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The abdomen is a module made up of four regions*:

The multiplicity of systems represented here make for a potentially wide and frustrating differential diagnostic analysis of symptoms and signs. Accurate diagnosis of common abdominal surgical conditions requires detailed knowledge of anatomical layers*, good clinical skills and a weighted analysis of the likely pathological processes involved. This will enable the correct choice of ordered investigations (if any), reducing the differential diagnosis to a manageable number that may be able to be narrowed to just one.

Treatment may begin broadly but becomes focused* as the diagnosis does.

The most common (and confusing) presenting complaint is pain (often associated with referral). It is important to be aware that the presentation may be atypical.

When assessing pain, the clinician must begin with an open mind and a good technique.

Acute cholecystitis involves obstruction of the cystic duct plus sepsis. It is the most common consequence* of cholelithiasis. There is often a history of similar episodes.

The symptoms are pain*, nausea and vomiting. The signs* are general and local.

The differential diagnosis* is extra-abdominal and abdominal diseases.

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