Screening And Investigations ABDO

Question 1

Investigation and management of Ruptured AAA

Answer 1

Ix: FAST scan (focused assessment with sonography for trauma)

Mgt: EVAR( endocascular aneurysm repair)

Question 2

Investigation and management of nephrolithiasis

Answer 2

Ix: CT KUB (kidney ureter bladder). Ideal for large scale picture.

Mgt: analgesia.
Stone

Question 3

Investigation and management of ascending cholangitis

Answer 3

ERCP for dx. and rx.

Endoscopic retrograde cholangiopancreatography

Question 4

Investigation, dx. and management of cholecystitis

Answer 4

Ultrasound of RUQ:
Distended gall bladder 
Thickened wall
Peri-cholecystic fluid - oedema in GB
Stones visible. Shadowing of stone 

Sign: post parandial colic

Question 5

Murphy sign;

Courvoisier Law:

Answer 5

Murphy: RUQ pain, fever, jaundice

Courvoisier Law: jaundice, painless distended GB -> head pancreas cancer

Question 6

Investigation and management of pancreatic cancer

Answer 6

Ix: CT scan
Mgt: Whipple’s surgery ( pancreaticoduodonectomy)

Question 7

Sepsis 6 for Initial Mgt.

Answer 7

Oxygen
Blood cultures (2 diff sites 1hr apart)
IV antibiotics
IV fluids
Monitor lactate
Monitor urine output

Question 8

Investigation and management of PUD?

Answer 8

Presentation: burning epi gastric pain, haematemesis and Melena, n/v
Ix: urea breath test
Mx: lifestyle, triple therapy (esomeprazole, amoxicillin, clarithromycin)

(Amoxicillin or metronidazole)
(Quadruple therapy with bismuth )

Memory mnemonic: twilight character EAMC + B

Question 9

What is the criteria for hepatic encephalopathy?

Answer 9

West haven criteria

consciousness, intellect and behaviour, neurological findings

Question 10

What is the criteria for liver cirrhosis?

Answer 10

Child's Pugh score, each criteria scoring 1/2/3
- serum bilirubin - biochemical/ obj
- serum albumin - biochemical/ obj
- INR - biochemical/ obj
- presence of ascites - clinical/subj
- encephalopathy - clinical/ subj
Points: 
5-6.     A.    15-50 yr expectancy 
7-9.     B.     Transplant candidate 
10-15. C.     1-3 month