Surgical Presenting Complaints Flashcards Preview

Y5 - Surgery > Surgical Presenting Complaints > Flashcards

Flashcards in Surgical Presenting Complaints Deck (15):
1

Upper GIT Bleed - Hx

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

2

Upper GIT Bleed - associated features

- Anorexia
- Dyspepsia
- Epigastric pain (SOCRATES)
- Features of chronic liver disease
- Weight loss

3

Upper GIT Bleed - Differentials

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

Lower GIT Bleeding - Types of Bleeding

- 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

Lower GIT Bleeding - Associated Features

- Altered bowel habits
- Abdominal pain/discomfort
- Mucus in stool
- Tenesmus
- Weight loss

6

Lower GIT Bleeding - Causes

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

7

Diarrhoea - Hx

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

Diarrhoea - Differentials

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

Jaundice - History

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

PR Bleeding - Differentials

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

11

PR Bleeding - History

- 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

PR Bleeding - Approach to management

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

13

PR Bleeding - Investigations

Blood
- FBC - WBC, Hb
- UEC
- LFT's
- Coagulation profile
- Group and hold, cross match

Stool - MCS - if worried about infective cause

14

PR Bleeding - exclusion of upper GIT bleeding

- 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

PR Bleeding - evaluation of lower GIT source

- 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