Abdominal pain 1 a) Appendicitis b) Cholecystitis c) Mesenteric angina d) Peptic ulcer e) Biliary colic f) Pancreatitis g) Large bowel infarction h) Crohns

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.

Abdominal pain 2 a) b) c) d) e) f) g) h) i) j) Acute appendicitis Diverticular disease Abdominal aortic aneurysm Perforated peptic ulcer Crohn's disease Ulcerative colitis Acute pancreatitis Diverticulitis Acute viral hepatitis Acute cholecystitis

Match one of the options above to the most likely scenario given below: 1) A 55-year-old male who has been taking antacids for long standing dyspepsia, presents with severe upper abdominal pain that has subsequently spread and become generalised. For the week prior to admission he had used ibuprofen to ease pain in his right knee On examination he is afebrile, pulse rate 120 beats per minute, BP 110/60. His abdomen does not move with respiration, it is rigid. Percussion note over the right lower ribs is resonant and bowel sounds are absent 2) A 76-year-old female presents with colicky pain in the left iliac fossa. She also complains of rectal bleeding and diarrhoea. She is febrile. A thickened mass is palpable in the left iliac fossa. It is tender. The white cell count shows a neutrophilia. 3) A 27-year-old male presents with anorexia, nausea, vomiting and fever of a few days duration. He has recently returned from a holiday in the Far East. On examination he is febrile, has icteric sclera and has tender hepatomegaly. 4) A 35-year old male presents with sudden onset of epigastric pain radiating to the back. The pain is severe and characterized as deep and boring. Eating food worsens the pain and bending forward relieves the pain. On examination the patient is febrile he has a tachycardia, and hypotension. Abdominal examination reveals flank ecchymosis and umbilical ecchymosis. On palpation there is epigastric tenderness with localized guarding and rebound, Bowel sounds are sluggish. 5) A 75-year-old male presents with central abdominal pain radiating through to his back. On examination he is tachycardic and hypotensive and has a pulsatile mass in the central abdomen with a systolic bruit audible over it