Abdominal

Question 1

Besides appendicitis, what could a short history of central pain moving to RIF be

Answer 1

Central — RIF shift, with fever and nausea could also be ileitis

May have longer history of diarrhoea and fever- possible in IBD
In females, ovarian pathology should be considered.

Question 2

How should you enquire about a patient’s scars and drugs

Answer 2

Why are you taking this drug?
Do you have an irregular heart rhythm (warfarin)/
ever had blood clots
what is the amlodipine for
do you have high bP
ever had an operation
what was it for
did they remove bowel or appendix

Mr Jones has an appendectomy which had acute complications and so required a laparotomy

Also has AF and hypertension

Question 3

Localise the different causes of abdominal pain

Answer 3

Head- Anxietyy

Lungs:
PE, lower lobe pneumonia

Heart:
IHD, MI can present with epigastric pain or LUQ pain

Bowel:
PUD, gastritis, oesophagitis, pancreatitis, splenomegaly, renal colic, renal mass, pyelonephritis, colitis (infective, inflammatory, drug related), bowel obstruction, appendicitis, cystitis, hepatitis, hepatobiliary mass, cholecystitis, biliary colic, tense ascitrws, constipation.

Question 4

Describe how UC can cause jaundice

Answer 4

Associated with primary sclerosing cholangitis, which can cause jaundice and is associated with a cholangiocarcinoma.

Question 5

Describe how drugs can cause jaundice

Answer 5

Aspirin and diclofenac are associated with gastritis, and PUD and also AKI, WHICH MAY CAUSE ABDOMINAL PAIN.
Many drugs `(including flucoxacillin) can cause hepatitis or cholestasis.

Question 6

Describe how travel may cause abdominal pain and jaundice

Answer 6

Many infective causes of abdominal pain and jaundice (malaria, viral hepatitis A and E- would be possible given history of eating street food and drinking potentially unsafe water).
Leptospiros, TB to name a few
He may also have an infective colitis.