Condition

Key points

Red flags

Management

Irritable bowel
syndrome

Abdominal pain
Mucous per rectum
Related to mood/stress
May be postinfectious
Chronic course
Check the ROME III criteria

Alternating diarrhoea and

constipation

Reassurance: in 50%, symptoms improve by 1

year
Explore food allergies
Constipation: ispaghula, methylcellulose
Diarrhoea: fibre, loperamide
Bloating: mebeverine
Proton pump inhibitor
Amytriptyline

Pregnancy

Missed period(s)
History of unprotected intercourse
Poor compliance with OCP
Drug interaction with OCP (e.g. antibiotics and OCP)

Splenomegaly

See Chapter 3 on
abdominal examination

Hepatomegaly

See Chapter 3 on
abdominal examination

Ascites

See Chapter 3 on
abdominal examination

Abdominal aortic
aneurysm

Abdominal/back pain
Pulsatile
Expansile

Trauma
Peripheral vascular disease
Risk factors for atheroma

See Chapter 14 on arterial examination

Pelvic mass

Fibroids
Bladder
Fetus
Ovarian cyst/malignancy

Cannot get below it on

palpation

Pelvic ultrasound
Refer to gynaecologist

Renal cell carcinoma

Haematuria
Flank pain
Abdominal mass

Generalised symptoms
Left varicocele

Bloods: full blood count, Us+Es, alkaline

phosphatase, erythrocyte sedimentation rate
Urine microscopy and cytology
Imaging: renal ultrasound, CT/MRI, chest
X-ray, IVU
Surgery
Robson Staging

Folic acid
Follow-up in antenatal clinic

Hints and tips for the exam

Remember the 5 Fs and 1 T of abdominal
distension (Figure 31.1)
Fat (hypothyroidism, Cushings disease)
Fluid (is this ascites?)
Faeces (constipation, obstruction is it complete?)
Flatus (complete obstruction, food intolerance, irritable bowel syndrome)
Fetus (pregnancy test)
Tumour

Womens health
The sex of the patient will help rule out a number of
pathologies that only affect women. If your patient is

Figure 31.1 Abdominal distension