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Z Year3 Clinical Presentations > Left Iliac Fossa Pain > Flashcards

Left Iliac Fossa Pain Flashcards

1
Q

What are the gastro differentials for LIF pain in post-menopausal women?

A
  1. Acute diverticulitis
  2. Constipation
  3. IBD
  4. Ischaemic colitis
  5. Pneudomembranous colitis
  6. Locally perforated sigmoid carcinoma
  7. IBS
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2
Q

What are the non-gastro differentials for LIF pain in post-menopausal women?

A
  1. Leaking AA
  2. UTI
  3. Uteric coli
  4. Pyelonephritis
  5. Shingles
  6. Rectus Sheath haematoma
  7. Diabetic ketoacidosis
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3
Q

What are the non-gastro differentials for LIF pain in premenopausal women?

A
  1. Ectopic pregnancy
  2. Mittelschmeriz
  3. Haemorrhage into a functional ovarian cyst
  4. Pelvic inflammtory disease
  5. Torsion/rupture of an ovarian cyst
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4
Q

What are the non-gastro differentials for LIF pain in men?

A
  1. Testicular torsion

2. Haemorrhage into a testicular tumour

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5
Q

What would pain initially poorly localised, midline and colicky then migrates to LIF suggest?

A

acute diverticulitis

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6
Q

What would pain that migrates down the left flank and iliac fossa suggest?

A

ureteric stone

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7
Q

What would sudden onset LIF pain suggest?

A
  1. perforation of viscus
  2. acute haemorrhage (e.g. into ovarian cyst or from ruptured AAA)
  3. torsion (ovary, testes)
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8
Q

What would initially colicky midline pain to LIF pain suggest?

A

acute diverticulitis

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9
Q

What would colicky LIF pain suggest?

A

ureteric calculi

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10
Q

What would constant LIF pain suggest?

A

established diverticulitis and other

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11
Q

What would sharp LIF pain suggest?

A
  1. haemorrhage
  2. perforation
  3. torsion
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12
Q

What would LIF pain that radiates to groin suggest?

A

ureteric pain

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13
Q

What would LIF pain that feels better with defecation suggest?

A

IBS

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14
Q

What would LIF pain that feels better when lying still?

A

peritonitis

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15
Q

What would LT abdominal discomfort for months and years with LIF pain suggest?

A

IBS

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16
Q

What would a 2-3 day history of LIF pain and pervious episodes suggest?

A

acute diverticulitis

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17
Q

What would LIF pain with nay movement being painful?

A

peritonitis (e.g. due to colonic perforation)

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18
Q

What would excruciating LIF pain suggest?

A
  1. ureteric colic

2. colonic perforation secondary to diverticulitis or a sigmoid carcinoma

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19
Q

What would LIF pain with nausea and vomiting suggest?

A
  1. acute diverticulitis

2. pelvic inflammatory disease

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20
Q

What would LIF pain with fever suggest?

A
  1. acute diverticulitis

2. infection

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21
Q

What would LIF pain with a prolonged change in bowel habit suggest?

A
  1. IBS
  2. diverticular disease
  3. IBD
  4. colorectal carcinoma
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22
Q

What would LIF pain with rectal bleeding suggest?

A
  1. acute diverticulitis
  2. bloody diarrhoea with UC
  3. psedomembranous colitis
  4. ischaemic colitis
  5. colorectal carcinoma
23
Q

What would LIF pain with bloating suggest?

A

IBS

24
Q

What would LIF pain with weight loss suggest?

A

colorectal carcinoma

25
Q

What gyancological symptoms do you check with LIF pain and why?

A
  • new vaginal discharge and or dyspareunia consistent with pelvic inflammatory disease
  • check any chance of pregnancy
26
Q

What MHx do you ask about with LIF pain?

A
  1. Steroids

2. Recent use of antibiotics, PPIs

27
Q

Why do you check if patient is taken steroids?

A

can dampen inflammatory response, masking signs and symptoms

28
Q

Why do we check if patient with LIF pain has recent use of antibiotics and PPIs?

