Makindo Medical Notes

Clinical History

1. Onset and Duration: Determine when the pain began and if it has been present for at least 3 months to classify as chronic.
2. Location and Radiation:
   • Where is the pain localized (e.g., epigastric, periumbilical, lower abdomen)?
   • Does the pain radiate to other areas (e.g., to the back, groin)?
3. Character of Pain:
   • Is it dull, crampy, sharp, or burning?
   • Constant or intermittent?
4. Aggravating and Relieving Factors:
   • What makes it worse (e.g., eating, specific foods, stress)?
   • What alleviates the pain (e.g., antacids, rest)?
5. Associated Symptoms:
   • Weight loss, nausea, vomiting, bloating, change in bowel habits
   • Fever or jaundice
   • Urinary symptoms or dysmenorrhea (in women)
6. Medical and Surgical History:
   • Previous abdominal surgeries
   • Known gastrointestinal conditions (e.g., GERD, IBS, IBD)
   • Chronic diseases (e.g., diabetes, liver disease)
7. Family History: Family history of gastrointestinal diseases or malignancies.
8. Medication History: Review medications, including NSAIDs, which may cause gastrointestinal irritation.

Physical Examination

1. General Inspection: Assess for pallor, jaundice, or signs of dehydration.
2. Vital Signs: Check for fever, tachycardia, or hypotension.
3. Abdominal Examination:
   • Inspection: Look for distension, scars, or visible peristalsis.
   • Palpation: Identify tenderness, masses, or organomegaly.
   • Percussion: Assess for hepatomegaly or splenomegaly and check for shifting dullness.
   • Auscultation: Note bowel sounds (hyperactive, hypoactive, or absent).
4. Rectal Examination: Consider in cases with altered bowel habits or rectal bleeding.
5. Pelvic Examination: In females, assess for gynaecological causes if pain is in the lower abdomen.

Investigations

1. Blood Tests:
   • Complete Blood Count (CBC): Assess for infection, anaemia, or inflammation.
   • Liver Function Tests (LFTs): Check for liver or biliary causes.
   • Pancreatic Enzymes (amylase/lipase): To rule out chronic pancreatitis.
   • Electrolytes and Renal Function: Assess for dehydration or renal causes.
   • C-reactive protein (CRP) or ESR: Markers of inflammation, especially for IBD.
2. Stool Tests:
   • Fecal occult blood test (FOBT) for gastrointestinal bleeding.
   • Calprotectin or lactoferrin for inflammatory bowel disease screening.
   • Stool culture if infectious aetiology is suspected.
3. Imaging:
   • Abdominal ultrasound: For liver, gallbladder, and kidney pathology.
   • CT or MRI abdomen: For more detailed imaging, especially if a mass or chronic inflammatory condition is suspected.
4. Endoscopy:
   • Upper GI endoscopy if GERD, gastritis, or peptic ulcer disease is suspected.
   • Colonoscopy if IBD, colorectal cancer, or chronic diarrhoea is a concern.

Possible Causes of Chronic Abdominal Pain

• Gastrointestinal Causes:
  • Gastroesophageal reflux disease (GERD)
  • Peptic ulcer disease
  • Chronic pancreatitis
  • Inflammatory bowel disease (e.g., Crohn's disease, ulcerative colitis)
  • Irritable bowel syndrome (IBS)
  • Diverticulitis
  • Chronic constipation or bowel obstruction
  • Colorectal cancer
• Hepatobiliary Causes:
  • Chronic hepatitis
  • Cholecystitis or chronic gallbladder disease
  • Primary biliary cirrhosis
• Gynaecological Causes (in females):
  • Endometriosis
  • Chronic pelvic inflammatory disease (PID)
  • Ovarian cysts or masses
• Renal Causes:
  • Chronic pyelonephritis
  • Nephrolithiasis (kidney stones)
• Psychological Causes: Chronic abdominal pain can be associated with anxiety, depression, or somatization disorders.

Management

1. Treat the Underlying Cause:
   • Specific treatment for IBD, GERD, IBS, or chronic infections
   • Symptomatic treatment as needed (e.g., antacids, laxatives, antispasmodics)
2. Lifestyle Modifications:
   • Dietary adjustments based on diagnosis (e.g., high-fiber diet for constipation)
   • Encourage regular physical activity
   • Avoid trigger foods and smoking cessation
3. Psychological Support: Consider referral for mental health support if psychological factors are contributing to pain.
4. Follow-Up: Regular reviews to assess response to treatments and monitor for any new symptoms.

Summary