Acute intermittent porphyria
Large bowel infarction
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
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
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.