Differential Diagnosis Of Acute Abdominal Pain

Here’s a sordid acronym: BITCH.

Acute abdominal pain

  • Bleeding (haemorrhage)
  • Inflammation
  • Twisting (torsion, leading to ischaemia)
  • Congestion (obstruction)
  • Hole (perforation)

Bleeding

  • Ruptured AAA, ovarian cyst, ectopic pregnancy or abdominal organ
  • Leads to haemoperitoneum, meaning blood in the abdominal cavity

Inflammation

  • -itis of any organ in the abdominal area
  • Just think of the anatomy in the region to come up with possibilities
  • Appendicitis is the most likely surgical cause, while gastroenteritis is a common ailment of the masses

Twisting

  • Sigmoid volvulus
  • Torsion of gonadal structures (ovaries or testes)

Congestion

  • Things that involve blockage
  • Constipation
  • Intestinal obstruction, ureteric obstruction from renal calculus or urinary retention
  • Mesenteric ischaemia

Hole

  • Perforated gastrointestinal structure
  • Gastric or duodenal ulcers
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Gravity Strikes Again

Why do your feet swell during aeroplane flights? It’s not sudden-onset elephantiasis (probably).

Instead, it’s due to blood pooling in your veins. (As blood tends to do when stationary, thanks to gravity.)

Yes, gravity strikes again!

References

  1. Sheps, S. (2016). Foot swelling during air travel: A concern?. Retrieved from https://www.mayoclinic.org/foot-swelling/expert-answers/faq-20057828

The Persimmon Principle

As delicious as they might be, persimmons can cause a phytobezoar. This refers to an indigestible clump of fibres that can lead to intestinal obstruction. (Everyone’s least favourite thing, unless you’re super weird!)

That’s an uncommon complication from eating too many of this fruit, not that eating fruit is inherently a bad thing.

Luckily, persimmon phytobezoars can be conquered with Coca-Cola.

It’s drinks such as that which, under normal circumstances, contain an excess of sugar. That’s in contrast to fruit. Ironically, in this case, the roles of causative agent and cure have been reversed.

References

  1. Picco, M. (2017). Bezoars: What foods can cause this digestive problem?. Retrieved from https://www.mayoclinic.org/diseases-conditions/gastroparesis/expert-answers/bezoars/faq-20058050
  2. Naotake Funamizu, Tomotaka Kumamoto, Atsushi Watanabe, Tomoyoshi Okamoto, and Katsuhiko Yanaga (2015) Intestinal Obstruction Caused by Persimmon Bezoar: A Case Report. Int Surg: July-August 2015, Vol. 100, No. 7-8, pp. 1194-1198.
  3. DAVIS C, TARUN D. The Persimmon Bezoar. AMA Arch Surg. 1957;75(2):188–192. doi:10.1001/archsurg.1957.01280140026005
  4. Fengbo Tan, Hongbin Mo, Xiao He, Haiping Pei; An unusual case of gastric outlet obstruction caused by multiple giant persimmon phytobezoars, Gastroenterology Report, , gow042, https://doi.org/10.1093/gastro/gow042
  5. Hayashi, K., Ohara, H., Naitoh, I., Okumura, F., Andoh, T., Itoh, T., Nakazawa, T., … Joh, T. (2008). Persimmon bezoar successfully treated by oral intake of Coca-Cola: a case report. Cases journal, 1(1), 385. doi:10.1186/1757-1626-1-385
  6. Ertuğrul, G., Coşkun, M., Sevinç, M., Ertuğrul, F., & Toydemir, T. (2012). Treatment of gastric phytobezoars with Coca-Cola given via oral route: a case report. International journal of general medicine, 5, 157-61.
  7. Dickinson, K., & Bernstein, J. (2018). If sugar is so bad for us, why is the sugar in fruit OK?. Retrieved from https://theconversation.com/if-sugar-is-so-bad-for-us-why-is-the-sugar-in-fruit-ok-89958