History-taking model
Kaji Sritharan, Vivian A Elwell, Sachi Sivananthan in Essential OSCE Topics for Medical and Surgical Finals, 2007
Differential diagnosis of abdominal pain Right upper quadrant (RUQ): cholecystitis, duodenal ulcer, hepatitis, congestive hepatomegaly, pyelonephritis, appendicitis, right-sided pneumonia.Left upper quadrant (LUQ): ruptured spleen, gastric ulcer, aortic aneurysm, perforated colon, pyelonephritis, left-sided pneumonia.Right lower quadrant (RLQ): appenditis, gynaecological causes (cyst, abscess, ectopic pregnancy), renal stone, hernia, mesenteric adenitis, Meckel’s diverticulitis, inflammatory bowel disease (IBD), perforated bowel (caecum), psoas abscess.Left lower quadrant (LLQ): diverticulitis, gynaecological causes (cyst, abscess, ectopic pregnancy), renal stone, hernia, inflammatory bowel disease (IBD), perforated bowel (sigmoid).Epigastrium: myocardial infarct (MI), peptic ulcer, cholecystitis, perforated oesophagus.
Management of Acute Intestinal Ischaemia
Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams in Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
As noted above, the classic presentation of acute mesenteric ischaemia is pain out of proportion to examination findings. Patients may develop abdominal tenderness to palpation as the disease progresses, developing ‘peritoneal signs’ such as guarding and rebound tenderness when full-thickness ischaemia or perforation occurs. The presence or absence of bowel sounds is a non-specific finding. Bowel sounds are often present early in the disease process and may in fact be hyperactive. Peristalsis, and therefore bowel sounds, decrease as the intestine becomes increasingly ischaemic. Although the examination should focus on the abdomen, it is also important to search for physical exam findings that may provide clues to the aetiology (arrhythmia or murmur, abdominal compartment syndrome) or alternative causes of abdominal pain when the diagnosis is uncertain. It is important to remember that a paucity of physical exam findings does not eliminate a diagnosis of acute mesenteric ischaemia.
Abdomen
David Heylings, Stephen Carmichael, Samuel Leinster, Janak Saada, Bari M. Logan, Ralph T. Hutchings in McMinn’s Concise Human Anatomy, 2017
The abdomen or abdominal cavity (in popular parlance the ‘tummy’) is the part of the trunk below the diaphragm that separates it from the thoracic cavity. Abdominal pain is a common reason to visit the doctor. The abdomen is also the site where excess fat is deposited. While most of the digestive system lies within the abdomen, the oesophagus is mostly in the thorax and the digestive system also extends below the pelvic brim in the lowest part (p. 190) into the pelvic cavity or pelvis. The upper abdomen also contains the kidneys, adrenal glands and spleen. Because of the way the diaphragm bulges upwards into the thorax, the abdominal cavity is larger than might be expected when looking at the outside of the trunk, but lower down it is less capacious than might be expected because of the way the lumbar region of the vertebral column projects forwards in the middle of the posterior abdominal wall. Muscles form the rest of the posterior wall, as they do the anterolateral wall.
Sudden rupture with internal bleeding and shock following torsion and necrosis of a large uterine leiomyoma
Published in Journal of Obstetrics and Gynaecology, 2019
Yi-Lin Chen, Li-Ru Chen, Kuo-Hu Chen
An acute onset of abdominal pain is a rather uncommon presentation of uterine leiomyomas. The most common causes for abdominal pain are degeneration of leiomyomas, expulsion of submucous myomas, compression to the pelvis, rather than infection, necrosis or torsion of leiomyomas (Gupta and Manyonda 2009). Pedunculated subserosal myomas are, especially, at the risk of torsion and the challenge is in making the diagnosis. Because symptoms and physical findings associated with torsion and necrosis of uterine leiomyomas, including abdominal pain, gastrointestinal discomfort, pelvic masses and peritoneal irritation are usually non-specific, a diagnosis is frequently intra-operative due to the poor correlation between clinical presentation and the classic radiological findings (Marcotte-Bloch et al. 2007; Roy et al. 2005). Necrobiosis can be ischaemic following the torsion of the vascular pedicle of subserosal leiomyomas. Without a timely diagnosis and management, gangrene and peritonitis or tumour rupture with internal bleeding and hypovolemic shock can be life threatening.
Cow milk protein allergy and other common food allergies and intolerances
Published in Paediatrics and International Child Health, 2019
Wiparat Manuyakorn, Pornthep Tanpowpong
Typical symptoms include abdominal pain, cramps, bloating, flatulence and diarrhoea. Some patients may also suffer from fatigue, mood swing and headache. Symptoms usually occur a few hours after undigested lactose reaches the colon, causing osmotic diarrhoea. Bacterial fermentation of the lactose also creates flatulence and bloating from intraluminal gas (carbon dioxide and hydrogen) and short-chain fatty acids cause acidic stools [53]. The non-invasive test for lactose maldigestion/intolerance in children is to ingest a lactose load on an empty stomach and measure breath hydrogen and/or methane, commencing from baseline up to 3–5 hours after ingestion as these gases are produced by bacterial fermentation of the undigested lactose in the gastrointestinal tract, then enter the bloodstream and finally reach the lungs. Preparation for the test usually includes cessation of antibiotics, laxatives and probiotics for 14 days with overnight nil per os before the test. An elevation of breath hydrogen over 20 ppm after the lactose load is considered to indicate lactose maldigestion [46].
Constipation in the elderly from Northern Sardinia is positively associated with depression, malnutrition and female gender
Published in Scandinavian Journal of Gastroenterology, 2018
Maria Pina Dore, Giovanni Mario Pes, Stefano Bibbò, Patrizia Tedde, Gabrio Bassotti
Constipation is a common complaint and the prevalence of self-reported constipation in the adult population is estimated to be around 30% [1], with the female gender preferentially affected. Observational and prospective epidemiological studies in both Western [2] and Eastern [3] countries have reported different frequencies according to age. In community-dwelling elderly people [4] or in those residing in long-term facilities [5] the prevalence may rise to 60%. Constipation affects especially older adults and may result in deterioration of health-related quality of life. Patients often complain difficult stool passage usually associated with hardened feces, straining and unsatisfactory defecation [6]. Additional symptoms may include abdominal pain and/or discomfort and bloating. Patients may experience complications such as overflow fecal incontinence, hemorrhoids, anal fissures and fecal impaction that may require hospitalization [7].
Related Knowledge Centers
- Abdominal Aortic Aneurysm
- Appendicitis
- Differential Diagnosis
- Ectopic Pregnancy
- Irritable Bowel Syndrome
- Abdomen
- Gastroenteritis
- Diverticulitis
- Pain
- Signs & Symptoms