Abdominal Pain

Question 1

Signs of perforated Appendix

Answer 1

Shoulder tip pain indicative of peritonitis
Sudden drop in pain level

Shock and peritonitis

Question 2

What is Charcot’s triad and what does it indicate

Answer 2

Fever
Jaundice
RUQ pain

Indicates blockage of Common Bile Duct and subsequent cholangitis (infection of the bile duct)

Question 3

What is Reynold’s pentad and what does it indicate

Answer 3

Fever
Jaundice
RUQ pain
Altered mental state
Shock

Ascending cholangitis - infection tracking up the biliary tree, more serious

Question 4

Which liver enzyme is raised in biliary conditions

Answer 4

Alk Phos

Question 5

Which drug should be avoided in biliary conditions

Answer 5

Morphine/opioids - spasm of sphincter of Oddi

Question 6

Management of Cholecystitis/cholangitis

Answer 6

Endoscopic biliary tract drainage
Cholecystectomy
Analgesia, Abx (broad spec - cefotaxime)

Question 7

Investigations for biliary pathology

Answer 7

USS biliary tree
Obstructive jaundice picture - Raised ALP, low ALT + Jaundice
No Jaundice in Cholecystitis as no back flow of bile

Question 8

What is Rigler’s sign?

Answer 8

Air on both sides of bowel wall on AXR - sign of pneumoperitoneum secondary to perforation

Question 9

AXR findings in bowel obstruction

Answer 9

SBO - coiled spring appearance
LBO - dilated large bowel - can tell from Haustra
Sigmoid volvulus - coffee bean appearance

Question 10

How does presentation of SBO/LBO differ

Answer 10

LBO - constipation is early feature, vomiting less common, faecal vomiting late
SBO - vomiting early, progresses quickly –> severity

Question 11

Principle of management of Bowel Obstruction

Answer 11

Decompress where possible - bowel rest, resus, observe

Surgical - laparotomy +/- resection depending on aetiology

Question 12

Management of diverticulitis

Answer 12

Surgical + medical symptom management

Broad spec Abx - Cefuroxime + metronidazole

Question 13

Management for ovarian cysts of various sizes

Answer 13

<50mm - conservative - usually incidental finding
50-70mm - yearly USS follow up
70mm+ - surgical excision - for smaller cysts also if symptomatic

Question 14

Which investigations would you order in suspected pancreatitis

Answer 14

Serum lipase - most sensitive
Serum amylase also used but not first line
MRCP - magnetic resonance cholangiopancreatography
Investigations to determine if biliary aetiology
NOT USS - pancreas poorly visualised on USS

Question 15

Management of acute pancreatitis

Answer 15

Analgesia - Buprenorphine - Avoid morphine due to sphincter of oddi spasm

Aspiration and drain + culture –> Abx
Rising CRP suggests necrosis

Question 16

Red flags in peptic ulcer disease

Answer 16

Anaemia - IDA from blood loss
Melaena
Anorexia
Haematemesis
Rapid onset
swallowing difficulties

Question 17

Abx treatment for H. Pylori?

Answer 17

Amoxicillin + Clarithromycin