Why is my stomach so distended
Abdominal Distension: The 6 Fs that can help your diagnosis
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The approach to a patient with abdominal distention needs to be viewed in the appropriate clinical
context.
I can’t emphasize enough the importance of a good history which will determine your
level of concern in working your patient up.
As a gastroenterologist, many patients who see me in clinic have chronic gastrointestinal
complaints, most notably abdominal bloating and often related to irritable bowel syndrome.
Hence the clinical context of how these patients present will help focus your attention on
whether the complaint constitutes a benign condition or something which can be catastrophic
if not addressed in a timely manner.
We can generally approach the complaint of abdominal distention by considering the 6
F’s:
Fluid Flatus
Feces Fetus
Fat Fatal Tumour
By fluid, we refer to abdominal ascites often due to liver disease but sometime congestive
heart failure.
The absence of flatus may signify a mechanical small or large bowel obstruction or possibly
intestinal pseudo-obstruction.
“Feces" alerts one to consider simply being “backed up” i.e constipation or certain
malabsorption conditions such as carbohydrate intolerance or celiac disease and if negative,
by exclusion IBS.
The last three F’s are self explanatory and easily excluded by a pregnancy test and
imaging when indicated.
An appropriate physical exam is then performed paying attention to the level of distress
of your patient.
Direct your attention to identifying a fluid wave shift or shifting dullness which would
indicate the presence of ascites.
Look for peritoneal signs which would direct you to obtain an urgent surgical assessment,
such as rebound tenderness, pain on percussion and involuntary guarding.
Complete your assessment with appropriate blood work and likely imaging by way of abdominal
ultrasound if looking for ascites or abdominal x-ray and maybe a CT scan if you are concerned
with a possible bowel obstruction or perforated viscous.
