Case 3 - Bloating Flashcards
Differential diagnosis of bloating, the five Fs
The five Fs:
- Fat
- Faeces
- Fluid (Ascites)
- Flatus (obstruction)
- Foetus
Differential diagnosis of bloating - conditions
Intra-abdominal malignancy Irritable bowel syndrome Ascites Small or large bowel obstruction Constipation Splenomegaly Hepatomegaly Coeliac disease Urinary retention Obesity PCKD Fibroids
Colorectal cancer: Right-side presents… (3)
Insidious onset, unexplained iron-deficiency anaemia, weight loss
Colorectal cancer: Left-side presents… (2)
Change in bowel habit, tenesmus
Colorectal cancer: risk factors (6)
Obesity IBD Familial adenomatous polypodies Hereditary non-polypodies colorectal cancer Low fibre High red meat
Duke’s staging for colorectal cancer
A = cancer in the mucosa only
B = Breaches muscle
C = Spread to local lymph node
D - Distant metastatic spread
Colorectal cancer - Tests and Therapy
Faecal occult blood screening
MRI staging for rectal
Chemo+surgery
Radiotherapy for rectal
IBS - Rome III criteria
More than 3 months of pain
- Relieved with defecation
- Change of stool form
- Change of stool frequency
Irritable bowel syndrome - treatment
Mebeverine, hyoscine, loperamide, diet (Reduced insoluble fibre, reduced sugar, dietary exclusions)
Ovarian carcinoma: diagnosis is … and prognosis is …
Late diagnosis, poor prognosis
What treatments can be done for ovarian carcinoma? (2)
Try chemotherapy, debunking surgery
Omental carcinomatosis - omental ‘cake’ - what cancers are associated with this?
Ovarian carcinoma is most common - colonic, gastric and pancreatic carcinomas among other intra-abdominal are also possible
Bloating may be a non-specific presentation of …
Ovarian carcinoma
No vomiting with bloating makes what less likely??
Bowel obstruction
Bloating and pain not relieved by defecation makes what less likely?
Less likely to be IBS
