Makindo Medical Notes

📖 Introduction

• 🫃 Abdominal distension = abnormal enlargement or bloating of the abdomen, often with discomfort or pain. Causes range from benign (gas, constipation) to serious (obstruction, cancer, liver failure). A structured history, exam, and targeted investigations are essential.

🩺 Common Causes

• 💨 Gas Accumulation: Swallowed air, fizzy drinks, beans, bacterial fermentation.
• 💧 Fluid Retention (Ascites): Cirrhosis, heart failure, malignancy.
• 🚧 Bowel Obstruction: Adhesions, tumours, hernias, volvulus.
• 🚽 Constipation: Chronic stool loading with bloating.
• 🤰 Pregnancy: Physiological, progressive enlargement.
• 🌱 Irritable Bowel Syndrome (IBS): Bloating post-meals, alternating bowel habit.
• 🥛 Malabsorption Syndromes: e.g. Coeliac disease, pancreatic insufficiency.
• ⚪ Ovarian Cysts/Tumours: Space-occupying pelvic masses.
• 🫀 Liver Disease (Cirrhosis): Portal HTN + low albumin → ascites.

📊 Summary Table: Causes of Abdominal Distension

⚠️ Red Flags

• Sudden severe abdominal pain.
• Bilious or feculent vomiting.
• Fever, peritonism, or sepsis signs.
• Unexplained weight loss or anaemia.
• Rapidly progressive distension.

🔬 Diagnostic Approach

• 📖 History + Exam → bowel habits, diet, systemic disease.
• 🩻 Imaging → US, CT, AXR for obstruction, fluid, or masses.
• 🧪 Bloods → FBC, LFTs, U&E, CRP.
• 📹 Endoscopy → if concern for coeliac, IBD, malignancy.

🛠️ Management Principles

• 🎯 Treat the underlying cause: cirrhosis, constipation, obstruction, IBS, etc.
• 💊 Symptomatic relief: simethicone, diuretics, analgesia.
• 🥦 Diet: low-FODMAP for IBS, high-fibre for constipation, GF diet for coeliac.
• 👨‍👩‍👦 Education & reassurance: explain benign vs serious causes, safety-net for red flags.

🧑‍⚕️ Case Examples

Case 1: 👨 A 55-year-old man with known cirrhosis presents with progressive abdominal swelling, ankle oedema, and early satiety. 🔎 US shows ascites; paracentesis confirms transudative fluid. ✅ Managed with spironolactone, low-salt diet, and scheduled paracentesis.

Case 2: 👩 A 35-year-old woman presents with recurrent bloating and alternating diarrhoea/constipation. She notices worsening symptoms after pasta and bread. 🔎 tTG-IgA is positive; duodenal biopsy confirms coeliac disease. ✅ Started on a strict gluten-free diet → marked symptom improvement.