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.

Pop-up div Successfully Displayed

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