RT Book, Section
A1 Murtagh AO, John
A1 Bird, Sara
SR Print(0)
ID 1163949173
T1 See a doctor, support a lawyer
T2 Murtagh's Cautionary Tales, 3rd Edition
YR 2019
FD 2019
PB McGraw-Hill Education (Australia) Pty Ltd
PP Sydney, Australia
SN 9781743767443
LK murtagh.mhmedical.com/content.aspx?aid=1163949173
RD 2024/04/24
AB Long  ago,  during  my  term  as  a  surgical  registrar  I  was  asked  to  see  a  rather  rugged  65-year-old  farmer  with  chronic  intermittent  abdominal  pain.  The  problem  was  puzzling  the  Resident  Medical  Officer  (RMO),  especially  as  the  patient  had  the  ‘thick  file’  syndrome.  He  was  a  rather  likeable  phlegmatic  man  who  seemed  to  have  a  genuine  problem  and  was  embarrassed  by  his  occasional  visits  to  various  doctors  and  the  emergency  department.  He  described  the  pain,  which  was  located  centrally,  as  colicky,  mild  to  moderate  and  dull.  It  was  associated  with  mild  abdominal  distension,  nausea  (no  vomiting)  and  constipation  with  hard,  pellet-like  stools.  Diagnoses  that  had  been  suggested  were  irritable  bowel  syndrome  and/or  abdominal  adhesions.  He  said  that  the  painful  attacks  which  simply  felt  like  ‘a  kick  in  the  guts’  would  dissipate  as  quickly  as  they  came.  He  had  a  history  of  a  cholecystectomy  21  years  previously.