal colic
- pyelonephritis
what are causes of abdominal pain in left lumbar region of abdomen?
- renal colic
- pyelonephritis
what are causes of abdominal pain in umbillical region of abdomen?
- early appendicitis
- mesenteric adenitis
- meckel’s diverticulitis
what are causes of abdominal pain in right iliac region of abdomen?
- late appendicitis
- crohns disease
- ectopic pregnancy
- ovarian cyst
what are causes of abdominal pain in left iliac region of abdomen?
- diverticulitis
- ulcerative colitis
- ectopic pregnancy
- ovarian cyst
what are causes of abdominal pain in pelvic region of abdomen?
- UTI
- urinary retention
- testicular torsion
what is approach to intestinal pain?
- careful history = establish all symptoms, any relation to meal times or defecation. are symptoms worse at night
- urgency, tenesmus (feeling of something on stomach), incontinence
- examination, including rectal exam
is pathology or functional?
what is basic examination of intestinal pain?
- full blood count (check for anaemia)
- check renal function (electrolyte upset or dehydration)
- inflammation present →check CRP elevated, platelets elevated
- check for coeliac disease →serology
- stool tests
what is measured in stool tests?
- measure altered blood in stool to determine likelihood of underlying cancer, polyps
- measure faecal calprotectin (is there mucosal inflammation?)
- GI infection screen (if acute diarrhoea); PCR screen for bacterial and viral causes of gastroenteritis
what further tests can be done in intestinal pain (more hospital ones)?
- colonoscopy or sigmoidoscopy = gold standard test but does depend on quality of endoscopist (user error occurs) →need to drink 2L of fluid to flush out so can be tricky for some people especially if frail, elderly
- CT colonoscopy
- CT abdomen & pelvis with/without IV contrast
- ultrasound
- abdominal x-ray →reserved for emergency
in reality resources are limited so clinicians have to prioritise who needs more urgent scans
what is faecal immunochemical tests (FIT)?
= measures faecal haemoglobin concentrations in stool – to detect altered blood as a marker of underlying disease
what happens in FIT stool sample?
- tiny test tube that take stiny sample of faeces (single sample)
- automated analysis that allows lab scientists to measure how much blood in stool
- can measure tiny amounts of altered blood in stool
what is new protocol for bowel cancer suspicions in GP (instead of just referring to loads of endoscopies and not many being cancer)?
→stool test is good rule out test, if FIT score less than 10 micrograms per gram then ok (negative test) so don’t refer (only a tiny proportion developed cancers after negative FIT test)
= helps prioritise patients for investigations
is faecal haemoglobin concentration inferior to symptoms in predicting underlying cancers and polyps etc?
- Faecal haemoglobin concentration is superior to symptoms in predicting underlying CRC/polyps/IBD
what is detected in FIT test?
detecting antibodies specific to human haemoglobin, presence of these antibodies serves as a marker for altered blood in GI tract
