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MW S Rationales Files/Abdomen Rationale.Pdf A RATIONALE FOR THE ABDOMEN A RATIONALE FOR the ABDOMEN Assoc. Prof. Warwick Carter MB.BS; FRACGP; FAMA A guide to the diagnosis of diseases that may cause abdominal symptoms. 1 A RATIONALE FOR THE ABDOMEN CONTENTS Introduction SECTION ONE Abdominal Symptoms Diagnostic Chart A chart that leads the user through the location of abdominal symptoms to possible diagnoses. SECTION TWO Diagnostic Algorithm for Abdominal Symptoms Symptoms involving the abdomen and the conditions that may be responsible SECTION THREE Abdominal Conditions The symptoms, signs, investigation and treatment of medical conditions that may cause an abdominal symptoms. Appendices The interpretation of selected pathology tests 2 A RATIONALE FOR THE ABDOMEN INTRODUCTION This book is designed for both the medical student and the doctor who is not a specialist. It will take the user through a logical rationale in order to diagnose, and then treat, virtually every condition causing abdominal symptoms likely to be encountered outside a specialist practice. There are two ways to reach a diagnosis, using the chart in Section One, or the Diagnostic Algorithms in Section Two. In Section One, a chart will guide the user through the location of presenting symptoms for most abdominal conditions to a selection of possible diagnoses. As an alternative, the algorithms in Section Two will indicate the diagnoses possible with a variety of abdominal presenting symptoms. Once a diagnosis has, or number of differential diagnoses have been made, a detailed explanation of the various diagnoses can be found in the largest part of the book, Section Three. This has been written in a style that should be easy to understand by even junior medical students, with technical terms explained in each monograph, but should still be useful to the non-specialist doctor. The symptoms, signs, investigations and treatment of a very wide range of conditions are explained, along with pictures of the more common conditions. I trust that you will find it useful. Warwick Carter Brisbane OTHER BOOKS IN THIS SERIES A Rationale for Rashes A Rationale for Eyes A Rationale for the Brain A Rationale for the Chest 3 A RATIONALE FOR THE ABDOMEN Section ONE ABDOMINAL SYMPTOMS DIAGNOSTIC CHART 4 A RATIONALE FOR THE ABDOMEN COMMON CAUSES OF PAIN IN REGIONS OF THE ABDOMEN A Right Upper Quadrant : Acute cholecystitis, biliary colic, hepatitis, pneumonia. B Epigastrium : Peptic ulcer, gastritis, pancreatitis, Crohnʼs disease, heart disease. C Left Upper Quadrant : Splenomegaly (? cause), irritable bowel syndrome, basal pneumonia. D Right Loin : Ureteric colic, pyelonephritis, duodenal ulcer. E Periumbilical : Early appendicitis, small bowel obstruction, perforated peptic ulcer, ruptured aortic aneurysm, mesenteric artery occlusion, Crohnʼs disease, Meckelʼs diverticulitis. F Left Loin : Ureteric colic, diverticulitis, irritable bowel syndrome, pyelonephritis. G Right Iliac Fossa : Appendicitis, mesenteric adenitis, ureteric colic, unruptured ectopic pregnancy, ovarian cysts, Meckelʼs diverticulitis, salpingitis, inguinal and femoral hernia, testicular torsion. H Hypogastrium : Large bowel obstruction, ruptured ectopic pregnancy, cystitis, uterine cramps, endometriosis, pelvic inflammatory disease. 5 A RATIONALE FOR THE ABDOMEN I Left Iliac Fossa : Gastroenteritis, colonic carcinoma, ureteric colic, diverticulitis, unruptured ectopic pregnancy, ovarian cysts, ulcerative colitis, constipation, salpingitis, inguinal or femoral hernia, testicular torsion. 6 A RATIONALE FOR THE ABDOMEN Section Two DIAGNOSTIC ALGORITHMS FOR ABDOMINAL SYMPTOMS 7 A RATIONALE FOR THE ABDOMEN Abdominal Colic DIAGNOSTIC Severe, spasmodic, remitting pain Gastroenteritis (diarrhoea, vomiting) ALGORITHMS Food poisoning Constipation Gastric cancer FOR ABDOMINAL Peptic ulceration (epigastric, eased by antacids) Small bowel obstruction (eg. postsurgical, stricture, SYMPTOMS hernia) Large bowel obstruction (eg. volvulus, diverticulitis) Intussusception (child, red currant jelly faeces) AND SIGNS Small or large intestinal neoplasm or tumour Uterine colic (eg. missed abortion, period pain) See also Abdominal Pain Abdominal Distension (Abdominal Bloating) Giardial intestinal infection FORMAT Irritable bowel syndrome (pain, irregular bowel habits) Severe constipation Presenting Symptom Nervous swallowing of air (Alternate Name) Depression (poor sleep, loss of interest) Explanation of terminology Eating disorders (eg. anorexia nervosa) System or other group of symptoms Ileus (nausea, pain, silent abdomen) Diagnoses that may present with this symptom Premenstrual syndrome [alternate name of diagnosis] (other symptoms of Peritonitis (pain, fever) each diagnosis, or a discussion of the diagnosis) Intestinal obstruction (pain, borborygmi) Other entries to consider Sigmoid volvulus (colic) Ascites (shifting dullness) Denervation syndrome (diarrhoea, oesophageal surgery) Clinical Sign Gas bloat syndrome (can't vomit) (Alternate Name) [Abbreviation] Gaseous drinks and fermentable foods (eg. Exp: An explanation of the sign, with its legumes, grains) methodology described in sufficient detail to Hormone replacement therapy enable the practitioner to perform the test. See also Ascites Int: The interpretation of the sign. (+) The diseases, syndromes etc. that should be considered if the test is positive Abdominal Mass (++) The interpretation of an exaggerated or Superficial mass grossly positive test Lipoma (–) Ditto for a negative test result Sebaceous cyst (subcutaneous, punctum) (AB) Ditto for an abnormal test result Umbilical hernia Phys: The pathophysiology of the sign to enable Inguinal hernia its significance to be better understood Incisional hernia Other entries to consider Post-traumatic scarring Rectus sheath haematoma Divarication of the recti Deep mass Carcinoma of bowel or stomach 8 A RATIONALE FOR THE ABDOMEN Crohn's disease (epigastric pain, tender, diarrhoea) Infantile colic (4 to 16 weeks of age) Hodgkin's disease Constipation (cause should be determined) Other lymphomas Pseudomembranous colitis (diarrhoea) Metastatic carcinoma Intestinal perforation (? after trauma) Appendiceal abscess (right iliac fossa mass) Sphincter of Oddi syndrome (RUQ pain, nausea, Pancreatic tumour diarrhoea) Aortic aneurysm (pulsatile, central) Volvulus (severe colic, distension) Pregnancy Uterine fibroid or tumour Hepatobiliary-pancreatic Ovarian tumour or cyst Hepatitis (us. RUQ, jaundice, nausea) Hydatid cyst Cirrhosis (us. RUQ, fatigue, nausea) Distended gall bladder (Murphyʼs sign +) Cholecystitis (us. RUQ, nausea, jaundice) Hepatomegaly Biliary colic (intermittent, tender, shock) Splenomegaly Pancreatic carcinoma (symptoms vary with site) Enlarged kidney Pancreatitis (nausea, tender, shock) Pyloric stenosis (male infant) Bladder carcinoma Genitourinary Vertebral tumours Testicular torsion (tender testicle, nausea, <40 Neuroblastoma years) Endometriosis (dysmenorrhoea, dyspareunia) Salpingitis (cramps, fever, leucorrhoea) Abdominal Noise Ovarian cyst or teratoma (sudden onset) See Borborygmi Mittelschmerz [ovulation syndrome] Ectopic pregnancy (abnormal vaginal bleeding) Abortion (vaginal bleeding, hypogastric cramps) Cystitis (dysuria, frequency, hypogastric pain) Abdominal Pain Pyelonephritis (loin pain, nausea, headache) Cardiovascular Renal and ureteric colic (nausea, haematuria) Aortic aneurysm (pulsatile mass, shock) Nephrotic syndrome (proteinuria, oedema) Haemolytic anaemia (jaundice, malaise, pallor) Pelvic inflammatory disease (vaginal discharge, Sickle cell anaemia (jaundice, fever, negroid) dysuria) Thalassaemia major (hepatosplenomegaly, lethargy, jaundice) Infections Rheumatic fever (arthralgia, chorea, fever) Protozoal or metazoal intestinal infections Mesenteric artery occlusion (nausea, melaena, Tuberculosis (symptoms vary with organs involved) diarrhoea) Mumps pancreatitis (tender and swollen parotid Subacute bacterial endocarditis (fever, malaise, glands) arthralgia) Viral, bacterial and toxic enteritis Typhoid fever and other salmonelloses Gastrointestinal Brucellosis (fever, fatigue, arthralgia) Gastritis (anorexia, haematemesis, nausea) Leptospirosis (fever, myalgia, nausea) Peptic ulcer (us. epigastric, tender, nausea) Actinomycosis (fever, colic, sinuses in skin) Irritable bowel syndrome (dyspepsia, varied bowel Infectious mononucleosis (adenitis, fever) habits) Septicaemia (fever, tachycardia, malaise) Crohn's disease (us. epigastric, tender, nausea) Bilharzia (diarrhoea, urticaria, fever) Small intestine tumours (melaena, anorexia, nausea) Syndromes Meckel's diverticulitis (melaena, anorexia, nausea) Afferent loop syndrome (relief by vomiting, Gut obstruction (colic, vomiting, constipation) steatorrhoea) Ileus (precipitating factor, distension, vomiting) Budd-Chiari syndrome (hepatomegaly, ascites) Appendicitis (us. RIF, anorexia, nausea) Carcinoid syndrome (cramps, flush, neck oedema, Diverticulitis (us. LIF, diarrhoea and constipation, facial oedema) melaena) Dumping syndrome (epigastric, postprandial) Coeliac disease (anaemia, underweight) Fitz-Hugh-Curtis syndrome (vaginal discharge, Ulcerative colitis (diarrhoea, fever, weight loss) perihepatitis) Intussusception (child, brief attacks) Henoch-Schönlein syndrome (purpura, excess 1 A RATIONALE FOR THE ABDOMEN bleeds) Bilharzia (diarrhoea, urticaria, fever) Congestive cardiac failure (dyspnoea, oedema, Other cough) Muscular strain Chronic renal failure (nausea, pruritus, lethargy) Peritonitis (acutely tender, ileus) Hepatitis (jaundice, hepatomegaly, malaise) Adhesions (colic) Pericarditis
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