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Managing abdominal emergencies

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Here’s a scenario with some questions

A elderly patient known to have paroxysmal AF but not anticoagulated due to falls risk presents with severe abdominal pain. On examination he is hypotensive but his abdomen is soft without any peritonism. A venous blood gas shows a lactate of 8.

What diagnosis are you concerned about?

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What is your diagnostic test of choice?

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What is the difference between mesenteric ischaemia and ischaemic colitis?

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And one more!

A 42 year old female presents with continuous right upper quadrant pain for the last 48 hours. She has a fever and looks unwell but observations are otherwise in normal range.

What is your differential diagnosis?

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What is Charcot’s triad? Which condition causes it?

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Which investigations will you request?

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She has an ultrasound of her abdomen and it reveals a liver abscess. Which organisms may cause a liver abscess?

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What is your management?

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Try some OSCE stations

  1. Acute assessment – abdominal pain
  2. Acute assessment – abdominal pain II
  3. Appendicitis history
  4. Acute Cholecystitis history
  5. Find lots more stations here!
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