Makindo Medical Notes Comprehensive Medical Encyclopedia | Education for Healthcare Professionals

Makindo Medical Notes "One small step for man, one large step for Makindo"
Download all this content in the Apps now Android App and Apple iPhone/Pad App

MEDICAL DISCLAIMER: The contents are under continuing development and improvements and despite all efforts may contain errors of omission or fact. This is not to be used for the assessment, diagnosis, or management of patients. It should not be regarded as medical advice by healthcare workers or laypeople. It is for educational purposes only. Please adhere to your local protocols. Use the BNF for drug information. If you are unwell please seek urgent healthcare advice. If you do not accept this then please do not use the website. Makindo Ltd.

OSCE Acute Abdominal Pain

About

Anaesthetics and Critical Care

Obstetrics Gynaecology

Oncology

Ophthalmology

Oral Medicine and Dentistry

Statistics and Research

Stroke

Surgery

Toxicology

Trauma and Orthopaedics

Twitter

Urology

🩺 OSCE Station – Acute Abdominal Pain

Candidate Instructions 👩‍⚕️

You are a final year medical student. A 45-year-old patient has presented to the Emergency Department with abdominal pain. Take a focused history. At the end, summarise your findings to the examiner and outline your differential diagnoses and initial investigations. Do not perform an abdominal examination at this station.

Key Areas to Cover ✅

📍 Site, Onset, Character, Radiation, Associated symptoms, Timing, Exacerbating/relieving factors, Severity (SOCRATES approach).
🚨 Red flags: vomiting blood, melaena, jaundice, haemodynamic compromise.
🍽️ Gastrointestinal symptoms: nausea, vomiting, bowel habit change, rectal bleeding.
🧪 Urinary/reproductive: dysuria, frequency, haematuria; LMP, pregnancy status, gynaecological history in women.
📜 Past medical/surgical history: gallstones, peptic ulcer, pancreatitis, IBD, vascular disease, surgeries.
💊 Medications, allergies, alcohol, smoking, drug use.

Examiner Prompts 💬

“How would you differentiate between surgical and medical causes of abdominal pain?”
“What immediate bedside investigations would you request?”

Differential Diagnoses 🔎

Region	Common Causes
Right upper quadrant	Biliary colic, cholecystitis, hepatitis, peptic ulcer
Left upper quadrant	Gastritis, splenic infarct/rupture, pancreatitis
Right lower quadrant	Appendicitis, renal colic, Crohn’s flare, ectopic pregnancy
Left lower quadrant	Diverticulitis, renal colic, ovarian cyst rupture
Epigastric	Pancreatitis, peptic ulcer, MI (consider atypical ACS)
Diffuse/generalised	Peritonitis, bowel obstruction, mesenteric ischaemia

Mark Scheme (10 points) 📝

Domain	Marks	Details
History of pain (SOCRATES)	3	Clear structure, character + radiation + severity
Associated GI/GU/gynae symptoms	2	Nausea, vomiting, bowel habit, dysuria, LMP
Past history & risk factors	2	PMH, PSH, meds, alcohol, vascular risk
Red flags	2	Shock, peritonitis, GI bleed, AAA rupture
Summary & plan	1	Coherent summary with initial DDx & investigations

Investigations 🔬

Bedside: obs, urinalysis (infection, haematuria), pregnancy test in women.
Bloods: FBC, U&E, LFT, CRP, amylase/lipase, clotting, group & save, troponin if epigastric pain.
Imaging: abdominal US (RUQ pain), CT abdo/pelvis (suspected obstruction, perforation, AAA), CXR for free air.

Management 🩺

Resuscitate: IV access, fluids, analgesia, antiemetics.
Keep NBM if surgical pathology suspected.
Surgical review if peritonitis, obstruction, AAA, appendicitis suspected.
Medical management for non-surgical causes (e.g. gastritis, hepatitis, renal colic with analgesia and fluids).

Teaching Commentary 📚

Abdominal pain OSCEs test whether you can take a safe, structured history. Always think anatomically (quadrants) + systemically (GI, GU, gynae, vascular). Spotting red flags early and mentioning urgent imaging/fluids/surgical review will score highly. In exams, your differential breadth and safe planning matter more than nailing the “right” diagnosis.

🧑‍⚕️ Case Examples — Acute Abdominal Pain in Adults

Case 1 (Biliary Colic → Cholecystitis): 🟢 A 45-year-old woman presents with sudden right upper quadrant pain after a fatty meal, radiating to the right shoulder. She has fever and Murphy’s sign is positive. Ultrasound shows gallstones with gallbladder wall thickening. Diagnosis: Acute cholecystitis. Teaching point: RUQ pain + fever + Murphy’s sign suggests cholecystitis; managed with IV antibiotics and cholecystectomy.
Case 2 (Perforated Peptic Ulcer): 🌡️ A 50-year-old man with history of NSAID use presents with sudden, severe epigastric pain radiating to the back. Abdomen rigid with peritonism. Upright CXR shows free air under the diaphragm. Diagnosis: Perforated peptic ulcer. Teaching point: “Board-like” abdomen + free air = perforation; requires urgent surgery and IV antibiotics.
Case 3 (Acute Diverticulitis): 🍽️ A 62-year-old man presents with left lower quadrant abdominal pain, fever, and altered bowel habit. Exam reveals LLQ tenderness and mild guarding. CT abdomen confirms diverticulitis. Diagnosis: Acute diverticulitis. Teaching point: LLQ pain + systemic upset in older adults suggests diverticulitis; manage with antibiotics, fluids, and surgery if perforated.
Case 4 (Ruptured Abdominal Aortic Aneurysm): 🚨 A 70-year-old man with hypertension develops sudden severe back and abdominal pain with collapse. He is hypotensive with a pulsatile abdominal mass. Diagnosis: Ruptured AAA. Teaching point: Classic triad = pain, hypotension, pulsatile mass; requires immediate vascular surgery and resuscitation.
Case 5 (Acute Pancreatitis): 🔥 A 40-year-old woman presents with severe epigastric pain radiating to the back, worse when lying flat and relieved by sitting forward. Amylase is 800 U/L. Diagnosis: Acute pancreatitis. Teaching point: Think pancreatitis with severe epigastric pain + raised amylase/lipase; assess severity (Glasgow score), give IV fluids, analgesia, and monitor for complications.
Case 6 (Acute Appendicitis): 🔪 A 25-year-old man presents with abdominal pain that started centrally and migrated to the right iliac fossa over 12 hours. Exam reveals McBurney’s point tenderness with rebound. CRP and WCC are raised. Diagnosis: Acute appendicitis. Teaching point: Classic migratory pain with peritonism; requires appendicectomy. Delay risks perforation and peritonitis.
Case 7 (Small Bowel Obstruction): 🌀 A 60-year-old woman with past hysterectomy presents with colicky abdominal pain, vomiting, and abdominal distension. On exam: high-pitched “tinkling” bowel sounds. Abdominal X-ray shows multiple fluid levels. Diagnosis: Small bowel obstruction (adhesional). Teaching point: Colicky pain + vomiting + distension + tinkling sounds = obstruction; management = NG tube, fluids, and surgery if strangulated.
Case 8 (Mesenteric Ischaemia): ⚡ A 68-year-old man with atrial fibrillation presents with sudden severe abdominal pain out of proportion to clinical findings. Lactate is elevated. CT angiogram confirms mesenteric artery occlusion. Diagnosis: Acute mesenteric ischaemia. Teaching point: “Pain out of proportion” is the hallmark; urgent revascularisation ± bowel resection is required.

PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

Edit