A

potentially pseudomembranous colitis (c.diff colitis) in patient with LIF pain and diarrhoea

29
Q

What do you look for in general examination of patient with LIF pain?

A
  1. How unwell?
  2. Does she appear to have generalised peritonitis?
  3. Withering in pain unable to keep still?
  4. Signs of GI malignancy
30
Q

How do you check how unwell a patient is?

A

check obs: HR, BP, temp, repsiration + sats

31
Q

What are signs of generalised peritonitis?

A

Is she lying very still, taking shallow breaths and looking pale?

32
Q

What would a patient with LIF pain writhing in pain, unable to keep still suggest?

A

ureteric colic

33
Q

What are signs of GI malignancy in general examination?

A

cachetic, jaundiced

34
Q

What do you look for in the abdominal exam for someone with LIF pain?

A
  1. Focal tenderness
  2. Generalised peritonitis
  3. Massess
  4. Left supraclavicular lymphadenopathy (Troisier’s sign)
35
Q

What would focal tenderness with LIF pain suggest?

A

uncomplicated acute diverticulitis

36
Q

What would generalised peritonitis (guarding, rigid abdo, absent bowel sounds) with LIF pain suggest?

A

suspect perforation of colonic diverticulum, sigmoid carcinoma or AAA

37
Q

What would palpable masses in LIF suggest?

A
  1. Acute diverticulitis
  2. Sigmoid carcinoma may also be palpable
  3. Centrally laterally pulsatile mass is AAA until proven otherwise
38
Q

What would left supraclavicular lympathdenopathy (Troisier’s sign) with LIF pain suggest?

A

GI malignancy

39
Q

Why do you carry out a rectal exam in LIF pain patient?

A

detect a pelvic abcess in patients with acute diverticluitis or detect a rectal malignancy

40
Q

When do you do a vaginal exam with LIF pain?

A

if also new vaginal discharge

41
Q

What may you find on a vaginal exam with LIF pain?

A

cervical motion tenderness - pelvic inflammatory disease

42
Q

What blood tests do you use for LIF pain?

A
  1. VBG
  2. FBC
  3. U+Es
  4. CRP
43
Q

Why do you do a VBG with LIF pain?

A
  1. High lactate and/or metabolic acidosis: ischaemic bowel

2. Glucose: check if diabetic ketoacidosis

44
Q

What are you looking for in FBC with LIF pain?

A

WCC elevated in inflammtory conditions e.g. acute diverticulitis + pseudomembranous colitis

45
Q

Why do you do U+Es in LIF pain?

A
  • Establish baseline before IV fluids / surgery

- check no AKI

46
Q

Why do you do CRP in LIF pain?

A

useful for UC and c.diff colitis

47
Q

What imaging do you use if you suspect diverticulitis and why?

A
  1. Abdominal CT with contrast
  2. CXR: if any clinical suspicion of perforated viscus
  3. AXR: to rule out bowel obstruction
48
Q

What other imaging would you do if a woman is premenopausal?

A

transabdominal ± transvaginal US

49
Q

What imaging can you not use in acute phase of illness/acute diverticulitis?

A

colonscopy or double contast barium enema

50
Q

What is the management of acute diverticulitis in the acute phase?

A
  1. Analgesia
  2. Bowel rest: by clear fluids only
  3. IV fluids: if unable to maintain sufficient oral intake
  4. Antibiotics: cover Gram neg bacteria and anaerobes
  5. Venous thromboembolism prophylaxis
  6. Monitor: if symptoms do not improve within 48-72hrs further investigation
51
Q

When is a patient with acute diverticulitis offered a colonoscopy (or barium enema)?

A

2-6 weeks after resolution of this episode to confirm diagnosis

52
Q

Why do you do a colonsocpy in acute diver?

A
  • assess extent of diverticulosis and the degree of stricturing secondary to inflammation
  • can exclude other diagnoses e.g. carcinoma or colitis
53
Q

What is the conservative management for acute diver?

A

maintain high intake dietary fibre to reduce future episodes

54
Q

When is patient with acute diver offered colonic resection?

A

if two future acute diverticulitis episodes also lead to hospital admission

Z Year3 Clinical Presentations (37 decks)

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