Station - Instructions for candidate
You are a senior medical student on placement in the Emergency Department of Fiona Stanley Hospital.
Rosa Marchetti, a 64-year-old woman, is in the Emergency Department with 18 hours of colicky central abdominal pain, vomiting and increasing abdominal swelling. She has vomited several times since arriving. The triage observations and nursing handover are provided above.
| Triage observations | Triage observations: heart rate 104 regular, blood pressure 132/78 mmHg, respiratory rate 20, oxygen saturation 97% on room air, temperature 37.4 degrees C, pain score 7/10. |
|---|---|
| Nursing handover | The patient has vomited several times in the department and has not yet received intravenous fluids or analgesia. |
Results provided:
CT abdomen and pelvis with intravenous contrast
| Item | Value | Reference range |
|---|---|---|
| Report | Multiple dilated fluid-filled small bowel loops measuring up to 4.2 cm, with a discrete calibre change in the lower central abdomen; distal small bowel and colon are decompressed. No free intraperitoneal gas. Mild adjacent mesenteric fluid, with preserved bowel wall enhancement. | - |
imaging other - read aloud by the examiner
The scan shows several fluid-filled loops of small bowel that are wider than expected. In the lower central abdomen, the bowel changes abruptly from widened loops to narrower loops. The bowel wall still enhances after contrast. There is a small amount of fluid nearby, but no free gas is seen. The large bowel is not distended.
Look up an example image: Radiopaedia adhesive small bowel obstruction CT
Your tasks are to:
- Take a focused history of the presenting complaint and relevant background, including past history, medications, allergies and social circumstances.
- Perform a focused examination of the periphery, abdomen, hernial orifices and rectum. Describe to the examiner what you would like to examine and the relevant findings will be provided to you.
- Request any relevant investigations, including imaging. Results will be provided by the examiner if appropriately indicated.
- Interpret the investigation results provided to you.
- State the most likely diagnosis and two to four differential diagnoses, with brief justification for each.
- Outline the initial management plan, including immediate treatment, referral and safety-netting.
- Summarise your findings and plan to the examiner.
- Please verbalise each examination step to the examiner; findings will be provided when you reach the relevant step.
- You do not need to perform any procedure, insert a tube or prescribe in writing.
- Summarise your findings and plan to the examiner at the end; the examiner will not ask additional questions.
This is a 15-minute station, with 2 minutes of reading time.