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


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


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.