Skip to Main Content

++

Probability diagnosis

++

Irritable bowel syndrome

++

Mittelschmerz/dysmenorrhoea

++

Constipation

++

Peptic ulcer/gastritis

++

Serious disorders not to be missed

++

Vascular:

++

  • mesenteric artery ischaemia

  • AAA

++

Cancer/neoplasia:

++

  • bowel/stomach cancer

  • pancreatic cancer

  • ovarian tumours

++

Infection:

++

  • hepatitis

  • recurrent PID

++

Pitfalls (often missed)

++

Adhesions

++

Appendicitis

++

Biliary disease: gallstones, sludge

++

Food allergies

++

Hernia

++

Lactase deficiency (i.e. lactose intolerance)

++

Constipation/faecal impaction

++

Chronic pancreatitis

++

Coeliac disease

++

Inflammatory bowel disease

++

Crohn disease

++

Endometriosis

++

Diverticular disease

++

Subacute obstruction (cancer, adhesions, etc.)

++

Rarities:

++

  • tropical infections (e.g. hydatids, melioidosis, strongyloides)

  • uraemia

  • lead poisoning

  • porphyria

  • sickle cell anaemia

  • hypercalcaemia

  • Addison disease

++

Masquerades checklist

++

Depression

++

Drugs

++

Spinal dysfunction

++

UTI

++

Is the patient trying to tell me something?

++

A strong possibility: consider hypochondriasis, anxiety, sexual dysfunction, Munchausen syndrome.

++

Key history

++

This includes a detailed pain analysis, especially associated features such as micturition, bowel function, menstruation, diet and psychological features. Note relevant past history (incl. abdominal surgery), drug intake, travel, family history. Enquire about ‘red flags’ for organic disease (e.g. weight loss, fever, nocturnal pain or diarrhoea, progressive symptoms).

++

Key examination

++

  • General appearance including psyche and vital parameters

  • Abdominal examination: inspection, auscultation, palpation, percussion (in that order)

  • Rectal examination

  • Vaginal examination (if appropriate)

  • Office urine test

++

Key investigations

++

  • Urinalysis including MCU

  • FBE

  • ESR/CRP

  • Lipase/amylase

  • LFTs

  • U&E

  • Plain abdominal X-ray

  • Other imaging (e.g. ultrasound, IVU) according to findings and intuition

  • Endoscopy as appropriate

++

Consider

++

  • H. pylori testing

  • coeliac disease

++

Diagnostic tips

++

  • Consider gallstones and duodenal ulcer if the patient is woken (e.g. at 2–3 am) with abdominal pain.

  • Be very mindful of constipation, especially in the elderly, and be skilled at digital rectal examination.

  • Avoid repeated investigations unless a new symptom develops and the patient becomes unwell.

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

Murtagh Collection Full Site: One-Year Subscription

Connect to a suite of general practice resources from one of the most influential authors in the field. Learn the breadth of general practice, including up-to-date information on diagnosis and treatment, as well as key clinical skills like communication.

$145 USD
Buy Now

Pay Per View: Timed Access to all of Murtagh Collection

48 Hour Subscription $34.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.