Clinical Presentations Flashcards
(32 cards)
1
Q
Abdo pain DDX
A
GIT gastroduodenal intestinal hepatobiliary pancreatic splenic
Urinary tract Gynae Vascular Peritoneum Abdominal wall Retroperitoneum Referred pain Medical causes
2
Q
Abdo pain DDX
gastroduodenal
A
Peptic ulcer
Gastritis
Malignancy
Gastric volvulus
3
Q
Abdo pain DDX intestinal
A
- Appendicitis
- Obstruction
- Diverticulitis
- Gastroenteritis
- Mesenteric adenitis
- Strangulated hernia
- Inflammatory bowel disease
- Intussusception
- Volvulus
- TB
4
Q
Abdo pain DDX hepatobiliary
A
- Acute cholecystitis
- Chronic cholecystitis
- Cholangitis
- Hepatitis
5
Q
Abdo pain DDX pancreatic
A
- Acute pancreatitis
- Chronic pancreatitis
- Malignancy
6
Q
Abdo pain DDX splenic
A
- Infarction
* Spontaneous rupture
7
Q
Abdo pain DDX Urinary tract
A
- Cystitis
- Acute retention of urine
- Acute pyelonephritis
- Ureteric colic
- Hydronephrosis
- Tumour
- Pyonephrosis
- Polycystic kidney
8
Q
Abdo pain DDX Gynae
A
- Ruptured ectopic pregnancy
- Torsion of ovarian cyst
- Ruptured ovarian cyst
- Salpingitis
- Severe dysmenorrhoea
- Mittelschmerz
- Endometriosis
- Red degeneration of a fibroid
9
Q
Abdo pain DDX Vascular
A
- Aortic aneurysm
- Mesenteric embolus
- Mesenteric angina (claudication)
- Mesenteric venous thrombosis
- Ischaemic colitis
- Acute aortic dissection
10
Q
Abdo pain DDX Peritoneum
A
1 or 2 peritonitis
primary spontaneous peritonitis = infection that develops in the peritoneum
secondary peritonitis, which usually develops when an injury or infection in the abdominal cavity allows infectious organisms into the peritoneum.
11
Q
Abdo pain DDX Abdominal wall
A
- Strangulated hernia
- Rectus sheath haematoma
- Cellulitis
12
Q
Abdo pain DDX Retroperitoneum
A
Retroperitoneal haemorrhage, e.g. anticoagulants
13
Q
Abdo pain DDX Referred pain
A
- Myocardial infarction
- Pericarditis
- Testicular torsion
- Pleurisy
- Herpes zoster
- Lobar pneumonia
- Thoracic spine disease, e.g. disc, tumour
14
Q
Abdo pain DDX Medical causes
A
- Hypercalcaemia
- Uraemia
- Diabetic ketoacidosis
- Sickle cell disease
- Addison’s disease
- Acute intermittent porphyria
- Henoch–Schönlein purpura
- Tabes dorsalis
15
Q
Abdo pain Dx General
A
FBC ESR U+Es LFTs Serum amylase MSU CXR AXR US
16
Q
Abdo pain Dx Specific
A
BG Serum Ca CRP VDRL Sickling test Urinary porphobilinogens ABGs BHCG ECG OGD IVU Barium enema Small bowel enema Duplex Doppler Angiography CT MRCP
17
Q
Abdo pain DDx beware
A
• Always examine the hernial orifices.
• Always check for localised tenderness if colicky
abdominal pain becomes constant. Tachycardia,
fever and a raised white cell count suggests
infarction.
