Lumps, bulges and how’s your bowel?

Abdo pain 2 started with a clinic for problem bowels.  This was quite good as I got my own little consulting room to chat to the patients with before presenting them to the consultant.  Unfortunately, most of the time I had no idea what was wrong the patient.  Thankfully, neither did the consultant, and most had to be signed up for further tests.  That was a little frustrating, as it would have been nice to find out the diagnosis, but it improved my history taking skills.  There was an intriguing case of a patient who had their appendix removed when they were little and 5 years later and for the next 10 years they were still getting pain in that region, although the pain was now increasing.  It was thought that fibrous scar tissue that formed after the removal of the appendix was being pulled on when the patient moved in certain positions or did heavy lifting. 

I spent an afternoon in a hernia clinic getting up close and personal with men’s testicles and palpating for defects.  My competency this week was on examination of a swelling and I was sent to see a patient in the surgical assessment unit.  The patient was sat in a side room waiting for me to assess them but I had no idea where to start.  Their whole arm from shoulder to wrist had an enormous, pulsating, swollen vein running down it.  I really didn't want to touch it in case it burst.  At its widest it was 4 cm.  It was so distracting it quite put me off proper examination technique.  After the exam I was told the patient had kidney failure and it was a fistula that had which is a communication between the artery and vein to help give haemodialysis.  They were about to have surgery to reverse it.  It wasn't something I’d come across before, so it was quite astounding to see.