History
A 63-year-old lady with a history of lymphoma complicated with cord compression presents to the surgical department with generalised abdominal discomfort and distension. She has no fever, jaundice or gastrointestinal bleeding symptoms. There are no urinary symptoms. She is bedbound due to lower limb weakness secondary to the cord compression.
•Temperature 37.2°C, pulse 64 bpm, BP 103/62mmHg, SaO2 98-100% on RA.
•Hydration satisfactory.
•Examination of the hands reveals no clubbing and normal-appearing palmar creases.
•Head and neck examination is unremarkable.
•Cardiovascular: HS dual, no murmur.
•Auscultation of her chest reveals right lower zone crepitation.
•Abdominal examination reveals a soft, non-tender abdomen, with mild distension and no shifting dullness.
•No signs of oedema.
Investigations
•CBC:
–WBC 4.5 x 109/L;
–haemoglobin 9.2g/dL;
–platelets 295 x 109/L.
•Total bilirubin 9μmol/L.
•ALP 65 IU/L.
•ALT 22 IU/L.
•Albumin 30g/L.
•Creatinine 45μmol/L.
•INR 1.05.
•Serum potassium normal.
•Adjusted calcium normal.
•Amylase level normal.
•Thyroid function test is normal.
What are the possible causes of generalised abdominal distension?
The causes of generalised abdominal distension can be memorised using the mnemonic “6Fs”:
•Fat (obesity).
•Faeces (constipation).
•Fetus (pregnancy).
•Flatus (gaseous distension).
•Fluid (ascites).
•Fatal growth (neoplasm).
What are the organic causes of constipation 1?
•Drugs:
–opiates;
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