GP CCE Cases · gastrointestinal-health
Acute abdominal pain — CCE clinical encounter
CCE-style clinical encounter: a 49-year-old with eight hours of worsening right iliac fossa pain, a normal early examination, and a partner insisting it is 'just gastro'. The candidate must reassess, detect developing peritonism, exclude pregnancy, and escalate appropriately.
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RACGP CCEFRACGP oralsCFPC SOOs
Prompt
A 49-year-old male attends with eight hours of pain that started periumbilically and has moved to the right iliac fossa. He ate takeaway last night and 'probably just has gastro'. Anorexic, vomited twice. On examination: tender at McBurney point with localised guarding. Pulse 96, temperature 37.6°C. His partner is in the room saying 'it's the same thing he always gets after takeaway'.
Objectives
- Recognise the migrating pain pattern (periumbilical to RIF) as appendicitis until excluded. [3]
- Perform a focused examination detecting localised peritonism without causing undue pain. [4]
- Engage the partner's 'gastro' narrative respectfully while explaining why this presentation differs. [2]
- Investigate and refer: bloods, surgical referral, imaging discussion. [2]
- Safety-net explicitly for peritoneal progression.
References4ShowHide
- [1]Forbes A, Bachmann KF, Kase K et al. Potential time-sensitive biomarkers for the detection of acute mesenteric ischaemia: a systematic review of animal data. Biomarkers : biochemical indicators of exposure, response, and susceptibility to chemicals, 2026.PMID 42322198
- [2]Peery AF, Strate LL, Stollman N et al. ACG Clinical Guideline: Colonic Diverticulitis. The American journal of gastroenterology, 2026.PMID 42390126
- [3]Pathak A, Jiang X, Jaworski JJ et al. CT Versus Ultrasound in Young Women With Right Iliac Fossa Pain: A Single-Centre Retrospective Study. ANZ journal of surgery, 2026.PMID 42438097
- [4]Di Gioia CC, Alame A, D'Apolito M et al. The ABCDEFG point-of-care ultrasound protocol for acute non-traumatic abdominal pain: a prospective observational study. Journal of ultrasound, 2026.PMID 42498899