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 EMQ 16



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EMQ: 16

Abdominal pain

a)      Appendicitis

b)     Cholecystitis

c)      Mesenteric angina

d)      Peptic ulcer

e)      Biliary colic

f)        Pancreatitis

g)      Large bowel infarction

h)      Crohn’s disease

i)        Colon cancer

j)        Irritable bowel syndrome

1) A 67-year-old male who is known to have ischaemic heart diseases and transient ischaemic attacks, presents with abdominal pain related to meals. The pain comes on shortly after he eats and this has made him reduce his intake of food and lose weight. On examination there is a bruit over the upper abdomen.

2) A 56-year-old businessman presents with epigastric pain. The pain is gnawing in nature and is relieved by food but increases when he is hungry and wakes him up from his sleep in the early hours of the morning.  He is stressed at work and smokes heavily.

3) A 30-year-old male presents with severe abdominal pain of acute onset. The pain is relieved by leaning forward. He gives a history of binge drinking and admits to a recent binge. On examination he looks unwell, there is generalised tenderness over his abdomen and there is bruising in the flanks.

4) A 72 year old male who has had a previous myocardial infarction and stroke is admitted with abdominal pain, diarrhoea and bleeding per rectum. He awoke from his sleep with severe left sided abdominal pain and this was followed by profuse watery diarrhoea and later he began passing fresh blood per rectum. On examination he looked unwell was tachycardic and there was   a systolic bruit audible over the central abdomen.

5) A 27-year-old female presents with a history of abdominal pain of several months duration. She admits to passing loose motions and she has lost weight. She smokes 20 cigarettes per day.  On examination there are painful tender erythematous nodules over her shins and there is a tender mass in the right iliac fossa.


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