Pain in the Abdomen

Scenario

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A 68 year old woman presents with “acute lower back pain, constipation and a past history of hysterectomy ? Ca” in the central and lower abdomen
associated with back pain. The pain has a long history but the quality has changed in the last 4 weeks.

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A CT is performed and reported as:
No abnormality is seen in the lung fields or mediastinum.
In the abdomen no abnormality is seen in the liver pancreas spleen or suprarenal glands. The kidneys are unremarkable. The small bowel is normal in calibre throughout. There is a little gaseous distension of the large bowel but gas and faecal material are present all way to the rectum. There are no pelvic masses or lymphadenopathy. There is no free fluid or any other abnormality in the abdomen
.”

The Pain Management Team are consulted for assistance in managing pain relief. As the medical student, you feel it prudent to look at the CT scan even though it is normal.

The images of T10 and T12 are provided here.

Tasks

  1. If you order a test, you should be able to identify what you were looking for. Discuss the scientific basis of this statement.
  2. List four oncological conditions which cannot wait until tomorrow to be recognised.
  3. Describe the results of your failure to recognize each condition.

Opinion

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