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 EMQ 17



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EMQ: 17

Abdominal pain

a)      Mesenteric angina

b)      Cholecystitis

c)      Appendicitis

d)      Acute intermittent porphyria

e)      Peptic ulcer

f)        Biliary colic

g)      Pancreatitis

h)      Large bowel infarction

i)        Crohn’s disease

j)       Hyperparathyroidism

1) A 16-year-old boy is admitted with abdominal pain. The pain started in the periumbilical region and then shifted to the right iliac fossa. It is a constant pain and he feels nauseated and has vomited several times. On examination there is tenderness and rebound tenderness in the right iliac fossa.

2) A 27-year-old female is admitted with abdominal pain, vomiting and constipation. She gives a history of depression. She has recently started taking the oral contraceptive pill. There is family history of a similar illness.

On examination she is tachycardic and her blood pressure is high. There is evidence of a peripheral motor neuropathy. The nurse on the ward reports to you that she is afraid the patient might have haematuria as a sample of urine taken from the patient had been inadvertently left standing and the urine had turned red.

3) A 63-year-old male is admitted with abdominal pain. There is a history of renal colic and the patient also complains of pain in his bones. On further questioning he says he is constipated and passes a lot of urine. The patient has corneal calcification.

4) A 50-year-old female presents with abdominal pain.  The pain is described as a cramping discomfort, which is constant. The pain is severe. It is felt in the epigastrium and radiates to the back. The pain comes on rapidly and lasts from 3- 6 hours. It is associated with nausea and vomiting. The pain is related to meals coming on a few hours after a meal, especially a fatty meal. The patient says she is having recurrent episodes of pain like this. No other significant illnesses, she is married and has 5 children. She is obese.

5) A 53-year-old female presents with abdominal pain. The pain is in the upper abdomen on the right side under the ribs. The pain radiates to the right shoulder. The pain is worse on breathing in deeply.  She has nausea and vomiting and fever.  On examination she is markedly tender in the right hypochondrium.


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