chapter 30 Gastroenterology
COMMON PRESENTATIONS
ACUTE ABDOMINAL PAIN1,2
Nature of pain
Mechanisms of abdominal pain
Type and chronicity of pain
Biliary ‘colic’ is continuous rather than intermittent, in the epigastrium or RUQ.
GENERALISED ABDOMINAL PAIN
LOCALISED ACUTE ABDOMINAL PAIN
Left iliac fossa
CONSTIPATION
While the cause of constipation may be a simple matter of diet, drug side effect or behavioural bowel habit, constipation may be an indication of a serious underlying disorder.
Investigation
Therapeutics
DIARRHOEA
Acute diarrhoea
Investigation
Viral gastroenteritis/enteritis
Treatment
Bacterial gastroenteritis
Nausea, vomiting, diarrhoea and abdominal pain are common to most. Neurological, hepatic and renal complications can also occur. Rapid onset (hours) after ingestion of contaminated food suggests a pre-formed toxin, while a longer incubation period (1–3 days) suggests a bacterial or viral cause.
Enterotoxigenic E. coli
A leading cause of traveller’s diarrhoea. Adheres to the gut wall and produces enterotoxins.
Salmonella
Complications include osteomyelitis, bacteraemia, abscesses, meningitis and pneumonia.
Antibiotics are generally not advised.
If required, when disease is severe or patient is at risk of complications:
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