Exam + investigations Flashcards
(26 cards)
LIF drug history?
Steroids dampen inflammatory response, masking symptoms
General exam generalised peritonitis?
lying very still, taking shallow breaths, and looking pale.
General exam ureteric colic?
writhing in pain, unable to keep still.
General exam cachetic or jaundiced?
liver metastases from colon cancer.
Abdo exam focal tenderness?
uncomplicated acute diverticulitis presents with local tenderness and guarding.
Abdo exam generalised peritonitis?
suspect perforation of a colonic diverticulum, sigmoid carcinoma, AAA
Abdo exam masses?
palpable in LIF of patients with acute diverticulitis. Sigmoid carcinoma may be a central laterally pulsatile mass is AAA.
Abdo exam troisers sign?
(left supraclavicular lymphadenopathy), suggests gastrointestinal malignancy.
Rectal exam?
Pelvic abscess may be detectable in patients with acute diverticulitis,
can also palpate a rectal malignancy.
Vaginal exam?
Necessary in LIF pain and vaginal discharge, as cervical motion tenderness would lend weight to a diagnosis of pelvic inflammatory disease.
LIF Investigations VBG?
high lactate/metabolic acidaemia = patient is acutely unwell or has ischaemic bowel.
Normal glucose can’t be DKA.
LIF Investigations FBC?
WCC elevated is inflammatory (diverticulitis, pseudomembranous colitis).
LIF Investigations U&Es?
establish baseline electrolyte status and check they haven’t developed acute kidney injury.
LIF Investigations CRP?
useful for UC and c. difficile.
LIF pain acute diverticulitis?
constant LIF pain, preceded by vague midline colicky pain, associated with nausea and fever.
Acute diverticulitis acute phase treatment (5)?
analgesia, bowel rest (clear fluids), IV fluids, antibiotics, venous thromboembolism prophylaxis.
Abdo CT with contrast?
diagnoses acute diverticulitis and helps plan elective surgery.
LIF pain CXR?
if suspicion of perforated viscus.
LIF pain AXR?
useful for ruling out bowel obstruction.
Treatment for perforated diverticulitis?
fluid resuscitation, blood tests, analgesia, antibiotics, CT, emergency laparotomy.
IBS?
chronic abdo pain, cramping, bloating and altered bowel habit. Do FBC for anaemia of chronic disease, and TTG for coeliac disease.
Symptoms of pregnancy?
lower abdo pain, vaginal bleeding, amenorrhoea
Pelvic inflammatory disease?
acute lower abdo pain, new vaginal discharge, vomiting, fever, adnexal tenderness on vaginal examination.
Diverticulitis epidemiology?
5% of 40yrs, 30% of 60yrs, 65% of 85yrs. 70% are asymptomatic, 20% develop acute diverticulitis, 10% develop rectal bleeding.
