CBL 1

Question 1

9 regions of the stomach and what is found in them?

Answer 1

Question 2

Example

• 30 year old man with severe generalised abdominal pain. The pain is so severe that he is finding it difficult to breath. He smokes and is on non-steroidal anti-inflammatory drugs for right knee pain. The surgical team have requested X- rays

Questions

What is the condition presenting with generalised abdominal pain and what is the likely cause?

What are the predisposing factors?

What sort of X-rays have been requested and what is likely to be seen?

Answer 2

• What is the condition presenting with generalised abdominal pain and what is the likely cause?
  
  • Perforated Duodenal ulcer
  • Pancreatitis
• What are the predisposing factors?
  
  • Smoking, alcohol, NSAIDs
• What sort of X-rays have been requested and what is likely to be seen?
  
  • Erect CXR (free sub-diaphragmatic air)
  • CT

Question 3

Example

• 16 year old boy with worsening abdominal pain. It began in the centre of his abdomen yesterday, but has now shifted to his right iliac fossa. He is feeling nauseated and has lost his appetite. The nursing staff tell you that he is pyrexial.

Questions

• What condition classically presents in this way?
• What does pyrexial mean?
• What other vital signs should be checked?

Answer 3

• What condition classically presents in this way?
  
  • Appendicitis
• What does pyrexial mean?
  
  • Elevated temperature
• What other vital signs should be checked?
  
  • Heart rate
  • Blood pressure
  • pulsoxymetry

Question 4

Example

• 45 year old woman who has been having pain in the right upper quadrant of her abdomen for the last 5 hours. She has been vomiting. She has had similar pains in the past after eating a cooked breakfast, but this episode is much worse. Someone has mentioned a scan to her.

Questions

• What sort of patient is described? (FFF)
• What is the likely type of pathology?
• What sort of scan is most useful here?

Answer 4

• What sort of patient is described? (FFF)
  
  • 5Fs (Female/Fat/Forty…..Fair/Fertile)
• What is the likely type of pathology?
  
  • Gallstones
  • Biliary colic
  • Cholecystitis
• What sort of scan is most useful here?
  
  • USS
  • MRCP (if dilated bile ducts due to gallstones)

Question 5

Example

• 75 year old man with pain in his left iliac fossa for the last 3 days. The pain is gradually getting worse, and is now making it too painful for him to move around the bed.

Questions

• Differential diagnosis
• Diagnosis
• Treatment
• Predisposing factors
• Potential problems

Answer 5

• Differential diagnosis
  
  • Diverticulitis
  • Colonic cancer (perforated)
  • Incarcerated inguinal hernia
  • Ureteric colic
  • Ruptured iliac aneurysm
• Diagnosis
  
  • Diverticulitis
• Treatment
  
  • IV antibiotics
  • Bowel rest
  • Percutaneous drainage of abscess
  • Surgery (Hartmann’s) if perforated
• Predisposing factors
  
  • Low fibre diet
  • Constipation
  • Connective tissue disorder (Ehlers Danlos/Marfans)
• Potential problems
  
  • Perforation
  • Stricture
  • Colovesicle fistula

Question 6

Example

• 35 year old man with a history of drinking a bottle of vodka daily. He has had severe upper abdominal pain since last night. The pain is getting worse.

Questions

• Differential diagnosis
• Investigations to confirm diagnosis
• Other causes of pancreatitis

Answer 6

• Differential diagnosis
  
  • Pancreatitis
• Investigations to confirm diagnosis
  
  • Serum Amylase
  • CT
• Other causes of pancreatitis
  
  • Gallstones, steroids,idiopathic, hyperlipidaemia
  • Drugs ( thiazide diuretics, azathioprine)
  • Viruses (coxsachie, Mumps, HIV)
  • Trauma
  • Anatomical defects (congenital)
  • Pregnancy

Question 7

Example

• A 52 year old woman who has been sent in with increasing abdominal distension and vomiting. She has had a perforated appendix removed 15 years ago. She has not had her bowels open for 2 days. The nurses say she is “very dry” with very little urine output and there is an intra-venous infusion already set up.

Questions

• Differential diagnosis
• Difference between small and large bowel obstruction
• Management
• Causes
• Complications

Answer 7

• Differential diagnosis
  
  • Adhesional small bowel obstruction
• Difference between small and large bowel obstruction
  
  • Nausea/vomiting
  • Tinkling bowel sounds
• Management
  
  • Drip & Suck
  • If no resolution in 24 hours – Operation
  • (‘never let the sun go down twice on a SBO’)
• Causes
  
  • Adhesions from previous surgery
  • Hernias
  • Gallstone ileus (see chart)
• Complications
  
  • Perforation
  • Ischaemia/necrosis
  • Aspiration pneumonia