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Clinical Presentations Flashcards

1
Q

Abdo pain DDX

A 
GIT
gastroduodenal
intestinal
hepatobiliary
pancreatic
splenic

Urinary tract
Gynae
Vascular
Peritoneum
Abdominal wall
Retroperitoneum
Referred pain
Medical causes
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2
Q

Abdo pain DDX

gastroduodenal

A

Peptic ulcer
Gastritis
Malignancy
Gastric volvulus

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3
Q

Abdo pain DDX intestinal

A
  • Appendicitis
  • Obstruction
  • Diverticulitis
  • Gastroenteritis
  • Mesenteric adenitis
  • Strangulated hernia
  • Inflammatory bowel disease
  • Intussusception
  • Volvulus
  • TB
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4
Q

Abdo pain DDX hepatobiliary

A
  • Acute cholecystitis
  • Chronic cholecystitis
  • Cholangitis
  • Hepatitis
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5
Q

Abdo pain DDX pancreatic

A
  • Acute pancreatitis
  • Chronic pancreatitis
  • Malignancy
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6
Q

Abdo pain DDX splenic

A
  • Infarction

* Spontaneous rupture

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7
Q

Abdo pain DDX Urinary tract

A
  • Cystitis
  • Acute retention of urine
  • Acute pyelonephritis
  • Ureteric colic
  • Hydronephrosis
  • Tumour
  • Pyonephrosis
  • Polycystic kidney
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8
Q

Abdo pain DDX Gynae

A
  • Ruptured ectopic pregnancy
  • Torsion of ovarian cyst
  • Ruptured ovarian cyst
  • Salpingitis
  • Severe dysmenorrhoea
  • Mittelschmerz
  • Endometriosis
  • Red degeneration of a fibroid
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9
Q

Abdo pain DDX Vascular

A
  • Aortic aneurysm
  • Mesenteric embolus
  • Mesenteric angina (claudication)
  • Mesenteric venous thrombosis
  • Ischaemic colitis
  • Acute aortic dissection
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10
Q

Abdo pain DDX Peritoneum

A

1 or 2 peritonitis

primary spontaneous peritonitis = infection that develops in the peritoneum

secondary peritonitis, which usually develops when an injury or infection in the abdominal cavity allows infectious organisms into the peritoneum.

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11
Q

Abdo pain DDX Abdominal wall

A
  • Strangulated hernia
  • Rectus sheath haematoma
  • Cellulitis
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12
Q

Abdo pain DDX Retroperitoneum

A

Retroperitoneal haemorrhage, e.g. anticoagulants

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13
Q

Abdo pain DDX Referred pain

A
  • Myocardial infarction
  • Pericarditis
  • Testicular torsion
  • Pleurisy
  • Herpes zoster
  • Lobar pneumonia
  • Thoracic spine disease, e.g. disc, tumour
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14
Q

Abdo pain DDX Medical causes

A
  • Hypercalcaemia
  • Uraemia
  • Diabetic ketoacidosis
  • Sickle cell disease
  • Addison’s disease
  • Acute intermittent porphyria
  • Henoch–Schönlein purpura
  • Tabes dorsalis
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15
Q

Abdo pain Dx General

A 
FBC ESR
U+Es
LFTs
Serum amylase
MSU
CXR
AXR
US
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16
Q

Abdo pain Dx Specific

A 
BG
Serum Ca
CRP
VDRL
Sickling test
Urinary porphobilinogens
ABGs
BHCG
ECG
OGD
IVU
Barium enema
Small bowel enema
Duplex Doppler
Angiography
CT
MRCP
17
Q

Abdo pain DDx beware

A

• Always examine the hernial orifices.
• Always check for localised tenderness if colicky
abdominal pain becomes constant. Tachycardia,
fever and a raised white cell count suggests
infarction.

