腹痛是病人就诊时极其常见的症状，多数由腹部脏器疾病引起，但腹腔外疾病及全身性疾病也可引起。腹痛的性质和程度，既受病变性质和刺激程度的影响，也受神经和心理因素的影响。由于原因较多，机制复杂，诊断前必须充分了解病史，进行全面体格检查和必要的辅助检查，结合病理生理改变，进行综合分析，才能做出正确诊断。

腹泻指排便次数增多，粪质稀薄，或带有黏液、脓血或未消化的食物。每日排便3次以上，或粪便总量大于200g，其中粪便含水量大于80%，则可认为是腹泻。

Abdominal pain may be due to underlying gastrointestinal or extra-intestinal conditions.The latter include disorders of the genitourinary tract, abdominal wall, thorax, or spine.Disorders causing abdominal pain which involve the gastrointestinal system include:peptic ulcer disease, gastro-enteritis, gallstone disease,pancreatitis, mesenteric ischemia, appendicitis, diverticulitis,inflammatory bowel disease, infectious colitis and tumor.Perhaps the most common causes of abdominal pain are irritable bowel syndrome and functional dyspepsia.

Diarrhea is the passage of loose or watery stool.The differential diagnosis of diarrhea is broad.The causes include infection, inflammation, malabsorption,and medication.Irritable bowel syndrome produces constipation, diarrhea, or an alternating bowel pattern.Fecal mucus is common in irritable bowel syndrome,while diarrhea with pus and/or blood may occur in inflammatory bowel disease or infectious diarrhea.Steatorrhea develops with malabsorption.

D: Good morning.How may I help you?

P: I have a stomach ache.

D: Please can you show me where on your tummy(or abdomen)you feel the pain?

P: Here(patient pointing to epigastrium).

D: Can you describe the pain to me?

P: It’s a strong pain, and it travels to my back.

D: How long have you had the pain?

P: For almost 2 weeks now.It does not go way!

D: How bad is the pain? Let’s say on a 1 to 10 scale, 10 being the worst pain.How would you rate your pain?

P: I would say 4-5 maximum.

D: Is there anything that would bring on the pain or make it worse?

P: I don’t think so.

D: How about food, does it bring on the pain?

P: No.Quite on the contrary, it hurts more during late nights and early mornings.

D: Have you had any similar attack before?

P: No, but my stomach feels bloated and uncomfortable from time to time.

D: How is your bowel motion?

P: Same as before, at least to my eyes.

D: Have you lost any weight?

P: I don’t think so.

D: Do you have any other symptoms you wish to tell me about?

P: No, I don’t think so.

D: Have you sought medical advice since the pain started?

P: Yes.The doctor gave me Talcid and other antacids for dyspepsia.

D: Did they help?

P: I’d say a little.

D: Do you take any other medications on a regular basis?

P: No.

D: May I just double check whether or not you take aspirin, warfarin, steroids or any kind of painkiller?

P: No.I don’t take any of those drugs.

D: Do you drink or smoke?

P: I smoke 20 cigarettes per day.I have a beer or two with friends occasionally, however not in the last 2 weeks.

D: Do any family members or close friends have similar symptoms?

P: No.

D: Please may I examine you?

P: Yes, ok doctor.

D: Please lie on your back, keep your knees bent, and try to relax.

P: Is there anything wrong with me, doctor?

D: I think you have peptic ulcer disease, but I recommend a gastroscopy and ultrasound scan of your abdomen to confirm the diagnosis and make sure it is not something to worry about.

P: I’m not sure, I have always heard how horrible an endoscopy experience can be.Do I have any other options?

D: There are other options but it won’t be as good, and you may end up having to have endoscopy in the end.For example, you may have a barium swallow instead,which is an X-ray examination with you, drinking some thick fluid to let the radiologist evaluate the movements and lining of your stomach and intestine.However it may miss abnormalities like a small ulcer or erosion which endoscopy can detect.Also, if required, endoscopy allows small tissue samples to be taken for further tests.For the endoscopy, you will be given a sedation to make you feel more comfortable.You will be aware of what is going on, but may not remember it afterwards.During the procedure, you will be asked to swallow a tube with a camera on its end.This allows the endoscopist to look at your food pipe(esophagus), stomach and duodenum in detail for any problems and, if required, take tissue samples for further tests.

P: Okay, I think I will take the endoscopy with sedation then.

D: Your recent use of Talcid may make testing for bacteria infection in the stomach inaccurate.I will arrange for you to have additional blood and stool test for the infection.You will have the endoscopy and all the other tests tomorrow morning, so please do not have any breakfast tomorrow.You should fast from midnight, please.

P: Endoscopy, blood test and be fasting from midnight.Is that all?

D: Yes.Do you have any questions?

P: No, thank you very much.

D: You’re welcome.See you tomorrow.

D: Good morning.How may I help you today?

P: My stools have been watery for 3 days now and I have to go to the toilet 3 to 4 times a day to open my bowels.

D: I see.Can you describe your stools to me? What color is it?

P: It’s pale yellow.

D: Is there any blood on the stools?

P: No.

D: Any mucus on the stools?

P: No, just very loose and watery.

D: Does it smell badly?

P: I’d say it’s almost odorless.

D: Do you feel you need to open your bowels but it does not empty properly?

P: Well, there is this embarrassing rush with watery stools coming out.But I don’t feel my bowel has not emptied properly each time I go to the toilet.

D: Do you have other symptoms such as abdominal pain,nausea and vomiting or lethargy?

P: I have a pain around my belly button that waxes and wanes in waves.It gets better after I open my bowels.I barely want to eat anything these days.

D: Can you keep any fluids or food down?

P: Not really.I feel anything I drink or eat passes through me or I vomit them up.I feel thirsty.

D: Any dizziness?

P: No.

D: Have you taken your temperature?

P: Yes, I think it’s normal.

D: Have you ever had similar episodes before?

P: No, doctor.

D: Have you traveled recently?

P: About 2 weeks ago, I visited my parents in another city.I go there often so it’s unlikely to be the cause of my diarrhea.

D: Is there any family member or close friend with similar symptoms?

P: I know someone from work have been on sick leave these days.I’m not sure if it’s relevant.

D: Do you have any other medical condition we have not talked about?

P: No.

D: Are you on any regular medication?

P: No.

D: I think you have gastroenteritis, a virus infection in your bowels.At the moment you are not seriously ill,but you are loosing fluids.Since you cannot maintain adequate fluid intake by mouth, I recommend that you be admitted to hospital so that we can give you fluids via a drip in your arm, to keep you well hydrated.We will do some tests on your blood and stool to confirm the diagnosis.If it proves to be a virus infection, which is quite common in this season,you will recover in 3-8 days with fluid support alone.If the results come back telling another story, I will discuss this with you and adjust your treatment, where required.Is that okay?

P: Yes, thank you doctor.Since it’s an infection, Can it spread to my family? I have a 1-year-old baby.

D: Ask someone to disinfect your eating and drinking vessels as well as your cloth, towel and sheets.Pay attention to personal hygiene especially hands washing.If anyone develop similar problem, visit a doctor immediately.