16. Right Iliac Fossa Pain Flashcards
What other diagnoses must you consider in a female with RIF pain?
What else will you look for on examination of a male patient with RIF pain? (9)
7 Blood tests?
- Urine?
- Imaging? (5)
What features of the history, clinical examination, and investigations help you rule out other diagnoses?
- Mesenteric adenitis?
- Meckel’s diverticulum?
- Constipation?
- Acute onset of Crohn’s disease?
- Gastroenteritis?
- Renal/ureteric colic?
- Pancreatitis?
- Testicular pathology?
How would you manage Mr Beck’s acute appendicitis?
Mr Beck is taken to theatre for a diagnostic laparoscopy which confirms a friable, gangrenous appendix. Removal of the appendix is challenging. He remains well for the first 24 hours after surgery but you are then called at 2am by one of the ward nurses who is concerned that something is wrong. Mr Beck was initially comfortable but is now complaining of generalised abdominal pain and has vomited twice. You attend the ward and find Mr Beck is clammy and pale. He is taking shallow, fast breaths, and has a fast radial pulse. His chest sounds clear. He is tender and guarding throughout the abdomen and retches into a sick bowl while you are there. He tell you he has been feeling increasingly unwell since dinnertime and he confirms that he has passed wind several times since surgery, but not yet opened his bowels. His observation chart is below. How will you manage Mr Beck? What is the most likely diagnosis?
What is the Sepsis 6?
What are the main causes of appendicitis?
What is the neuroanatomical basis of the shifting location of the pain in appendicitis?
Which 2 incisions are commonly used for an open appendicectomy?
What is an interval appendicectomy?
Are you aware of any relationship betwen appendicectomy and IBD?
