Abdominal Distension: The 6 Fs that can help your diagnosis


The approach to a patient with abdominal distention
needs to be viewed in the appropriate clinical context. I can’t emphasize enough the importance
of a good history which will determine your level of concern in working your patient up. As a gastroenterologist, many patients who
see me in clinic have chronic gastrointestinal complaints, most notably abdominal bloating
and often related to irritable bowel syndrome. Hence the clinical context of how these patients
present will help focus your attention on whether the complaint constitutes a benign
condition or something which can be catastrophic if not addressed in a timely manner. We can generally approach the complaint of
abdominal distention by considering the 6 F’s: Fluid
Flatus Feces
Fetus Fat
Fatal Tumour By fluid, we refer to abdominal ascites often
due to liver disease but sometime congestive heart failure. The absence of flatus may signify a mechanical
small or large bowel obstruction or possibly intestinal pseudo-obstruction. “Feces” alerts one to consider simply being
“backed up” i.e constipation or certain malabsorption conditions such as carbohydrate
intolerance or celiac disease and if negative, by exclusion IBS. The last three F’s are self explanatory
and easily excluded by a pregnancy test and imaging when indicated. An appropriate physical exam is then performed
paying attention to the level of distress of your patient. Direct your attention to identifying a fluid
wave shift or shifting dullness which would indicate the presence of ascites. Look for peritoneal signs which would direct
you to obtain an urgent surgical assessment, such as rebound tenderness, pain on percussion
and involuntary guarding. Complete your assessment with appropriate
blood work and likely imaging by way of abdominal ultrasound if looking for ascites or abdominal
x-ray and maybe a CT scan if you are concerned with a possible bowel obstruction or perforated
viscous.

7 Replies to “Abdominal Distension: The 6 Fs that can help your diagnosis”

  1. My life has been drastically affected by stomach pain and bloating,I lost near 4 stone in weight in 8 weeks and I’m at a loss,so it’s laxatives nightly and total depression because of non stop pain and no diagnosis apart from I.B.S which should be banned as a diagnosis since at least 12 different issues could be considered,it’s stolen my ambition and hopes

  2. I have a mysterious belly distention for 4 years which makes it weird is that it literally occured overnight after feeling something was squeezing inside my abdominal area when sitting on a car ride. I slept over and the day after I woke up, I come up with this fluid filled feeling in my abdomen and distention(!) nothing can be found by doctors so far but it is there I am puzzled really. so weird I cannot retract my abdomen as before too. it still keeps its mystery for me!! Muscle issue?? vein issue? inflammation??? I am clueless

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