17. Left Iliac Fossa Pain Flashcards Preview

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Flashcards in 17. Left Iliac Fossa Pain Deck (17)
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1
Q

What are the main differentials for LIF pain in a 76yo female?

A
Acute diverticulitis
Constipation
IBD
Ischaemic colitis
Leaking AAA
Pseudomembranous colitis
Locally perforated sigmoid carcinoma
2
Q

Describe the pain experienced in Acute diverticulitis?

A

Pain initially poorly localised, midline + colicky

Migrates to LIF + becomes constant

3
Q

After characterising the LIF pain what other symptoms should you ask about?

A
Nausea + vomiting: Acute diverticulitis + PID 
Fever: Acute diverticulitis
Change of bowel habit
Rectal bleeding: colitis 
Bloating: IBS 
Weight Loss
Gynaecological problems
4
Q

What examinations are important to consider in someone with LIF pain?

A

Abdo exam, DRE + vaginal examination

5
Q

How would you manage diverticulitis in the acute phase?

A
Analgesia
Bowel rest
IV fluid
Antibiotics
VTE prophylaxis
Monitor
6
Q

What may be offered 2-6 weeks after resolution of acute diverticulitis?

A

Colonoscopy to confirm the diagnosis + assess the extent of diverticulosis + exclude cancer

7
Q

What is diverticulosis?

A

Presence of diverticula in the bowel

8
Q

What is diverticular disease?

A

Symptomatic diverticulosis: painless bleeding, altered bowel habit

9
Q

What is diverticulitis?

A

Painful inflammation in patients with diverticular disease

10
Q

What is pseudomembranous colitis? What is used to treat this?

A

Acute inflammatory condition of the bowel usually caused by Clostridium difficile
Oral vancomycin

11
Q

In younger adults, what other causes of LIF must be considered?

A

F: gynae pathologies e.g. ectopic pregnancy
M: Testicular torsion/ tumour

12
Q

What drugs can dampen the inflammatory response, thus masking how ill a patient truly is?

A

Steroids

13
Q

What drugs predispose patients to pseudomembranous colitis?

A

Antibiotics

PPIs

14
Q

What is the imaging modality of choice for diagnosing Acute diverticulitis?

A

Abdominal CT with contrast

15
Q

What investigations are contraindicated in patients with Acute diverticulitis?

A

Colonoscopy

Barium enema

16
Q

What is a loop stoma?

A

loop of bowel brought to surface + half-opened: allows the faecal matter to drain into stoma bag without reaching distal anastomoses.
Colon stays connected to rectum

17
Q

What is an end stoma?

A

proximal bowel limb brought to the surface of the abdomen to create a stoma
Distal bowel limb removed, or surgically closed + left inside the abdomen