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Y3 Oxford Cases > Left Iliac Fossa Pain > Flashcards

Left Iliac Fossa Pain Flashcards

1
Q

What are the differentials for left iliac fossa pain

A 
Acute diverticulitis
Constipation
IBD
Ischaemic colitis
Pseudomembranous colitis
AAA
Locally perforated sigmoid carcinoma
UTI 
Pyelonephritis
IBS
Shingles
DKA
Testicular torsion or haemorrhage into tumour
Ectopic pregnany, Mittelschmerz (mid-cycle pain) or haemorrhage into cyst
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2
Q

Which differentials for LIF pain can only occur in menstruating women

A

Ectopic pregnancy
Mittelschmerz
Haemorrhage into ovarian cyst

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3
Q

What does the site of LIF pain indicate

A

Poorly localised initially (intermittent) then migrates to LIF (constant) is suggestive of acute diverticulitis
Migration of pain down the flank and iliac fossa is suggresive of a uteric stone

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4
Q

What does the onset of LIF pain suggest

A

Sudden - suggestion of a perforation of viscus or acute haemorrhage or torsion

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5
Q

What does the character of LIF suggest

A

Colicky midline pain - acute diverticulitis
Colicky pain - Uteric calculi
Constant - established diverticulitis and others
Sharp - haemorrhage, perforation or torsion

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6
Q

What does any alleviating factors suggest

A

Discomfort due to IBS may be alleviated by defecation

Lying still may be alleviating for peritonitis

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7
Q

What does the timing of LIF suggest

A

many months or years - IBS

2-3 days with previous episode - Acute diverticulitis

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8
Q

What is the relevance of exacerbating factors of LIF pain

A

Motion - peritonitis e.g. pain every time they hit a bump on a road

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9
Q

What other symptoms should be enquired about with LIF pain

A

Nausea and vomiting (acute diverticulitis)
Fever (infection, inflammation)
Change in bowel habits (IBS, diverticular, IBD, carcinoma)
Rectal bleeding (diverticulitis, UC, PM colitis, ischaemic colitis, colorectal carcinoma
Bloating (IBS)
Weight loss (carcinoma)
Gynaecological problems - new discharge, dyspareunia (pelvic inflammatory disease, pregnancy)

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10
Q

What should be asked about in the drug history for LIF pain

A

Steroids (dampen the inflammatory response and masks signs and symptoms)
Antibiotics - C. diff and PM colitis

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11
Q

What should be looked for on exam for LIF pain

A

How unwell they look, basic obs
Peritonitis? (staying still, small breaths and pale)
Writhing in pain? unable to keep still?
Cachetic or jaundice?

Focal tenderness
Generalised peritonitis
Massess
Troisier’s signs (left supraclavicular lymphadenopathy) - GI malignancy

Rectal exam - pelvic abscess, rectal malignancy

Vaginal exam - Cervical motion tenderness -> pelvic inflammatory disease

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12
Q

What blood tests should be ordered for LIF pain

A

VBG - lactate and metabolic acidaemia (ischaemic bowel), check glucose for DKA
FBC - WCC raised in inflammation
U+Es - Fluid status for resus
CRP - inflammation

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13
Q

What investigations may be ordered for suspected diverticulits

A

Abdominal CT with contrast - imaging of choice of diverticulitis
Erect CXR - pneumoperitoneum
AXR - rule out bowel obstruction

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14
Q

Management for acute diverticulitis

A
  1. Analgesia
  2. Bowel rest
  3. IV fluids
  4. antibiotics
  5. VTE prophylaxis
  6. Monitor
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15
Q

What is the follow up for acute diverticulitis

A

Offer colonoscopy or barium enema 2-6 weeks after resolution to visualised the colonic lumen and confirm diagnosis
Assess the extent of diverticulosis and the degree of stricturing + exclude other differentials

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16
Q

What is the classic presentation for acute pelvic inflammatory disease

A 
Sexually active women
Acute lower abdominal pain
New vagina discharge
Vomiting 
Fever
Adnexal tenderness
17
Q

What are the most common causes of pelvic inflammatory disease

A

STIs, bacterial e.g. chlamydia or gonorrhoea

18
Q

What is the management of Pelvic inflammatory disease

A

Vagina, urethral and endocervical swabs
Empirical antibiotics
Referral to GUM clinic
Avoidance of sexual intercourse during treatment
Partner notification
Consider alternative contraception to protect against STIs

19
Q

What are the main complications of diverticulitis

A 
Perforation -> abscess, peritonits
Abscess foramtion
Fistulation into adjacent structures
Chronic inflammatory structures -> bowel obstruction 
Haemorrhage
20
Q

Why are colovesical fistula more likely to occur in men

A

The uterus sits between the sigmoid colon and the bladder

21
Q

What are the risk factors for ectopic pregnancy

A 
Previous ectopic 
Pelvic inflammatory disease
Tubular procedures
Endometriosis 
Pelvic surgery 
IVF 
Intrauterine contraceptive device
22
Q

What is Hinchey’s classification

A

For acute diverticulitis
Assessment of pertioneal contamination at the time of surgery and guides anastamoses

I - pericolic or mesenteric
II - walled-off pelvic abscess
III - generalised purulent peritonitis
IV - generalised faecal peritonitis

Y3 Oxford Cases (29 decks)

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