Billary Cases

Question 1

Abdo Pain in ED:

Associated Symptoms to ask about

Answer 1

• Associated symptoms-fever, vomiting, backpain, collapse
• Bowel movement
• Urinary symptoms
• LMP etc

Question 2

Abdo Pain in ED: Investigations

Answer 2

• Urinalysis & pregnancy test
• VBG-lactate, BM
• ECG (>50 years or cardiac hx)
• FAST scan-AAA & free fluid
• bloods
• Imaging: Erect CXR-perforated viscus; Ultrasound scan-GB, kidneys, AA, ovaries

Question 3

Abdo Pain in ED: Life-threatening conditions

Answer 3

• AAA
• Ruptured solid organ(spleen. Liver, kidney)
• Perforated viscus (duodenum, appendix, colon)
• Ruptured ectopic pregnancy
• Ischaemic bowel
• Bowel obstruction
• Abdominal trauma (blunt & penetrating)
• Torsion of the testis/ovary

Question 4

Abdo Pain in ED: Risk Factors for ruptured ectopic pregnancy

Answer 4

–previous ectopic
–PID
–Tubal damage ect.

Question 5

Abdo Pain in ED: Medical causes

Answer 5

• Acute Coronary Syndrome (ACS)
• Pneumonia
• DKA
• Hypercalcaemia

Question 6

Abdo Pain in ED: General Mangement

Answer 6

• Decision not diagnosis
• Analgesia-iv paracetamol, morphine(titrate)
• Anti-emetic
• Iv fluids
• Iv antibiotics for intraabdominal sepsis(guidelines)
• NBM
• NG tube
• Urinary catheter