18
Q
Abdominal Swellings
RIGHT UPPER QUADRANT
DDx
A
LIVER
GALL BLADDER • Secondary to carcinoma of the head of the pancreas • Mucocele • Empyema • Carcinoma
RIGHT COLON • Carcinoma • Faeces • Diverticular mass • Caecal volvulus • Intussusception
RIGHT KIDNEY • Carcinoma • Polycystic kidney • Hydronephrosis • Pyonephrosis • Perinephric abscess • TB • Solitary cyst • Wilms’ tumour (nephroblastoma)
19
Q
Courvoisier’s law
A
‘in the presence of obstructive jaundice, if the gall bladder is palpable the cause is unlikely to be due to gallstones’
20
Q
Abdominal Swellings
RIGHT UPPER QUADRANT
Dx general
A
FBC ESR U+E LFT MSU AXR US
21
Q
Abdominal Swellings
RIGHT UPPER QUADRANT
Dx specific
A
Barium enema
Colonoscopy
CT
22
Q
Abdominal Swellings
LEFT UPPER QUADRANT
CAUSES
A
SPLEEN STOMACH • Carcinoma • Gastric distension (acute dilatation, pyloric stenosis) PANCREAS • Pseudocyst • Carcinoma KIDNEY See right upper quadrant, p. 9. COLON • Carcinoma of the splenic flexure • Faeces • Diverticular mass
23
Q
Abdominal Swellings
LEFT UPPER QUADRANT
Dx general
A
FBC ESR U+E LFT Serum amylase US
24
Q
Abdominal Swellings
LEFT UPPER QUADRANT
Dx specific
A
BG Barium enema Colonoscopy Gastroscopy CT
25
Abdominal Swellings EPIGASTRIUM
| DDx
```
ABDOMINAL WALL
• Lipoma
• Epigastric hernia
• Xiphisternum
• Metastatic deposits
STOMACH
• Congenital hypertrophic pyloric stenosis
• Carcinoma
• Acute gastric volvulus
PANCREAS
See left upper quadrant, p. 11.
TRANSVERSE COLON
• Carcinoma
• Faeces
• Diverticular mass
LIVER
See hepatomegaly, p. 215.
RETROPERITONEUM
• Aortic aneurysm
• Lymphadenopathy (lymphoma, secondaries from testicular
carcinoma)
OMENTUM
• Omental secondaries, e.g. stomach and ovary
```
26
Abdominal Swellings EPIGASTRIUM
| Dx specific
FBC ESR
U+Es
LFts
US
Blood glucose
May be abnormal with pancreatic carcinoma or previous
pancreatitis.
■■ CT
Pancreatic tumours. Pancreatic pseudocyst. Lymphadenopathy.
Aortic aneurysm. Omental deposits. Guided biopsy/FNAC.
■■ Barium enema
Carcinoma of the colon. Diverticular disease.
■■ Colonoscopy
Carcinoma of the colon. Diverticular disease.
■■ Gastroscopy
Carcinoma of the stomach.
■■ Laparoscopy
Carcinoma of the ovaries. Omental secondaries. Carcinomatosis
peritonei.
■■ Biopsy.
27
UMBILICAL swelling DDX
```
SUPERFICIAL
• Sister Joseph’s nodule (malignant)
HERNIA
• Paraumbilical
• Umbilical (children)
STOMACH
• Carcinoma
TRANSVERSE COLON
• Carcinoma
• Faeces
• Diverticular mass
SMALL BOWEL
• Crohn’s disease
• Carcinoma
• Mesenteric cysts
OMENTUM
• Secondary deposits, e.g. stomach, ovary
RETROPERITONEUM
• Aortic aneurysm
• Lymph nodes, e.g. lymphoma, secondaries from testicular
carcinoma
```
28
UMBILICAL swelling IX
GENERAL INVESTIGATIONS
■■ FBC, ESR
Hb carcinoma. WCC diverticular disease.
■■ U&Es
Vomiting. Dehydration, e.g. carcinoma of the stomach,
carcinoma of the bowel, Crohn’s disease.
■■ LFTs
Alkaline phosphatase raised with liver secondaries.
■■ US
Aortic aneurysm. Retroperitoneal lymphadenopathy.
SPECIFIC INVESTIGATIONS
■■ CT
Aortic aneurysm. Retroperitoneal lymphadenopathy. Omental
deposits. Guided biopsy/FNAC.
■■ Barium enema
Carcinoma of the colon. Diverticular disease.
■■ Colonoscopy
Carcinoma of the colon. Diverticular disease.
■■ Gastroscopy
Carcinoma of the stomach.
■■ Small bowel enema
Crohn’s disease. Lymphoma. Carcinoma.
