Module G.04: Acute Abdominal Pain

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Session 2013-2014 Grad Year 1 Semester 1

Module G.04:

Acute Abdominal Pain

STRUCTURE AND FUNCTION IN HEALTH AND DISEASE

 Describe the macroscopic and microscopic structure of upper alimentary tract from mouth to ileocaecal valve, including the liver, exocrine pancreas, biliary tree, vascular and nerve supply

 Describe and relate mechanisms of pain production to pain perception, intra-abdominal pain receptors and common intra-abdominal emergencies taking note of referred pain  Describe the physiology of digestion, including the biochemistry of local enzymes,

absorption of primary nutrients and the role of hormones  Consider the relationships between diet, exercise and weight.  Revisit the physiological response to exercise

 Describe the anatomy and physiology of the thyroid  Introduction to the endocrine system

 Consider the Basal Metabolic Rate

 Outline the principles of healing and pharmacological approaches to accelerate healing peptic ulcer and treat hiatus hernia

 Discuss the role of Helicobacter pylori treatment in peptic ulcer  Understand the differential diagnosis of the acute abdomen

 Understand the broad functions of the liver as an organ for synthesis, storage and detoxification

 Consider the principles of immediate management of a patient bleeding from the alimentary tract

 Discuss methods of investigating and treating the upper GIT without surgery POPULATION PERSPECTIVE

 Revise the interpretation of summary measures for categorical and continuous data (and be aware of practical uses of Normal and other frequency distributions such as Poisson and binomial)

 Define health (care) need (e.g. taxonomy of need)

 Outline “iceberg of disease” concept (including unmet health needs and estimated disease prevalence as applied to prevalence of “Indigestion”.

 Outline the principal characteristics of the UK diet, relate this to recommended targets and outline how bias might affect various study designs to determine food intake

 Outline how economic concepts might affect commissioning decisions made by Primary Care Trusts

INDIVIDUALS, GROUPS AND SOCIETY

 Consider the individual’s interpretation of health and disease

 Distinguish between illness and illness behaviour – the sick “role model”

 Explore psychological factors influencing individual experience of symptoms including age, gender etc

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PROFESSIONAL AND PERSONAL DEVELOPMENT

 Debate whether the promotion of fitness (as opposed to health) is a responsibility for the medical profession in the light of individual autonomy

 Reflect on why obligations of benificence and non-maleficence and why respect is morally binding

 Compare and contrast negligence and non-maleficence

 Consider behavioural breaches of principles of benificence and non-maleficence  Understand conflicts which may arise between benificence and non-maleficence HARC

 Anatomy abdominal cavity and diaphragm

 Anatomy upper alimentary tract from mouth to ileocaecal valve, including biliary tree and exocrine pancreas

 Radiographs: plain abdomen, barium swallow, meal, CT upper abdomen CLINICAL SKILLS

 History of indigestion and dysphagia  Examination abdomen

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Mr Taylor reluctantly agrees to join a work team to run a 10-kilometre charity race in two months’ time. Although he played a lot of sport at university (32 years ago), he has not exercised much since then, and is now at least 2 stones heavier. During his first practice run he becomes out of breath very quickly and eventually has to stop and decides to consult his doctor before training any further. Although otherwise healthy, he resolves to improve his fitness, ask for an exercise prescription and lose weight. He doesn’t believe you should have to be ill before seeking medical advice. His GP, Dr Walker, discovers that Mr Taylor regularly gets heartburn and sometimes wakes up at night with upper abdominal pain. An endoscopy is requested from the department at the local hospital where Dr Walker’s partner does a session on Tuesdays. Dr Walker collects blood from Mr Taylor for a Helicobacter pylori antibody test. Mr Taylor is frightened by the pain and wonders if he will need an operation. He remembers that years ago when his uncle’s ulcer perforated he had pain in the shoulder, not in the tummy. Mr Taylor wonders how pain felt in one part of the body can be caused by a remote anatomical structure and wonders if this has something to do with early human development/possibly while in the womb. What would happen to me if I had an ulcer myself and it bled instead of bursting? How would they find what and where I was bleeding from?

“My son had appendicitis last year and before his surgery the young doctor told me of all the concerns of “inflammation in the tummy”. Could I have something serious?” Mr Taylor who used to drink a lot of beer is also concerned to know whether his liver is working the way it should.

On examination Mr Taylor has a slow pulse and then admits he has had less energy lately and that easily gets cold. He also noticed recently that his hair is thinning – and his eyebrows as well! Dr Walker requests some thyroid function tests, arranges to see Mr Taylor with the results the following week and asks him to go in to see the Practice Nurse, Mandy Lint, before he leaves. Later, Mr Taylor recalls that his grandma had ‘thyroid trouble’. He goes to look up on the Internet whether such problems are hereditary and discovers that the thyroid controls the basal metabolic rate and is just one member of a large family of endocrine glands in his body.

Nurse Lint asks him to stand on the weighing scales but as he steps on he knocks his knee. “I’m so sorry, Mr Taylor”, she says, “I spilt some water on the scales earlier, but as it wasn’t much I didn’t think it would put anyone at risk.” That graze should heal up fine without any sutures. Just as he is about to leave she comments: “It’s a good job you came here today – thyroid disease is often late to be diagnosed.

She decides to use a questionnaire to assess his current diet in order to help her advise him on losing weight but Mr Taylor is reluctant to complete the questionnaire at first: “You know you’re causing me a lot of stress giving me this thing – and I’m supposed to be here to get better”! Nurse Lint is convinced that it is preferable to relieve symptoms without recourse to expensive medication if possible.

The nurse replies: “But in the greater scheme of things if filling this questionnaire in SCENARIO – Module 4: Acute Abdominal Pain

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chips? My wife has no time to prepare healthy meals. Can’t I just eat less of everything? Ill bet you the NHS have shares in pasta!”

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