18
Q

Abdominal Swellings

RIGHT UPPER QUADRANT
DDx

A

LIVER

GALL BLADDER
• Secondary to carcinoma of the head of the pancreas
• Mucocele
• Empyema
• Carcinoma
RIGHT COLON
• Carcinoma
• Faeces
• Diverticular mass
• Caecal volvulus
• Intussusception
RIGHT KIDNEY
• Carcinoma
• Polycystic kidney
• Hydronephrosis
• Pyonephrosis
• Perinephric abscess
• TB
• Solitary cyst
• Wilms’ tumour (nephroblastoma)
19
Q

Courvoisier’s law

A

‘in the presence of obstructive jaundice, if the gall bladder is palpable the cause is unlikely to be due to gallstones’

20
Q

Abdominal Swellings
RIGHT UPPER QUADRANT
Dx general

A 
FBC ESR
U+E
LFT
MSU
AXR
US
21
Q

Abdominal Swellings
RIGHT UPPER QUADRANT
Dx specific

A

Barium enema
Colonoscopy
CT

22
Q

Abdominal Swellings
LEFT UPPER QUADRANT
CAUSES

A 
SPLEEN
STOMACH
• Carcinoma
• Gastric distension (acute dilatation, pyloric stenosis)
PANCREAS
• Pseudocyst
• Carcinoma
KIDNEY
See right upper quadrant, p. 9.
COLON
• Carcinoma of the splenic flexure
• Faeces
• Diverticular mass
23
Q

Abdominal Swellings
LEFT UPPER QUADRANT
Dx general

A 
FBC ESR
U+E
LFT
Serum amylase
US
24
Q

Abdominal Swellings
LEFT UPPER QUADRANT
Dx specific

A 
BG
Barium enema
Colonoscopy
Gastroscopy
CT
25
Q

Abdominal Swellings EPIGASTRIUM

DDx

A 
ABDOMINAL WALL
• Lipoma
• Epigastric hernia
• Xiphisternum
• Metastatic deposits
STOMACH
• Congenital hypertrophic pyloric stenosis
• Carcinoma
• Acute gastric volvulus
PANCREAS
See left upper quadrant, p. 11.
TRANSVERSE COLON
• Carcinoma
• Faeces
• Diverticular mass
LIVER
See hepatomegaly, p. 215.
RETROPERITONEUM
• Aortic aneurysm
• Lymphadenopathy (lymphoma, secondaries from testicular
carcinoma)
OMENTUM
• Omental secondaries, e.g. stomach and ovary
26
Q

Abdominal Swellings EPIGASTRIUM

Dx specific

A

FBC ESR
U+Es
LFts
US

Blood glucose
May be abnormal with pancreatic carcinoma or previous
pancreatitis.
■■ CT
Pancreatic tumours. Pancreatic pseudocyst. Lymphadenopathy.
Aortic aneurysm. Omental deposits. Guided biopsy/FNAC.
■■ Barium enema
Carcinoma of the colon. Diverticular disease.
■■ Colonoscopy
Carcinoma of the colon. Diverticular disease.
■■ Gastroscopy
Carcinoma of the stomach.
■■ Laparoscopy
Carcinoma of the ovaries. Omental secondaries. Carcinomatosis
peritonei.
■■ Biopsy.

27
Q

UMBILICAL swelling DDX

A 
SUPERFICIAL
• Sister Joseph’s nodule (malignant)
HERNIA
• Paraumbilical
• Umbilical (children)
STOMACH
• Carcinoma
TRANSVERSE COLON
• Carcinoma
• Faeces
• Diverticular mass
SMALL BOWEL
• Crohn’s disease
• Carcinoma
• Mesenteric cysts
OMENTUM
• Secondary deposits, e.g. stomach, ovary
RETROPERITONEUM
• Aortic aneurysm
• Lymph nodes, e.g. lymphoma, secondaries from testicular
carcinoma
28
Q

UMBILICAL swelling IX

A

GENERAL INVESTIGATIONS
■■ FBC, ESR
Hb  carcinoma. WCC  diverticular disease.
■■ U&Es
Vomiting. Dehydration, e.g. carcinoma of the stomach,
carcinoma of the bowel, Crohn’s disease.
■■ LFTs
Alkaline phosphatase raised with liver secondaries.
■■ US
Aortic aneurysm. Retroperitoneal lymphadenopathy.
SPECIFIC INVESTIGATIONS
■■ CT
Aortic aneurysm. Retroperitoneal lymphadenopathy. Omental
deposits. Guided biopsy/FNAC.
■■ Barium enema
Carcinoma of the colon. Diverticular disease.
■■ Colonoscopy
Carcinoma of the colon. Diverticular disease.
■■ Gastroscopy
Carcinoma of the stomach.
■■ Small bowel enema
Crohn’s disease. Lymphoma. Carcinoma.
■■ Laparoscopy
Carcinoma of the ovaries. Omental secondaries. Carcinomatosis
peritonei.
■■ Biopsy
Benign versus malignant.

