Acute abdomen

Question 1

(6) Causes of pain in RIF (right iliac fossa)/RLQ abdomen

Answer 1

• Appendicitis
• Ovarian cyst (do a pelvic US)
• Terminal ileitis as a first Px of Crohn’s
• Meckel’s diverticulum (no bowel habit changes)
• complicated inguinal herniae
• gall bladder disease

Question 2

What (1) test should you do in a RIF pain in female?

Answer 2

urine beta-hCG

Question 3

Gynaecological causes of RIF pain

Answer 3

• Phsyiologic/pathologic ovarian torsion/ruptured cyst (sudden onset)
• endometeriosis
• PID/salpingitis
• pregnancy-related

Question 4

Medical (non GI/gynaecological) causes of RLQ abdomen pain

Answer 4

• mesenteric adenitis
• irritable bowel syndrome
• UTI/sepsis/pyelonephritis
• pneumonia
• inguinal lymphadenopathy

Question 5

2 very sensitive Ix for appendicitis

Answer 5

CT scan (-: irradiation in young/pregnant women)
Diagnostic laparoscopy

Question 6

Mx in an abdomen infection e.g. appendicitis

Answer 6

Resuscitation
Analgesia
Cannulae in, bloods first
NBM + trial of food 
Antibiotics: Ceftriaxone + metronidazole 

Watch for a day (4 hourly serial examinations) but DO NOT discharge -> diagnostic laparoscopy

Question 7

Pros and Cons of removing a normal appendix during diagnostic laparoscopy

Answer 7

Pros:

• it may be pathological microscopically although it looks normal
• gets rid of future cause
• already within the abdomen

Cons:
- risks of extra procedure

Question 8

What would you talk about with a pt who has multiple partners + unprotected sex?

Answer 8

• risks to all other partners
• pregnancy issue education
• counselling for her behaviour (there may be underlying causes e.g. depression)