LIF pain

Question 1

What are the ddx for LIF pain

Answer 1

Acute diverticulitis*
Constipation
IBD
Ischaemic colitis*
Leaking AAA*
Locally perforated sigmoid carcinoma*
UTI
Ureteric colic
Pyelonephritis*

Question 2

Pain that is initially poorly localised (midline) and colicky then migrates to LIF and becomes constant highly suggests what diagnosis

Answer 2

Acute diverticulitis

Question 3

Pain that migrates from midline to left flank to LIF is consistent with?

Answer 3

Ureteric stone as it migrates

Question 4

Sudden onset of LIF pain suggests what things?

Answer 4

Perforation of viscus
Acute haemorrhage
Torsion

Question 5

Acute diverticulitis is often preceded by what kind of pain?

Answer 5

Midline colicky pain

Ureteric colic may also result in colicky pain

Question 6

Defecation that alleviates pain points to what diagnosis?

Answer 6

IBS

Question 7

Acute diverticulitis often gives a history of how many days of LIF pain

Answer 7

2-3 days

Question 8

Name 2 excruciating pains of LIF

Answer 8

Ureteric colic

Colonic perforation secondary to diverticulitis or sigmoid carcinoma

Question 9

Nausea (and sometimes vomiting) are seen with which diagnosis

Answer 9

Acute diverticulitis (and sometimes Pelvic Inflammatory Disease)

Question 10

Fever indicates which pathology

Answer 10

Infective disease e.g. acute diverticulitis

Question 11

Rectal bleeding is a sign of?

Answer 11

UC, ischaemic colitis, colorectal carcinoma or pseudomembranous colitis.

Overt rectal bleeding without diarrhoea may indicate acute diverticulitis

Question 12

Bloating is a characteristic feature of?

Answer 12

IBS

Question 13

Dysparaeunia and new vaginal discharge are consistent with?

Answer 13

Pelvic inflammatory disease

Question 14

Recent use of PPIs or Abx may raise suspicions of which condition?

Answer 14

Pseudomembranous colitis, especially if patient presents with LIF pain and diarrhoea

Question 15

What should you look for on abdominal examination

Answer 15

1. Focal tenderness - acute diverticulitis patients present with local tenderness and/or guarding
2. Generalised peritonitis - suspect perforation of a colonic diverticulum, sigmoid carcinoma or AAA
3. Masses? - mass may be palpable in LIF in patients w acute diverticulitis
4. Virchows node - GI malignancy

Question 16

What should you look for in rectal examination

Answer 16

Pelvic abscess = acute diverticulitis

Rectal malignancy may be palpable

Question 17

Which blood tests would you do for someone with LIF pain?

Answer 17

1. VBG - high lactate/metabolic acidaemia = ischaemic bowel. Normal glucose = not DKA.
2. FBC - high WCC in acute diverticulitis or pseudomembranous colitis
3. U&Es
4. CRP

Question 18

Which imaging studies may be done in patients with LIF pain

Answer 18

CT abdomen - diagnoses acute diverticulitis
CXR - perforated viscus
AXR

If female and fertile - consider trans abdominal and transvaginal USS

Question 19

How should acute diverticulitis be managed

Answer 19

Analgesia
Bowel rest
IV fluids
Abx (e.g. Co-amoxiclav and metronidazole)
VTE prophylaxis

Then offer colonoscopy 2-6 weeks after this episode

Question 20

Which antibody test or other test can be used to test for coeliac disease

Answer 20

TTG (tissue transglutaminase) or Anti-endomysial antibodies

also check IgA levels