29
Q

RIGHT AND LEFT LOWER QUADRANTS SWELLING

CAUSES

A 
ABDOMINAL WALL
• Lipoma
• Spigelian hernia
LARGE BOWEL
RIGHT LOWER QUADRANT • Appendix mass/abscess
• Carcinoma of the caecum
• Carcinoma of the ascending colon
• Faeces
• Crohn’s disease
• Caecal volvulus
• Intussusception
LEFT LOWER QUADRANT • Carcinoma of the sigmoid colon
• Diverticular mass
• Faeces
• Sigmoid volvulus
• Crohn’s disease
SMALL BOWEL
• Crohn’s disease
• Carcinoma
• Lymphoma
• Ileo-caecal TB
OVARY/UTERUS/FALLOPIAN TUBE
• Ovarian cyst
• Ovarian neoplasm
• Ectopic pregnancy
• Tubo-ovarian abscess
• Uterine fibroid
KIDNEY
SPLEEN (MASSIVE SPLENOMEGALY)

RETROPERITONEUM
• Iliac artery aneurysm
• Lymphadenopathy
• Neoplasm of iliac bone, e.g. osteogenic sarcoma, Ewing’s
tumour
30
Q

RIGHT AND LEFT LOWER QUADRANTS SWELLING IX

A

GENERAL INVESTIGATIONS
■■ FBC, ESR
Hb  Crohn’s disease, carcinoma. ESR  carcinoma, Crohn’s
disease, ileo-caecal TB. WCC  appendicitis, diverticulitis.
■■ U&Es
Vomiting. Dehydration. Obstruction from carcinoma or Crohn’s disease.
■■ LFTs
Alkaline phosphatase  with liver secondaries.
■■ US
Ovarian lesions. Uterine lesions. Tubo-ovarian abscesses.
Pregnancy. Ectopic pregnancy. Iliac artery aneurysms.
Lymphadenopathy. Appendix mass. Crohn’s mass.
■■ AXR
Obstruction. Dilated loops of bowel. Ovarian teratoma (teeth,
etc.). Erosion of iliac bone – bone tumours.
SPECIFIC INVESTIGATIONS
■■ bHCG
Raised in pregnancy.
■■ Mantoux test
Ileo-caecal TB.
■■ CT
Ovarian lesions. Uterine lesions. Abscess. Ectopic pregnancy.
Iliac artery aneurysm. Lymphadenopathy. Appendix mass. Bone
tumours.
■■ Barium enema
Carcinoma. Diverticular disease.
■■ Small bowel enema
Crohn’s disease. Carcinoma. Lymphoma.
■■ Colonoscopy
Carcinoma (biopsy). Diverticular disease.
■■ Laparoscopy
Carcinoma, Crohn’s disease, ileo-caecal TB.
■■ Bone scan
Bone tumour.

31
Q

SUPRAPUBIC SWELLING CAUSES

A 
BLADDER
• Acute retention
• Chronic retention
• Carcinoma
UTERUS
• Pregnancy
• Fibroids
• Carcinoma
BOWEL
• Diverticular mass
• Crohn’s disease
• Carcinoma
OTHER
• Urachal cyst.
32
Q

SUPRAPUBIC SWELLING IX

A 
GENERAL INVESTIGATIONS
■■ FBC, ESR
Hb  tumour. WCC  infection.
■■ MSU
Red cells. White cells. Organisms, (infection precipitating)
retention. Malignant cells with carcinoma.
■■ US
Pregnancy. Fibroids. Bladder tumour. Urachal cyst.
SPECIFIC INVESTIGATIONS
■■ bHCG
Pregnancy.
■■ PSA
Carcinoma of the prostate.
■■ Cystoscopy
Bladder tumour. Biopsy.
■■ Barium enema
Colonic carcinoma. Diverticular disease. Crohn’s disease.
■■ Colonoscopy
Carcinoma. Diverticular disease.
■■ CT
Ovarian lesions. Uterine lesions. Bladder lesions. Urachal cyst.

DDx (3 decks)

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