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50 year old Chinese man with complaints of worsening abdominal distention
50 year old Chinese man with complaints of worsening abdominal distention
Generalized distension
Flatus
Diarrhea, rectal bleeding => IBD (refer to Crohn's disease). Other Sx: systemic e.g. fever, fatigue, weight loss; dyspnea, palpitations
Bacterial metabolism
Air in abdomen
Repetitive belching, bloating, abdominal pain => Aerophagia (swallowing of air). Other Sx: weight loss, diarrhea, anorexia
Fat
Fluid
Free (Ascites). Distension may be painless or associated with abdominal discomfort. Other Sx: weight gain, SOB (because of fluid accumulation and increased abdominal pressure), early satiety. Signs: fluid thrill, decreased bowel sounds
High SAAG (≥ 11g/L) indicative of portal hypertension
Fever, jaundice, lower extremity edema => Early Budd-Chiari Syndrome. Other Sx: severe right upper quadrant pain, hepatomegaly
Low SAAG (≤ 11g/L)
Biliary leak, nephrotic syndrome, pancreatitis, peritoneal carcinomatosis, tuberculosis
Common complication of cirrhosis and ascites => Spontaneous bacterial peritonitis ; Sx: fever, abdominal pain and tenderness, altered mental status
Localized
Abscess (pain, tenderness, warmth, redness in the affected area, fever, chills), pseudocyst (refer to left upper quadrant)
Feces
Fewer than 3 spontaneous bowel treatments per week, straining during > 25% of defecations => Constipation. Other Sx: abdominal discomfort/pain, nausea, vomiting
Bloating, abdominal pain (usually infraumbilical), obstipation => Acute intestinal obstruction. Other Sx: nausea and/or vomitting more likely with proximal colonic obstruction, possible dehydration/shock
Fatal growth
Associated weight loss => Malignancy
Localized distension
Right upper quadrant
Cancers: Hepatomegaly, hepatoma, liver cancer, renal tumour, pancreatic carcinoma
Nausea, vomiting => Gallbladder mucocele. Other Sx: minimal acute inflammatory signs, no fever/chills (indicative of infected bile with possible gallbladder empyema)
Jaundice => Primarily common bile duct obstruction
Hydronephrosis
Tuberculosis
Gradual onset of steady abdominal pain => Cecal volvulus. Other Sx: nausea, vomitting, obstipation, fever, hypotension
Left upper quadrant
Splenomegaly
Gastric distention (pyloric stenosis)
Pancreatic pseudocyst
Walled-off pancreatic fluid collection
Left kidney (refer to right upper quadrant kidney aspects)
Feces, diverticular mass
Epigastrium
Aortic aneurysm (umbilical too)
Lymphadenopathy: palpable lymph nodes
Omentum
Lipoma/hernia (refer to umbilical for hernia)
Umbilical
Palpation of soft mass with tenderness upon touch => Hernia. Other Sx: fever, constipation, abdominal pain, vomiting, redness/discolouration
Right and left lower quadrants
Abdominal pain => Diverticulitis. Other Sx: nausea, vomitng, low grade fever, rectal exam (mass or tenderness to palpation)
Suprapubic
Frequent urination, problems initiating urination, abdominal pain, inability to urinate => enlarged bladder (could be due to BPH). Other Sx: dysuria, nocturia, fatigue
Prolonged diarrhea with abdominal pain => Crohn's disease (refer to IBD). Other Sx: weight loss, fever, fatigue,
can also present with umbilical distension