■■ Laparoscopy
Carcinoma of the ovaries. Omental secondaries. Carcinomatosis
peritonei.
■■ Biopsy
Benign versus malignant.
29
RIGHT AND LEFT LOWER QUADRANTS SWELLING
| CAUSES
```
ABDOMINAL WALL
• Lipoma
• Spigelian hernia
LARGE BOWEL
RIGHT LOWER QUADRANT • Appendix mass/abscess
• Carcinoma of the caecum
• Carcinoma of the ascending colon
• Faeces
• Crohn’s disease
• Caecal volvulus
• Intussusception
LEFT LOWER QUADRANT • Carcinoma of the sigmoid colon
• Diverticular mass
• Faeces
• Sigmoid volvulus
• Crohn’s disease
SMALL BOWEL
• Crohn’s disease
• Carcinoma
• Lymphoma
• Ileo-caecal TB
OVARY/UTERUS/FALLOPIAN TUBE
• Ovarian cyst
• Ovarian neoplasm
• Ectopic pregnancy
• Tubo-ovarian abscess
• Uterine fibroid
KIDNEY
SPLEEN (MASSIVE SPLENOMEGALY)
```
```
RETROPERITONEUM
• Iliac artery aneurysm
• Lymphadenopathy
• Neoplasm of iliac bone, e.g. osteogenic sarcoma, Ewing’s
tumour
```
30
RIGHT AND LEFT LOWER QUADRANTS SWELLING IX
GENERAL INVESTIGATIONS
■■ FBC, ESR
Hb Crohn’s disease, carcinoma. ESR carcinoma, Crohn’s
disease, ileo-caecal TB. WCC appendicitis, diverticulitis.
■■ U&Es
Vomiting. Dehydration. Obstruction from carcinoma or Crohn’s disease.
■■ LFTs
Alkaline phosphatase with liver secondaries.
■■ US
Ovarian lesions. Uterine lesions. Tubo-ovarian abscesses.
Pregnancy. Ectopic pregnancy. Iliac artery aneurysms.
Lymphadenopathy. Appendix mass. Crohn’s mass.
■■ AXR
Obstruction. Dilated loops of bowel. Ovarian teratoma (teeth,
etc.). Erosion of iliac bone – bone tumours.
SPECIFIC INVESTIGATIONS
■■ bHCG
Raised in pregnancy.
■■ Mantoux test
Ileo-caecal TB.
■■ CT
Ovarian lesions. Uterine lesions. Abscess. Ectopic pregnancy.
Iliac artery aneurysm. Lymphadenopathy. Appendix mass. Bone
tumours.
■■ Barium enema
Carcinoma. Diverticular disease.
■■ Small bowel enema
Crohn’s disease. Carcinoma. Lymphoma.
■■ Colonoscopy
Carcinoma (biopsy). Diverticular disease.
■■ Laparoscopy
Carcinoma, Crohn’s disease, ileo-caecal TB.
■■ Bone scan
Bone tumour.
31
SUPRAPUBIC SWELLING CAUSES
```
BLADDER
• Acute retention
• Chronic retention
• Carcinoma
UTERUS
• Pregnancy
• Fibroids
• Carcinoma
BOWEL
• Diverticular mass
• Crohn’s disease
• Carcinoma
OTHER
• Urachal cyst.
```
32
SUPRAPUBIC SWELLING IX
```
GENERAL INVESTIGATIONS
■■ FBC, ESR
Hb tumour. WCC infection.
■■ MSU
Red cells. White cells. Organisms, (infection precipitating)
retention. Malignant cells with carcinoma.
■■ US
Pregnancy. Fibroids. Bladder tumour. Urachal cyst.
SPECIFIC INVESTIGATIONS
■■ bHCG
Pregnancy.
■■ PSA
Carcinoma of the prostate.
■■ Cystoscopy
Bladder tumour. Biopsy.
■■ Barium enema
Colonic carcinoma. Diverticular disease. Crohn’s disease.
■■ Colonoscopy
Carcinoma. Diverticular disease.
■■ CT
Ovarian lesions. Uterine lesions. Bladder lesions. Urachal cyst.
```
