ABSTRACT
Abdominal pain has the P2.O2.T.E.N.T.I.A.L. to be serious
Peritonitis/Perforation (see opposite)
PATH: Inflammation of viscus with extension to local peritoneum
PC: Constant, worsened by movement, patient tends to lie down and shallow breathe
Obstruction/cOlic
PATH: Colic suggests excessive contraction of viscus, e.g. due to obstruction or infection
PC: Waxes and wanes, patient tends to writhe and move around
Toxins
Food poisoning
Drugs, e.g. opioid addiction, antibiotics, anticholinesterases; radiotherapy
Poisons: Chronic lead poisoning; black widow spider bite
Endocrine crises
Diabetic ketoacidosis
Addison
Hypermetabolic state: Thyrotoxicosis; phaeochromocytoma; carcinoid
Neuro-psychiatric
Functional: Irritable bowel; anxiety; Munchausen syndrome
Radiculopathy: Shingles; spondylosis. NB: Dermatomal pattern and hyperaesthesia
Syphilis: ‘Tabetic crisis’
Thoracic origin (referred pain)
Basal pneumonia, pulmonary embolism; myocardial infarction; pericarditis; thoracic radiculitis
Inherited
Acute porphyria: Colic
C’1-esterase inhibitor deficiency: Hereditary angioedema
Familial Mediterranean fever
Abdominal wall
Rectus sheath haematoma (e.g. over-anticoagulation); myositis. NB: Worsened by lifting head off pillow
Labour or other gynaecological disorder
Ovarian torsion
Ectopic pregnancy
PID
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