A very common pitfall is misdiagnosing acute appendicitis, especially in the elderly, in children, in pregnancy and in those on steroids, where the presentation may be atypical. Early appendicitis presents typically with central abdominal pain that shifts to the right iliac fossa (RIF) some 4 to 6 hours later. This causes confusion early on. It can cause diarrhoea with abdominal pain, especially if a pelvic appendix, and can be misdiagnosed as acute gastroenteritis.

Disaccharidase deficiencies such as lactase deficiency are associated with cramping abdominal pain, which may be severe. The pain follows some time, maybe hours, after the ingestion of milk and is accompanied by the passage of watery stool. The association with milk may be unrecognised by the patient.

Herpes zoster, especially in the elderly patient with unilateral abdominal pain in the dermatomal distribution, is a trap. Referred pain from conditions above the diaphragm such as myocardial infarction, pulmonary embolism and pneumonia can be misleading. The rare general medical causes such as diabetes ketoacidosis, acute porphyria, Addison's disease, lead poisoning, tabes dorsalis, sickle cell disease, haemochromatosis and uraemia often create a diagnostic dilemma and should be kept in mind.

Specific pitfalls

• Misdiagnosing a ruptured ectopic pregnancy in the patient on contraception or with a history of normal menstruation or where the brownish vaginal discharge is mistaken for a normal period

• Failing to examine hernial orifices in a patient with intestinal obstruction

• Misleading temporary improvement (easing of pain) in perforation of gangrenous appendix or perforated peptic ulcer

• Overlooking a perforation in the elderly or in patients taking corticosteroids, because of relative lack of pain

• Overlooking acute mesenteric artery obstruction in an elderly patient with colicky central abdominal pain

• Attributing abdominal pain, frequency and dysuria to a urinary infection when the cause could be diverticulitis, pelvic appendicitis, salpingitis or a ruptured ectopic pregnancy

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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