General Sugery

Question 1

Outline the potential differential diagnoses for generalised abdominal pain? (4)

Answer 1

• Peritonitis
• Ruptured AAA
• Intestinal obstruction
• Ischaemic colitis

Question 2

Outline the potential differential diagnoses for RUQ pain? (3)

Answer 2

• Biliary colic
• Acute cholangitis
• Actue cholecystitis

Question 3

Outline the potential differential diagnoses for epigastric pain? (4)

Answer 3

• Acute gastritis
• PUD
• Pancreatitis
• Ruptured AAA

Question 4

Outline the potential differential diagnoses for central abdominal pain? (4)

Answer 4

• Ruptured AAA
• Intestinal obstruction
• Ischaemic colitis
• Early stage appendicitis

Question 5

Outline the potential differential diagnoses for RIF pain? (5)

Answer 5

• Acute appendicitis
• Ectopic pregnancy
• Ruptured ovarian cyst
• Ovarian torsion
• Meckel’s diverticulitis

Question 6

Outline the potential differential diagnoses for LIF pain? (4)

Answer 6

• Diverticulitis
• Ectopic pregnancy
• Ruptured ovarian cyst
• Ovarian torsion

Question 7

Outline the potential differential diagnoses for suprapubic pain? (4)

Answer 7

• Lower UTI
• Acute urinary retention
• Pelvic inflammatory disease
• Prostatitis

Question 8

Outline the potential differential diagnoses for loin-to-groin pain? (3)

Answer 8

• Renal colic (kidney stones)
• Ruptured AAA
• Pyelonephritis

Question 9

Outline the potential differential diagnoses for testicular pain? (2)

Answer 9

• Testicular torsion

- Epididymo-orchitis

Question 10

What are the signs of peritonitis? (5)

Answer 10

• Guarding; tensing of abdominal muscles when palpated
• Rigidity; involuntary persistent tightness/tensing
• Rebound tenderness; pain worse upon rapid release of palpation pressure
• Coughing test; coughing elicits abdominal pain
• Percussion tenderness; pain and tenderness upon percussion

Question 11

What are the three main types of peritonitis? (3)

Answer 11

• Localised peritonitis; caused by underlying organ inflammation (appendicitis, cholecystitis)
• Generalised peritonitis; caused by perforation of abdominal viscus
• Spontaneous bacterial peritonitis (SBP); associated with ascites and liver disease

Question 12

What should be done as part of the initial assessment in an unwell patient presenting with an acute abdomen?

Answer 12

Airway; patent and secure
Breathing; RR and SpO2
Circulation; HR, BP CRT, IV Access 
Disability; AVPU/GCS and Glucose
Exposure; full examination

Question 13

Outline which blood tests should be carried out with a patient presenting with an acute abdomen and why? (10)

Answer 13

• FBC; bleeding (Hb) and infection (WCC)
• U&Es; kidney function, contrast CT
• LFTs; hepatobiliary cause
• CRP; inflammation and infection
• Amylase; pancreatitis
• INR; synthetic function of liver
• Serum Calcium; scoring acute pancreatitis
• ABG; lactate (sepsis) and PaO2 for scoring acute pancreatitis
• G&S +/- RXM; may require transfusion
• Blood Cultures; if infection suspected

Question 14

Outline which imaging tests should be carried out with a patient presenting with an acute abdomen and why? (4)

Answer 14

• AXR; bowel obstruction
• Erect CXR; pneumoperitonism indicates perforation
• Abdominal USS; gallstones, biliary duct dilatation and gynaecological pathology
• CT Scan; AAA or other diagnosis

Question 15

Outline the initial management of a patient presenting with an acute abdomen? (10)

Answer 15

• ABCDE
• Alert Seniors
• Nil by mouth
• NG tube
• IV Fluids
• IV Abx
• Analgesia
• Investigations
• VTE
• Prescribe regular medication