Right Iliac Fossa Pain Flashcards
List the differential diagnosis for RIF pain.
Appendicitis Gastroenteritis Ureteric colic Inguinal hernia (especially if strangulated) Mesenteric adenitis Acute pancreatitis Testicular torsion Meckel’s diverticulitis
State two causes of RIF pain that are more common in children.
Intussusception
Mesenteric adenitis
What causes of RIF pain are more common in the elderly?
Caecal pathology (e.g. tumours, volvulus, diverticuli) AAA
List some gynaecological causes of RIF and LIF pain.
Ectopic pregnancy Pelvic inflammatory disease Mittelschmerz Torsion/rupture/haemorrhage of an ovarian cyst or tumour Salpingitis Threatened abortion Fibroid degeneration Uterine dehiscence
What is pelvic inflammatory disease?
Acute or chronic infection of the ovaries, fallopian tubes and uterus, usually resulting from an infection ascending from the vagina
Chlamydia trachomatis and Neisseria gonorrhoeae are causative agents
What is Mittelschmerz?
Mid-cycle RIF/LIF pain caused by rupture of the ovarian follicle
List some causes of RIF/LIF pain that are exclusive to males.
Testicular torsion
Haemorrhage into a testicular tumour
Before laying a hand on the patient, it is important to ascertain how much pain they are already in. State two ways in which you can assess how much pain they are in without touching them.
Ask them to cough
Ask them to suck their tummy in as far as possible and then puff it out again
(Ask them to look at their toes when lying down)
List some features of examination that would suggest that the patient is acutely unwell.
Tachypnoea
Tachycardia
Fever
Hypotension
Why is it important to take note of any surgical scars the patient may have on their abdomen?
Previous surgery increases the risk of post-surgical adhesion
Adhesions can lead to bowel obstruction
Why is it important to check for cervical lymphadenopathy in a patient with RIF pain?
Mesenteric adenitis is often preceded by an upper respiratory tract viral infection
This viral infection can cause cervical lymphadenopathy
NOTE: mesenteric adenitis is very difficult to distinguish clinically from appendicitis
What can cause absent bowel sounds?
Occurs if there is a functional bowel obstruction (e.g. paralytic ileus)
What can cause tinkling bowel sounds?
Small bowel obstruction
Why is it important to check for hernias in a patient with RIF pain?
Hernias can become strangulated and cause small bowel obstruction
What useful clues may be gained from performing a DRE?
Constipation
Masses
Blood (suggests inflammatory bowel disease, Meckel’s diverticulum bleed or caecal diverticular bleed)
Why is it particularly important to examine the external genitalia of men with RIF/LIF pain?
Testicular torsion and strangulated inguinal hernias can cause RIF/LIF pain