Diseases of Combined Stations (Procedures and Examinations)

Question 1

Acute abdomen
Describe the presentation / symptoms of appendicitis/peritonitis.

Answer 1

• Hx of migration of site of pain;
• Worse on movement;
• Associated with N&V;
• Fever;
• McBurney’s sign positive;
• Rovsing’s sign positive;
• Rebound tenderness;

Signs and symptoms of accompanying peritonitis
- Fullness Hx;
- Rigidity on palpation;
- Hypoactive bowel sounds on auscultation.

Question 2

Acute abdomen

Describe the symptoms/presentation of Biliary disease.

Answer 2

The biliary system is made up of organs and ducts that produce and store bile (helps break down fats and eliminate waste).
Is it composed of the: liver and gall bladder.

Biliary colic: (stones are lodged in the ducts of the gall bladder)
- RUQ pain only;
- Comes in waves (colicky);
- Radiates to the right shoulder;
- Aggravated by fatty meals.

Acute Cholecystitis: (Inflammation of the gallbladder that occurs when stones or sludge block the duct)
- RUQ pain + Fever
- Murphy’s sign positive on examination.

Acute cholangitis: (Inflammation of the bile duct, usually caused by bacteria ascending from its junction with the duodenum. It tends to occur if the bile duct is already partially obstructed by gallstones.)
CHARCOT’s TRIAD
- RUQ Pain;
- Fever;
- Jaundice;
• Steatorrhea;
• Brown urine;
• Itching;
• LFT’s raised