Core 8: The Surgical Abdomen
The Acute Abdomen module challenges students to broaden their differential diagnoses when approaching a patient who has abdominal pain. This can be applied to inpatient and primary care settings.
- This module forms part of the Core Curriculum.
- It requires 30 minutes preparation.
- It can be taught in 1 hour to 1 hour and 1/2.
- However, this topic can be broken down into individual pathologies, or extend for a long as the audience's attention can last.
Teaching This Topic
As with all modules, familiarise yourself with The 9 Rules of STITCCH.
It is often the case that a JMO will be asked to assess a patient with abdominal pain but lack an understanding of the common clinical presentations of gastrointestinal pathology and fail to think beyond the gastrointestinal system as a cause of abdominal pain. This is a common OSCE examination station and often arises in written examinations throughout medical school, however what is practiced clinically can vary dramatically to this.
Our role is not to introduce students to the plethora of pathology that can occur in the abdomen, rather it is to focus on common pathologies and how you can recognised them in a patients history and examination.
Here are some tips how to run the session effectively:
- Be as interactive as possible
- Focus on how anatomy and clinical presentations mirror each other
- Focous on how to interpret common investigation findings that confirm or exclude certain diagnoses (for example, LFT derangements that confirm choledocolithiasis, or ultrasound findings that confirm cholecystitis)
- Be sure to highlight vascular, genitourinary, gynaecological and testicular anatomy when discussing the lower abdomen and pelvis
- Consider the approach with three categories in mind: (1) the working diagnosis, (2) differential diagnoses, (3) life-threatening diagnoses to be excluded.
Here are common pitfalls to avoid:
- Covering every abdominal pathology you have ever seen
- Focusing on rare pathology
- Going into too much detail on a workup or high level management.
- Focus on perianal (or other anatomically distant) pathology.
From our feedback, the more interactive and ‘put on the spot’ you make the session, the more valuable it will be. Having students think on the spot and share their ideas in a non-threatening environment is key to making the session light-hearted and collaborative so that they can apply what they have learnt at medical school to a clinical patient.
- Curriculum Pack (7 pages)
- Differential Diagnosis of Abdominal Pain (1 page). Handout to be given mid-point in tutorial to guide discussion.
- No prescribed resources. Instead, look at the files/images/documents which helped you learn abdominal pathologies. Adapt and use what worked well for you.
1st Edition, 4 January 2016
Seyhan Sönmez via Flickr (link)