Abdominal Pathologies :)

BG: 48 year old female with 2 children Hypertension- well controlled with Amlodipine -Irritable bowel syndrome (15 year history) on Mebeverine -Menorrhagia- vaginal hysterectomy 2 years ago 2 month Hx worsening bowels- Alternating diarrhoea/constipation Associated lower abdominal pain Exam: alert, afebrile, BP 132/70, HR 70, reg Abdomen: mildly distended but soft non-tender (SNT), no masses, bowel sounds present FHx: Sister- breast cancer aged 48 Aunt- breast cancer aged 61 What is the next management step would you advise for this patient?

BG: 53 year old male, Vetenarian, MHx – hypertension PC: Agreed routine review to discuss blood results Notable results: Bili 131 (15-73) GGT 432 (15-73) ALP 505 (30-130) ALT 3017 (21-72) Eventually got hold of him 10 days later- he was on holiday! Whilst away admitted to a couple days when urine slightly darker and stools paler but since resolved Approx 5 units/week alcohol Reviewed in clinic: No abdo pain, no stigmata liver disease Exam: obs stable, sclera slightly jaundiced, abdomen soft, nontender, no hepatosplenomegaly What is(are) the most appropriate next step(s)?

Same Patient: blood tests repeated: Improving LFTs-except ALT still elevated Liver Screen: all negative but Hepatits Screen: Hep A: IgG + and IgM - Hep E: IgG + and IgM + What is a correct interpretation of these results?

What are possible differential diagnoses of raised ALT?

Abdominal Examination findings: Pain in the foregut ( [blank_start]esophagus[blank_end] to mid-duodenum, liver, [blank_start]gallbladder[blank_end], spleen, 1/2 [blank_start]pancreas[blank_end]) can be felt in the [blank_start]epigastric[blank_end] region. Pain in the midgut (mid-duodenum to [blank_start]proximal[blank_end] 2/3 transverse colon and 1/2 [blank_start]pancreas[blank_end]) can be felt in the [blank_start]umbilical[blank_end] region. Pain in the hindgut ([blank_start]distal[blank_end] 2/3 of transverse colon to 1/2 of [blank_start]anal[blank_end] [blank_start]canal[blank_end]) is usually in the [blank_start]pubic[blank_end] region.

Any gynae problem, always do a pregnancy test first.

24 year old presents complaining of a 2 day history of abdominal pain, vomiting and diarrhoea. He had made some stir fried rice for dinner 3 days ago and forgot to put it in the fridge. He has had no recent travel and is otherwise fit and well. A diagnosis of gastroenteritis is made. What is your most likely causative organism?

Always seek urgent specialist advice whenever a child or elderly are reported to have has a single episode of bloody diarrhoea

Management of acute diarrhea and gastroenteritis: Conservative: Fluids and [blank_start]electrolytes[blank_end] Medical: [blank_start]Antibiotics[blank_end] (if [blank_start]systematically[blank_end] unwell) and whould be based off of [blank_start]stool[blank_end] culture results

A 27 year old lady presents to you with a 6 month history of abdominal pain and bloating after meals. Her pain is relieved after defecation. She is also suffering from alternating diarrhoea and constipation and feels like she hasn’t emptied her bowels properly. She is very distressed about her symptoms as it is affecting her personal and work life. What is your main differential?

[blank_start]Irritable[blank_end] [blank_start]bowel[blank_end] [blank_start]syndrome[blank_end] is a common chronic functional disorder of the bowel causing abdominal cramps, bloating, constipation and/or diarrhea. Most common is [blank_start]women[blank_end] in their 20-30s.

What is NOT a potential reason for irritable bowel syndrome?

Irritable bowel syndrome is diagnosed if there is at least a [blank_start]6[blank_end] month history of abdomen pain, [blank_start]altered[blank_end] bowel habit, and [blank_start]bloating[blank_end]. The diagnosis is official if the abdominal pain is relieved by [blank_start]defecation[blank_end] or linked to altered bowel habit and AT LEAST 2 OF: passage of [blank_start]mucus[blank_end] altered stool passage (urgency, frequency, [blank_start]tenesmus[blank_end]) abdominal bloating symptoms worsened by [blank_start]eating[blank_end] On examination, the abdomen is usually normal with some generalized [blank_start]tenderness[blank_end]

What are ways to generally investigate for irritable bowel syndrome?

Main managements of IBS is dietary changes, peppermint old, and (if needed) loperamide

Buscapan can be given for irritable bowel syndrome.

A 45 year old gentleman presents with 7 month history of abdominal pain and unintentional weight loss. He has been feeling more tired lately and has noticed he has become increasingly paler. He has a PMH of asthma and coeliac disease. He explains that his father and his brother also experienced similar symptoms and were subsequently diagnosed with colorectal cancer. What is your main differential?

