GIT Cases Flashcards
- long standingalcohol misuse
- Parents alcoholics
- cask of port a day
- severeabdominal pain that radiates to the back
- sweating and feeling very weak.
- What physical examination would you perform?
- What is going on with this patient?
- What is the next appropriate step?
- What are the long term management issues?
What physical examination would you perform?
Vital signs
- May be febrile, tachycardic, low blood pressure if very unwell
General observation
- Usually in distress due to pain
Abdominal exam –looking for peritonism
What is going on with this patient?
Pancreatitis secondary to alcohol
Appropriate differential diagnoses
- Peptic ulcer disease
- Impacted gall stone
- Ascending cholangitis
- Reflux
- Oesophagealspasm
- Heart attack
- Ruptured abdominal aneurysm
- Pneumonia
What is the next appropriate step?
- Emergency department referral
- Confirm diagnosis with blood lipase levels and CT abdomen
- Nil by mouth
- Intravenous fluids
- Strong analgesia
- Monitor levels
- Monitor for complications (acute respiratory distress, necrotising
What are the long term management issues?
- RISK LEVEL of alcohol intake
- At risk of alcoholic liver disease, cirrhosis and its complications
- Will require support in this – drug and alcohol specialists
- May need psychological support
- Ask for other recreational drug use
- HepA and B vaccines
- Malnutrition in alcoholics – thiamine (type of vitamin B) replacement
- Complications of alcohol misuse – b12 deficiency and peripheral neuropathy
Intermittent abdominal pain
- Physical exam
- Differentials/provisional diagnosis
- Investigations
- Treatment
- What happened
Physical exam
- V signs
- abdominalexamination –tenderness, distension
Differentials/provisional diagnosis
- IBS (more common)
- Coeliac disease (important to exclude)
- gynaecologicalpathology (no gynaesymptoms
Investigations
blood tests –exclude coeliac disease and nutrient deficiencies
Treatment
- IBS –dietary modification, regular exercise, manage stress
- Coeliac–gluten free diet
Conclusion:
Patient was referred to gastroenterologist who performed an endoscopy and colonoscopy which were normal. She was diagnosed with probably IBS. She was encouraged to stick as much as possible to foods that did not cause her pain, and to avoid alcohol and coffee. She was also referred to a psychologist to manage her stress
