Left Iliac Fossa Pain Flashcards

1
Q

What are the surgical emergencies in a 76yo lady presenting with left iliac fossa pain?

A

Acute diverticulitis
Leaking AAA
Locally perforated sigmoid carcinoma
Pyelonephritis

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2
Q

What are the differentials in a 76yo lady with left iliac fossa pain that aren’t surgical emergencies?

A
Constipation
IBD
Ischaemic colitis
Pseudomembranous colitis
UTI
Ureteric colic
IBS
Shingles
Rectus sheath haematoma
DKA
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3
Q

Pain that is initially poorly

localized, midline, and colicky but which then migrates to the LIF and becomes constant is highly suggestive of what?

A

Acute diverticulitis

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4
Q

Pain that migrates down the left flank and iliac fossa suggests what?

A

Migration of a ureteric stone

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5
Q

What does sharp iliac fossa pain suggest?

A

Haemorrhage, perforation or torsion

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6
Q

What questions should you ask with someone with LIF pain?

A

SOCRATES

Nausea & Vomiting - Acute diverticulitis/PID
Fever
Change of bowel habits
Rectal bleeding
Bloating - Characteristic of IBS
Weight loss
Gynaecological symptoms
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7
Q

Why are colonoscopy and double-contrast barium enema contraindicated in the acute setting of LIF pain?

A

Risk of perforating the acutely inflamed colon

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8
Q

How is acute diverticulitis managed in the acute phase?

A

Analgesia

Bowel rest

IV fluids

Antibiotics

Monitor

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9
Q

What are the main complications of diverticulitis?

A

Perforation

Abscess formation

Fistulation

Chronic inflammatory strictures resulting in bowel obstruction

Haemorrhage

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10
Q

Are colovesical fistulas more common in men or women? Why?

A

Men

Thought to be because the uterus sits between the sigmoid and the bladder, forming a barrier to colovesical fistula formation

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11
Q

What is the most common type of fistula formation caused by diverticulitis?

A

Colovesical

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12
Q

What are the main risk factors for ectopic pregnancy?

A
Previous ectopic pregnancy
PID
Tubular procedures eg sterilization
Endometriosis
Pelvic surgery
IVF
Intrauterine contraceptive device
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13
Q

What is Hinchey’s classification?

A

This classification represents an assessment of peritoneal contamination at the time of surgery in the context of acute diverticulitis

As such, it may be used as a guide to the suitability for primary anastomosis following resection

I - Pericolic or mesenteric abscess
II - Walled-off pelvic abscess
III - Generalised purulent peritonitis (~5% mortality)
IV - Generalised faecal peritonitis (~35% mortality)

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