IBD and HNPCC put you at increased risk for colorectal cancer

What are these symptomatic of? Often colicky pain Rectal bleeding Bowel obstruction Tenesmus Mass in LIF Early changes in bowel habit

What are these symptomatic of: Weight loss Anemia Occult bleeding Mass in RIF

Most common presentation of colorectal cancer: [blank_start]rectal[blank_end] [blank_start]bleeding[blank_end] [blank_start]persisting[blank_end] change in bowel habit [blank_start]anemia[blank_end]

Urgent referral for cancer pathway if the patient is aged 40 and over with unexplained weight loss and abdominal pain.

How can you NOT investigate colorectal cancer?

The earlier the Duke stage (for ex: stage A vs stage B), the lower 5-year survival likelihood.

How can you manage colorectal cancer?

Bowel Cancer Screening Program: In England, men and women between the ages of [blank_start]60[blank_end]-74 years take part A bowel cancer testing kit is sent every [blank_start]2[blank_end] years 2 bowel cancer screening tests: [blank_start]Fecal[blank_end] [blank_start]occult[blank_end] blood testing – home testing kit Flexi-[blank_start]sigmoidoscopy[blank_end] – looking for polyps – one at age 55 years

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Which is pelvic pain associated with?

What is true regarding Chlamydia trachomatis?

Women with chlamydia present with dysuria and yellowish discharge and irregular bleeding

Males with chlamydia present with epididymitis, hematuria, dysuria, discharge, and sudden bursts of weakness

Investigations for chlamydia: Male: [blank_start]first[blank_end]-catch [blank_start]urine[blank_end] Female: [blank_start]vulvovaginal[blank_end] swab Both samples are sent for NAATs ([blank_start]nucleic[blank_end] [blank_start]acid[blank_end] [blank_start]amplification[blank_end] test)

Chlamydia complications: [blank_start]pelvic[blank_end] inflammatory disease, infertility, [blank_start]ectopic[blank_end] pregnancy Treatments: 100mg [blank_start]Doxycycline[blank_end] (danger: [blank_start]teratogenic[blank_end]) or 1 gram stat [blank_start]Azithromycin[blank_end]

Neisseria Gonnorhea is Gram-[blank_start]negative[blank_end] diplococcus Infects mucous membranes of the urethra, [blank_start]endocervix[blank_end], rectum, [blank_start]pharynx[blank_end] and conjunctiva transmitted sexually or [blank_start]perinatally[blank_end] Presentation: Women: [blank_start]Urinary[blank_end] [blank_start]Tract[blank_end] Infection Discharge [blank_start]Dysuria[blank_end] Men: Discharge: [blank_start]green[blank_end] and thick [blank_start]dysuria[blank_end]

Investigation for Gonnorhea: Women: [blank_start]Pharynx[blank_end], vaginal, rectal swab Men: Pharynx, [blank_start]urethral[blank_end], rectal swab

Ceftriaxone 500mg IM and Azithromycin 3G stat is how to treat gonnorhea.

Which of these are complications of gonnorhea?

What is the differential diagnosis for these symptoms? lower abdominal pain Deep dyspareunia Abnormal vaginal bleeding and/or discharge Right upper quadrant pain Lower abdominal tenderness Adnexal tenderness, cervical motion tenderness, or uterine tenderness Abnormal cervical or vaginal mucopurulent discharge Fever greater than 38°C

[blank_start]Peri[blank_end]-[blank_start]hepatitis[blank_end] is the development of adhesions between the liver and the peritoneum, causing right [blank_start]upper[blank_end] quadrant pa

How do you manage pelvic inflammatory disease?

The most common cause of a​ UTI is E colli

Obesity, poor bladder emptying, diabetes, kidney stones, and Vitamin E deficiency all put you at increased risk of a UTI.

In a UTI, there will be increased urgency and frequency of urination despite it being painful due to the feeling of incomplete urination.

What do you pay special notice for in a urinalysis of a UTI?

Which of these is not a possible complication of a UTI?

Management of UTI: [blank_start]Fluids[blank_end] (supportive) Analgesia 1. [blank_start]Trimethoprim[blank_end] 2. [blank_start]Nitrofurantoin[blank_end] for: Women - [blank_start]3[blank_end] days Men - [blank_start]7[blank_end] days

While both occur shortly after menarche, there is no underlying pelvic pathology in primary dysmennorea like there is in secondary dysmenorrhea.

Which of these may NOT be the reason for secondary dysmenorrhea?

[blank_start]Primary[blank_end] dysmennorhea is pain which begins just before menstruation and lasts up to [blank_start]72[blank_end] hours, progressively improving

NSAIDS, analgesia and contraceptive pill is how to manage dysmenorrhea.

You use ultrasounds and PAP smear tests to investigate for dysmenorrhea.

Which of these are emergency findings related to dysmenorrhea?

Contraception: Starting the pill on day [blank_start]5[blank_end] or before protects from pregnancy straight away. Otherwise, patients will need additional contraception until taken for [blank_start]7[blank_end] days.

What is NOT true regarding the pill?

If you forgot to take the pill yesterday, the missed pill should still be taken, even if it means taking two pills in today.