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OSCE - histories > Abdominal pain and diarrhoea > Flashcards

Abdominal pain and diarrhoea Flashcards

1
Q

What are the differential diagnoses for acute pain in the upper abdomen?

A
  1. Gallstone colic
  2. Acute cholecystitis
  3. Acute pancreatitis
  4. Acute cholangitis
  5. Gastric carcinoma
  6. Gastritis
  7. Oesophagitis
  8. Hiatus hernia
  9. ACS
  10. Pericarditis, pneumonia, empyema, herpes zoster, Boerhaave
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2
Q

What are the differential diagnoses for acute pain in the central abdomen?

A
  1. Small bowel obstruction
  2. Abdominal aortic dissection
  3. Crohn’s disease
  4. Mesenteric artery occlusion
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3
Q

What are the differential diagnoses for acute pain in the lateral abdomen?

A
  1. Appendicitis
  2. Pyelonephritis
  3. Renal calculus
  4. Ureteric calculus
  5. Salpingitis
  6. Ruptured ovarian cyst or torsion, endometriosis, Meckel’s diverticulitis
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4
Q

What are the differential diagnoses for acute pain in the lower abdomen?

A
  1. Cystitis
  2. Pelvic inflammatory disorder
  3. Pelvic endometriosis
  4. Ectopic pregnancy
  5. Large bowel obstruction
  6. Infective or ulcerative colitis
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5
Q

What characterises acute pancreatitis? And what would you suggest?

A

Pain radiating straight through to the back, better on sitting up or leaning forward. General tenderness, reduced bowel sounds

Suggest: FBC, U&E, CXR, AXR, amylase (will be high), CT pancreas

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6
Q

How would you manage acute pancreatitis?

A

Pethidine, fluids, NG tube and nil by mouth

Monitor calcium and glucose

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7
Q

What characterises acute cholangitis? And what would you suggest?

A

RUQ abdominal pain, jaundice, hypotension, fever

Suggest: FBC, U&E, CXR, AXR, US scan gallbladder, US biliary duct, blood culture

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8
Q

How would you manage acute cholangitis?

A

Fluid, analgesia, IV ABx

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9
Q

What characterises gastric carcinoma? And what would you suggest?

A

Anorexia, fullness, pain, Virchow’s node

Upper GI endoscopy and biopsy

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10
Q

What characterises gastritis? And what would you suggest?

A

Epigastric pain, dull or burning discomfort, nocturnal pain

Oesophagogastroscopy, barium meal and pH study

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11
Q

How would you manage gastritis?

A

Antacids, H2 blocker, PPI

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12
Q

What characterises oesophagitis? And what would you suggest?

A

Retrosternal pain, heartburn

Oesophagogastroscopy

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13
Q

How would you manage oesophagitis?

A

Small, often meals. Elevate head of bed. Antacids, PPI, H2 blocker

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14
Q

What characterises hiatus hernia? And what would you suggest?

A

Heartburn, worsens with stooping or lying, relieved with antacids

Oesophagogastroscopy, barium meal

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15
Q

What characterises small bowel obstruction? And what would you suggest?

A

Vomiting, constipation with complete obstruction

AXR

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16
Q

How would you manage small bowel obstruction?

A

NG tube, nil by mouth, fluids, surgery

17
Q

What characterises abdominal aorta dissection? And what would you suggest?

A

Tearing pain, hypertension

US scan, CT abdomen

18
Q

How would you manage abdominal aorta dissection?

A

Pain control, group and crossmatch. IV access, reduce BP and surgical intervention

19
Q

What characterises Crohn’s disease? And what would you suggest?

A

Chronic diarrhoea, abdominal pain, weight loss, RLQ mass and fullness, mouth ulcers

Colonoscopy with biopsy, barium studies

20
Q

What characterises mesenteric artery occlusion? And what would you suggest?

A

Vomiting, bowel urgency, melaena, diarrhoea

Mesenteric angiography, exploratory laparotomy

21
Q

What characterises appendicitis? And what would you suggest?

A

Pain initially central, but moves to RLQ, anorexia, low-grade fever, constipation, RLQ tenderness and guarding

US appendix, laparotomy

22
Q

How would you manage appendicitis?

A

nil by mouth, cross matching, broad spectrum ABx, surgical intervention

23
Q

What characterises pyelonephritis? And what would you suggest?

A

Pain in loin, riggers, fevers, vomiting, frequency of urination, renal angle tenderness

FBC: leucocytosis, MSU: pyuria, urine and blood culture and sensitivities

24
Q

How would you manage pyelonephritis?

A

Ampicillin, gentamicin, 3rd generation cephalosporin

25
Q

What characterises renal calculus? And what would you suggest?

A

Renal colic, mainly in loin, haematuria

Urinalysis, renal US scan, IVU, CT or MRI

26
Q

What characterises ureteric calculus? And what would you suggest?

A

Renal colic, moving from loin down to RLQ, haematuria

Urinalysis, renal US scan, IVU, CT or MRI

27
Q

What characterises salpingitis? And what would you suggest?

A

fever, nausea, vomiting, mucopurulent cervical discharge, irregular menses, bilateral lower abdominal pain, tenderness and guarding

High vaginal swab

OSCE - histories (20 decks)

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