Term
1. INTRODUCTION
Q: How would you start the consultation?
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Definition
A:
- "Hello, I’m one of the doctors in A&E. Could I confirm your full name and date of birth? Thank you. I understand you’ve been having abdominal discomfort – could you tell me more about that?"
- Keywords: Introduction, confirm identity, open-ended question. |
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Term
2. PRESENTING COMPLAINT (SOCRATES)
Q: What SOCRATES questions would you ask about abdominal pain? |
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Definition
A:
- Site: "Where exactly is the pain?"
- Onset: "When did it start?" (e.g., today)
- Character: "How would you describe it?" (cramping?)
- Radiation: "Does it move to your back, shoulder, or feel like a belt?"
- Associated: "Any nausea/vomiting? Unable to pass stool/gas?"
- Time: "Has the pain changed?"
- Exacerbating/Relieving: "Does anything worsen/relieve it?"
- Severity: "On a scale of 1–10?"
- Keywords: SOCRATES, cramping, radiation, severity scale. |
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Term
4. RISK FACTORS
Q: What obstruction-specific risk factors would you ask about?
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Definition
A:
- "Any prior abdominal surgery?" (→ adhesions)
- "History of bowel cancer, polyps, or chronic constipation?"
- "Taking opioids, anticholinergics, antidepressants?"
- Keywords: Prior surgery (commonest cause), opioids, cancer. |
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Term
| 5. PMAFTOSA HISTORY Q: Outline the PMAFTOSA framework. |
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Definition
| A: - Past Medical: Bowel disease, cancer, surgery. - Medications: Laxatives, opioids, antibiotics. - Allergies: Especially to analgesics/antibiotics. - Family: Colon cancer, IBD. - Travel: Infectious risks. - Occupation/Social: Smoking, alcohol, diet. - Alcohol/Opioids: "Any regular use?" (chronic constipation). - Keywords: PMAFTOSA, opioids, alcohol, family history. --- |
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Term
7. EFFECT ON LIFE
Q: How does obstruction impact daily life? |
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Definition
A:
- "Has this affected your appetite, sleep, or routine?"
- Expected: Unable to eat, bloating, fatigue.
- Keywords: Appetite loss, bloating, fatigue.
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Term
8. EXAMINATION (SCENARIO-SPECIFIC)
Q (All Scenarios): How would you introduce the abdominal exam? |
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Definition
| A: "I’d like to examine your abdomen now – this involves looking and gently pressing. Is that okay?" |
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Term
Scenario 1 & 2 (Mannequin):
Q: What are key findings? |
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Definition
A:
- Inspection: Distension, scars, visible peristalsis.
- Palpation: Discomfort on light/deep palpation.
- Auscultation: Increased bowel sounds (examiner states this).
- Skip percussion (due to pain). |
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Term
Scenario 3 (Real Patient):
Q: How does the exam differ? |
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Definition
A:
- Caution: "This might cause discomfort – tell me if it hurts."
- Auscultation: Silent abdomen (examiner states this → red flag).
- Lactate check: Request in blood tests (indicates ischemia).
- Keywords: Distension, increased sounds (Sc1/2), silent abdomen (Sc3), lactate.
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Term
9. PROVISIONAL DIAGNOSIS & EXPLANATION
Q: How would you explain suspected bowel obstruction? |
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Definition
A:
- "I’m concerned about a bowel obstruction – a blockage preventing stool/gas from passing."
- "Causes include scar tissue, a twist, or growth. We’ll do urgent tests to confirm and treat it."
- Keywords: Blockage, scar tissue, urgent tests.
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Term
10. MANAGEMENT PLAN
A. Immediate Stabilisation (All Scenarios):
Q: What are the ABC steps?
B. Investigations:
Q: What tests would you order?
A:
- Bloods: FBC, U&Es, CRP, LFTs, Group & Save, lactate (Sc3) .
- Sc1: Abdominal X-ray (dilated loops) → CT abdomen/pelvis (gold standard).
- Sc2/3: No imaging during exam.
- Keywords: X-ray (Sc1), CT (Sc1), lactate (Sc3).
C. Escalation:
Q: What urgent steps follow?
