Investigations

Question 1

RIF investigations FBC?

Answer 1

WCC may be raised in appendicitis, cholecystitis, basal pneumonia.

Question 2

RIF investigations CRP?

Answer 2

inflammatory markers

Question 3

RIF investigations VBG?

Answer 3

raised lactate and/or rasied metabolic acidosis are signs of ischaemia or sepsis

Question 4

RIF investigations U&Es

Answer 4

useful for baseline electrolyte status.

Question 5

RIF investigations serum amylase?

Answer 5

suggestive of pancreatitis.

Question 6

RIF investigations glucose?

Answer 6

diabetic ketoacidosis can present with an acute abdomen

Question 7

RIF investigations liver enzymes?

Answer 7

in context of raised amylase, provide prognostic info for pancreatitis, also useful for suspected biliary pathology.

Question 8

RIF investigations urinalysis?

Answer 8

haematuria may result from infection. Glucose and ketones are indicative of diabetic ketoacidosis. Positive leacucyte esterase and nitrates is UTI. UTI and appendiceal irritation of the bladder casue proteinuria.

Question 9

RIF investigations Abdominal USS?

Answer 9

useful for renal and biliary pathologies, can pick up appendicitis.

Question 10

RIF investigations erect CXR?

Answer 10

if suspected perforated viscus, as air seen under diaphragm.

Question 11

RIF investigations abdominal CT?

Answer 11

for determining extent of intra-abdominal collections and masses.

Question 12

RIF acute appendicitis?

Answer 12

low grade central abdominal pain that gradually migrates to RIF over 12 hrs and becomes more intense.

Question 13

RIF mesenteric adenitis?

Answer 13

follows upper respiratory tract infection or sore throat, common in children <15. The pain is often more diffuse than appendicitis, and signs of peritonitis are absent.

Question 14

RIF meckels diverticulitis?

Answer 14

classically indistinguishable from appendicitis

Question 15

RIF constipation?

Answer 15

wouldn’t cause a migration of pain to RIF, never results in fever or tachycardia

Question 16

RIF acute onset crohns?

Answer 16

often a history of diarrhoea and weight loss for weeks before.

Question 17

RIF Gastroenteritis?

Answer 17

vomiting and dairrhoea predominate.

Question 18

RIF renal/uretic colic?

Answer 18

writhing in pain rather than lying still.

Question 19

RIF pancreatitis?

Answer 19

migration of pain to RIF is atypical, and thered be epigastric pain.

Question 20

RIF testicular pathology?

Answer 20

no signs of testicular tenderness or any palpable abnormality.

Question 21

Management of appendicitis?

Answer 21

Adequate analgesia, IV fluids, first line treatment is appendectomy, should be NBM 6 hrs before. Perioperative broad spectrum antibiotics to reduce wound infection and abscess formation.