MLA Domain 5 · Presentation

Abdominal distension

9 conditions in Finalist present this way. Work down the list and ask what would separate each one from the next — that discriminator is the exam question.

classic presentation · 6

Ascites & spontaneous bacterial peritonitis

SBP (ascitic neutrophils ≥250) → antibiotics + albumin; high mortality and recurrence

Colonic pseudo-obstruction (Ogilvie syndrome)

Caecal diameter >12 cm, rising, or present >3–4 days → high perforation risk → active decompression

Necrotising enterocolitis

Pneumoperitoneum (perforation), shock, abdominal wall erythema → urgent surgery

Ovarian cancer

Persistent bloating/abdominal symptoms in a woman >50 → check CA125 (and refer)

Toxic megacolon

Perforation (sudden deterioration, free air, peritonitis) → emergency colectomy

Volvulus

Ischaemia/perforation (peritonism, raised lactate, free gas) → emergency surgery

recognised feature · 3

Coeliac disease

Severe malnutrition/failure to thrive; do NOT start a gluten-free diet before testing (false negatives)

Fibroids

Rapid growth or postmenopausal growth → consider (rare) leiomyosarcoma

Intestinal obstruction & ileus

Strangulation/ischaemia (constant pain, peritonism, fever, raised lactate) → emergency surgery