A:
- Refer to surgeons immediately (all scenarios).
- Sc3: Highlight "silent abdomen + high lactate = possible ischemia" (surgical emergency).
D. Monitoring:
Q: What ongoing care is needed?
A:
- Regular obs, fluid balance, urine output.
- Continue pain/nausea control.
- Keywords: Surgical referral, obs monitoring.
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11. SAFETY NETTING & FOLLOW-UP
Q: What advice would you give?
A:
- "We’ll monitor you closely. If pain/vomiting worsens, or you feel dizzy/feverish, alert us immediately."
- "Surgeons will decide if surgery is needed."
- Keywords: Worsening pain, fever, dizziness, urgent review.
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SCENARIO QUICK REFERENCE
| Feature | Scenario 1 | Scenario 2 | Scenario 3 |
|----------------------|----------------------|----------------------|------------------------------|
| Patient | 50M, no stool ×4d | Female, no stool ×2d | Real patient, ruptured appy |
| Gas | None ×2d | None ×1d | Advanced symptoms |
| Bowel Sounds | Increased | Increased | Silent (ischemia risk) |
| Imaging | X-ray → CT | None | None |
| Key Action | NG tube, surgical ref| Same as Sc1 | Check lactate |
Key Mnemonics:
- SOCRATES: Pain assessment framework.
- PMAFTOSA: Comprehensive history.
- NG Tube: Essential for decompression.
- Silent Abdomen + Lactate = Ischemia (Sc3).
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Use these flashcards to rehearse each consultation stage and scenario-specific nuances. Focus on bolded keywords for exam recall! |
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Definition
A:
- IV access + fluids (0.9% NaCl).
- Analgesia: Paracetamol ± IV morphine.
- Antiemetics: Ondansetron/cyclizine.
- Nil by mouth.
- NG tube: "We’ll place a tube through your nose to drain fluid/gas and ease vomiting."
- Keywords: IV fluids, NG tube, nil by mouth, analgesia. |
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Term
B. Investigations:
Q: What tests would you order? |
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Definition
A:
- Bloods: FBC, U&Es, CRP, LFTs, Group & Save, lactate (Sc3) .
- Sc1: Abdominal X-ray (dilated loops) → CT abdomen/pelvis (gold standard).
- Sc2/3: No imaging during exam.
- Keywords: X-ray (Sc1), CT (Sc1), lactate (Sc3). |
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Term
C. Escalation:
Q: What urgent steps follow? |
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Definition
A:
- Refer to surgeons immediately (all scenarios).
- Sc3: Highlight "silent abdomen + high lactate = possible ischemia" (surgical emergency). |
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Term
D. Monitoring:
Q: What ongoing care is needed? |
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Definition
A:
- Regular obs, fluid balance, urine output.
- Continue pain/nausea control.
- Keywords: Surgical referral, obs monitoring.
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Term
11. SAFETY NETTING & FOLLOW-UP
Q: What advice would you give? |
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Definition
A:
- "We’ll monitor you closely. If pain/vomiting worsens, or you feel dizzy/feverish, alert us immediately."
- "Surgeons will decide if surgery is needed."
- Keywords: Worsening pain, fever, dizziness, urgent review.
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Term
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Definition
- SOCRATES: Pain assessment framework.
- PMAFTOSA: Comprehensive history.
- NG Tube: Essential for decompression.
- Silent Abdomen + Lactate = Ischemia (Sc3). |
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Term
3. DIFFERENTIAL DIAGNOSIS SCREENING
Q: What questions rule out other causes? |
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Definition
A:
- "Any diarrhea, fever, shoulder tip pain, back pain, urinary issues?"
- "Recent travel/diet changes?"
- "When did you last pass stool? Last pass gas?" (Key: no stool ×4d, no gas ×2d )
- Keywords: Diarrhea (absent), fever, travel, stool/gas history.
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Term
| 6. ICE Q: How would you address ICE? |
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Definition
A: - Ideas: "What do you think this is?" - Concerns: "Are you worried it might be serious?" - Expectations: "What would you like us to do?"
- Reframing: Gently correct if patient says "just constipation." - Keywords: Ideas, concerns, expectations, reframing. --- |
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