Gastro - Surgery Flashcards
what is acute abdominal pain
pain lasting less than 24 hours
what do you need to know form a pain history
SOCRATES
as well as
RISK FACTORS
GENDER
DRUG HISTORY
SOCIAL HISTORY
SEXUAL HISTORY
what do you need for an abdo examinations
chaperone
Look at the abdomen
Palpate All Abdominal ‘Segments’
Start Away from maximally tender area and work towards it with light palpation
Feel for any lumps, masses or organomegaly and try to define
Listen
Do NOT forget PR and examination of genitalia (not always appropriate)
Initial ABCDE for abdo pain
Heart Rate
Blood Pressure
Oxygen Saturations
Urinalysis
Pregnancy Test (if appropriate!)
what investigations would you perform for abdo pain for a differential diagnosis
Ultrasound abdomen+/-pelvis
CT abdomen/pelvis
CT angiography
MRI abdomen
Endoscopy
what basic investigations would be done for people presenting with abdo pain
ECG
CXR
AXR
ABGs
During a PR digital examination you ask the patient to squeeze your finger. Which muscle is responsible for this function?
A
Internal Sphincter
B
External Sphincter
C
External oblique
D
Gracilis
E
Adductor longus
B
External Sphincter
voluntary - autonomic nerve
below dentate line - pain sensitive
true
above dentate line senstation is…
NOT pain - pressure, ischaemia NOT pain
dentate line denotes what
change form lower gut to rectum
A 45 year old fit male undergoes telephone consultation for bright red rectal bleeding and itching. There are no altered bowel habit and no family history. What investigation would you perform?
A
Colonoscopy
B
CT colonogram
C
Flexible sigmoidoscopy
D
Barium enema
E
MRI scan
C
Flexible sigmoidoscopy
not likely to have cancer
bright red bleeding
don’t go invasive
A patient presents to clinic with posterior anal fissure. What is the most commonly used treatment?
A - Lateral internal sphincterotomy
B - Botulinum toxin
C - Diltiazem cream – calcium channel blocker - dilator
D - Anal stretch
E - Phenol in almond oil injection
C - Diltiazem cream – calcium channel blocker - dilator
