examination

Question 1

What contributes more to the diagnosis than extensive investigation?

Answer 1

Careful examination

A thorough examination is essential for accurate diagnosis in medical conditions.

Question 2

What should be searched for in patients with intestinal complaints?

Answer 2

• General medical disorders
• Signs of intestinal obstruction
• Neurological disorders (especially spinal cord lesions)

These factors are crucial in assessing patients with intestinal issues.

Question 3

What are essential examinations for detecting abnormalities of the pelvic floor?

Answer 3

• Perineal inspection
• Rectal examination

These examinations can reveal issues such as abnormal descent or impaired sensation.

Question 4

Is it appropriate to investigate every person with a very common complaint?

Answer 4

No

Most patients will respond to dietary fibre supplementation and judicious use of laxatives.

Question 5

What symptoms in middle-aged or elderly patients require prompt investigation?

Answer 5

• Rectal bleeding
• Pain
• Weight loss

These symptoms may indicate serious underlying conditions.

Question 6

What initial investigations should be carried out for patients with simple constipation?

Answer 6

• Digital rectal examination
• Proctoscopy
• Sigmoidoscopy
• Routine biochemistry (including serum calcium and thyroid function tests)
• Full blood count

These tests help detect anorectal disease and other issues.

Question 7

What is justified if initial investigations are normal in patients with constipation?

Answer 7

A 1-month trial of dietary fibre and/or laxatives

This approach is often effective for managing simple constipation.

Question 8

What should be done if symptoms persist after initial treatment?

Answer 8

Examination of the colon by barium enema or colonoscopy

This is necessary to look for structural disease.

Question 9

What may be necessary if no cause is found and disabling symptoms are present?

Answer 9

Specialist referral for investigation of possible dysmotility

This may involve assessing conditions like ‘slow transit’ or ‘obstructed defecation.’

Question 10

What studies can be used to define problems related to dysmotility?

Answer 10

• Intestinal marker studies
• Anorectal manometry
• Electrophysiological studies
• Defecating proctography

These studies help in diagnosing specific motility issues.