Surgical Presenting Complaints Flashcards Preview

Y5 - Surgery > Surgical Presenting Complaints > Flashcards

Flashcards in Surgical Presenting Complaints Deck (15)
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1
Q

Upper GIT Bleed - Hx

A
  • Haematemesis? -> is the blood fresh, coffee ground or altered?
  • Amount of blood?
  • Volume of vomit?
  • How many episodes?
  • Malaena?
  • Previous episodes?
2
Q

Upper GIT Bleed - associated features

A
  • Anorexia
  • Dyspepsia
  • Epigastric pain (SOCRATES)
  • Features of chronic liver disease
  • Weight loss
3
Q

Upper GIT Bleed - Differentials

A

Oesophageal - oesophagitis, carcinoma, varices, Mallory-Weiss tear, hiatal hernia
Gastric - peptic ulcer, benign and malignant tumours
Duodenal - duodenitis, peptic ulcer

  • Most common = peptic ulcer disease
4
Q

Lower GIT Bleeding - Types of Bleeding

A
  • Spotting and fresh blood - haemorrhoids or fissure
  • Fresh and/or profuse bleeding - diverticular disease, IBD, carcinoma
  • Dark/altered blood - lesions in proximal colon (diverticular disease or carcinoma)
  • Red currant jelly stool - intussusception
  • Mucoid, bloody diarrhoea - enteric infections
  • Bloody diarrhoea - ischaemic colitis
5
Q

Lower GIT Bleeding - Associated Features

A
  • Altered bowel habits
  • Abdominal pain/discomfort
  • Mucus in stool
  • Tenesmus
  • Weight loss
6
Q

Lower GIT Bleeding - Causes

A
D - diverticular disease - most common
H - Haemorrhoids
C - CRC
I - IBD, infection (gastroenteritis - campylobactor, shigellosis, amoebea
Anal fissure
Colonic polyps
7
Q

Diarrhoea - Hx

A

Age
< 40 - IBS, infective, IBD
> 40 - carcinoma

Diarrhoea - increased frequency, increased volume

  • Frequency - how many times in 24hrs are the bowels opening? Do you have to get up at night to open bowels?
  • Consistency
  • Watery, clear frothy
  • Fluid/brown
  • Semi-formed or solid
  • Blood
  • Mucus
  • Fat (steatorrhoea)

Associated Features:

  • Systemic signs - anaemia, fever, arthritis
  • Nausea and vomiting, dehydration
  • Abdominal pain - SOCRATES
  • Weight loss, loss of appetite
  • Recent foreign travel
  • Family hx of IBD, polyps or cancer
8
Q

Diarrhoea - Differentials

A

Colonic causes

  • Inflammatory Bowel disease
  • Infective colitis
  • Bacterial: Campylobactor pylori, Shigella, E. coli, S typhi, Cholera, Clostridium difficile
  • Viral: rotavirus, adenovirus, astrovirus
  • Protozoal: Giardia, Entamoeba
  • Left-sided colonic malignancy
  • Ischaemic colitis
  • Overflow diarrhoea secondary to constipation
  • Coeliac disease
  • Secretory - post small bowel resection
  • Hyperthyroidism
  • Alcohol
  • Medications

Fatty - hepatobiliary disorders, pancreas exocrine insufficiency

9
Q

Jaundice - History

A
A - Alcohol consumption
B - Blood transfusion 
D - Drugs - recreational
F - Fever, family history, food poisoning
M - Medications
P - Previous history
S - Sexual contacts, stool colour - pale
T - Travel history
U - Urine colour - dark
W - Weight loss
10
Q

PR Bleeding - Differentials

A

Anatomical - diverticulosis
Infective - bacterial (Shigellosis, Campylobacter), protozoal (amobea)
Inflammatory - IBD
Neoplastic - CRC
Vascular - haemorrhoids, ischaemic colitis, angiogysplasia, radiation-induced

11
Q

PR Bleeding - History

A
  • Prior episodes of bleeding
  • Medications - NSAIDs, antiplatelets, anticoagulants
  • Travel/food hx
  • Weight loss
  • Fever, sweats
  • Abdominal pain (presence of abdominal pain suggests presence of inflammatory bleeding source - ischaemic or infectious colitis or a perforation)
  • Prior endoscopy (gastroscopy/colonoscopy)
  • Family hx
  • Radiation exposure
12
Q

PR Bleeding - Approach to management

A
  • IV access
  • Resuscitation - fluids/blood
  • Exclusion of upper GIT bleeding with upper endoscopy
  • Evaluation of lower GI source
13
Q

PR Bleeding - Investigations

A

Blood

  • FBC - WBC, Hb
  • UEC
  • LFT’s
  • Coagulation profile
  • Group and hold, cross match

Stool - MCS - if worried about infective cause

14
Q

PR Bleeding - exclusion of upper GIT bleeding

A
  • 10-15% of patients with severe haematochezia will have an upper GI source
  • Findings that are suggestive of upper GI source:
  • Haemodynamic instability
  • Orthostatic hypotension
  • Elevated BUN
  • Blood clots in the stool decrease the likelihood of an upper GI source
  • Investigations:
  • Upper endoscopy once patient is appropriately resuscitated
15
Q

PR Bleeding - evaluation of lower GIT source

A
  • Initial examination of choice = colonoscopy
  • CT angiography (requires active bleeding at time of imaging)
  • Radionuclide imaging (red cell scan)
  • Normal CT - takes images in portal venous phase
  • CT angiography - images in arterial phase