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
Abdominal pain relieved by defecation indicates …
IBS
Microcytic anaemia and diarrhoea indicates …
Left sided colorectal cancer
Multiple colonic polyps in 20s ….
Familial adenosis polyposies coli
Shifting dullness during abdominal exam indicates…
Ascites
What investigation is indicated in unexplained iron deficiency anaemia?
Upper and lower GI endoscopy
Tip - do not diagnose … in an older patient without being sure
IBS
CA-125 being high indicates what?
Ovarian cancer
