Small and large bowel

A 29-year-old woman asks whether she has coeliac disease. For three years she had bloating, loose stools and tiredness; four months ago she removed gluten from…

Clinical rotations · middle twist

A 19-year-old man has had 20 hours of pain that began around the umbilicus and has settled in the right lower abdomen, with anorexia and a temperature of 37.9 C…

Foundations · middle twist

A 58-year-old builder has noticed a bulge in the right groin over 6 months. It appears when he coughs or lifts and disappears when he lies down. On standing, th…

Foundations · middle twist

A 45-year-old man presents after four days of worsening right lower quadrant pain, fever and anorexia. Examination finds a tender, relatively fixed mass in the…

Clinical rotations · middle twist

A 79-year-old woman presents with four days of intermittent cramping abdominal pain, vomiting and increasing abdominal distension. She has no history of abdomin…

Clinical rotations · common

A 76-year-old man with persistent atrial fibrillation develops sudden severe abdominal pain and vomiting. He is pale and distressed, but his abdomen is initiall…

Clinical rotations · middle twist

A 67-year-old man with a previous midline laparotomy presents with colicky abdominal pain, vomiting and progressive distension. Initially the pain came in waves…

Clinical rotations · middle twist

A 24-year-old woman presents with 12 hours of abdominal pain, nausea and anorexia. The pain began around the umbilicus and is now most severe in the right iliac…

Clinical rotations · common

A 61-year-old man asks about bowel cancer screening. He has no change in bowel habit, rectal bleeding or iron deficiency, and his mother was diagnosed with bowe…

Clinical rotations · common

A 61-year-old man returns to discuss the result of a bowel cancer screening kit he completed through the national program, which detected blood in one of two sa…

Clinical rotations · common

A 76-year-old woman with atrial fibrillation, whose apixaban was stopped three weeks ago after a fall, presents with four hours of severe constant central abdom…

Clinical rotations · common

A 66-year-old man is five days after an ultra-low anterior resection for rectal cancer and had initially been recovering well. Overnight he developed an irregul…

Clinical rotations · common

A 78-year-old man from a residential aged care facility, with long-standing constipation, presents with three days of increasing abdominal distension and no pas…

Clinical rotations · common

A 22-year-old woman presents to the emergency department with 24 hours of lower abdominal pain that began around the umbilicus and is now most marked on the rig…

Clinical rotations · middle twist

A 28-year-old woman presents with eight months of crampy lower abdominal pain that eases after opening her bowels, together with bloating and a bowel habit alte…

Clinical rotations · common

A 62-year-old man attends his general practitioner for preventive health care and has no gastrointestinal symptoms. He has no personal or family history suggest…

Clinical rotations · common

A 72-year-old woman with a BMI of 30 presents with a tender right groin lump that has become irreducible over the past 6 hours. She reports mild nausea but no v…

Clinical rotations · niche

A 64-year-old man presents with a right-sided groin bulge that becomes more prominent on coughing. He reports no pain and has no difficulty with daily activitie…

Clinical rotations · middle twist

A 62-year-old man presents with a bulge in his right groin that becomes more prominent when he coughs and reduces spontaneously when lying down. On examination,…

Foundations · middle twist

A 72-year-old woman is undergoing evaluation for persistent postprandial fullness and intermittent epigastric discomfort. She has no history of reflux or dyspha…

Clinical rotations · middle twist

A 68-year-old man presents to the emergency department with a 24-hour history of worsening abdominal pain, nausea, and vomiting. He has a history of open sigmoi…

Clinical rotations · middle twist

Which of the following is a key principle of herniorrhaphy (hernia repair)?

Clinical rotations · common