Patient with abdominal pain Flashcards
When should surgical intervention (either preventative endovascular stent repair or insertion of a graft) be offered to patients with stable AAA?
If the aneurysm is bigger than 5cm.
For smaller aneurysms, conservative management with lifestyle modification and regular US screening.
What is Charcot’s triad and which conditions may it be seen in?
RUQ tenderness, fever, jaundice.
Biliary tract infections (cholecystits, cholangitis)
What is Reynold’s pentad and which condition may it be seen in?
RUQ tenderness, fever, jaundice, shock, mental confusion.
Particularly associated with ascending cholangitis.
What imaging modality is used to confirm a diagnosis of acute cholecystitis?
Ultrasound
What is the definitive treatment for cholecystitis?
Early laparoscopic cholecystectomy
What is the best investigation to order if suspicion of cholangitis is high?
Endoscopic Retrograde Cholangiopancreatograpy (ERCP) - directly visualises bile duct stone or obstruction and can perform biliary stone extraction at the same time.
Is vomiting an early or late symptom in small bowel obstruction?
Early
Is vomiting an early or late symptom in large bowel obstruction?
Late
Is constipation an early or late symptom in small bowel obstruction?
Late
Is constipation an early or late symptom in large bowel obstruction?
Early
Which form of bowel obstruction typically produce more severe colicky abdo pain?
Small bowel obstruction.
What is the first investigation to order in suspected ovarian cysts?
Transvaginal Ultrasound
After TVUS for ovarian cysts, what other investigations may be ordered?
CA125, laparotomy (to biopsy to determine nature of the cyst), MRI/CT
How are ovarian cysts managed?
Depends on the nature of the cysts
<5cm/simple/non-malignant: 6 monthly USS and CA125
>5cm/complex/malignant: Laparoscopic cyst removal
What is the key investigation that is diagnostic of acute pancreatitis?
Serum lipase (preferably) or amylase. Value is >=3 x the upper limit of normal = pancreatitis
What action tends to help temporarily relieve pain in patients with kindey stones?
Writhing around, a lot of movement
What first investigations should be ordered for suspected nephrolithiasis (kidney stone)?
CT KUB
FBC, urinalysis, U+Es, pregnancy test
How are kidney stones managed?
If they haven’t passed spontaneously …
<10mm: medical expulsion with tamsulosin PO
>10mm or failed medical therapy: surgical removal (lithotripsy usually sufficient)
Are duodenal or gastric ulcers more common?
Duodenal ulcers are ~ 3x more common than gastric ulcers
Does eating relieve or exacerbate gastric ulcer pain?
Exacerbates
Does eating relieve or exacerbate duodenal ulcer pain?
Relieves. Duodenal ulcer pain is worse when hungry/at night
