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IMF-049-01-0001-en	Why can a gastrointestinal symptom such as pain or vomiting not by itself place a patient in a disease category?	Each symptom can arise from benign, inflammatory, obstructive, vascular, infectious, metabolic, toxic or malignant disease, so it must be converted into an anatomical and physiological model.	Integrated Medical Foundations; chapter 49, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 72190f16a231d5a1d56414c0497199e79d77d42b054d7518fa891ec45d9772d7; editorial review pending	imf lang::en chapter::049 module::049-01 review::pending
IMF-049-01-0002-en	What does the safest approach to gastrointestinal assessment do, and what role do investigations play in it?	It defines onset and trajectory, localises the likely compartment, assesses hydration and perfusion, and searches for peritonitis or obstruction; investigations are used to answer explicit questions.	Integrated Medical Foundations; chapter 49, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 72190f16a231d5a1d56414c0497199e79d77d42b054d7518fa891ec45d9772d7; editorial review pending	imf lang::en chapter::049 module::049-01 review::pending
IMF-049-01-0003-en	Why is visceral pain diffuse and midline, whereas parietal inflammation gives a different pain?	Organs share autonomic afferents, so visceral pain localises poorly to the midline; parietal inflammation produces sharper local pain with guarding.	Integrated Medical Foundations; chapter 49, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 72190f16a231d5a1d56414c0497199e79d77d42b054d7518fa891ec45d9772d7; editorial review pending	imf lang::en chapter::049 module::049-01 review::pending
IMF-049-01-0004-en	Why does abdominal pain that is maximal at onset deserve urgent evaluation?	Sudden maximal pain suggests perforation, vascular catastrophe, torsion, rupture or obstruction.	Integrated Medical Foundations; chapter 49, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 72190f16a231d5a1d56414c0497199e79d77d42b054d7518fa891ec45d9772d7; editorial review pending	imf lang::en chapter::049 module::049-01 review::pending
IMF-049-01-0005-en	How does repeated vomiting progress to metabolic and renal harm?	It causes chloride and hydrogen loss, contraction alkalosis, potassium depletion and kidney injury.	Integrated Medical Foundations; chapter 49, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 72190f16a231d5a1d56414c0497199e79d77d42b054d7518fa891ec45d9772d7; editorial review pending	imf lang::en chapter::049 module::049-01 review::pending
IMF-049-01-0006-en	Why is dyspepsia not accepted as a final diagnosis?	Dyspepsia is a symptom cluster, so heartburn, early satiety, postprandial fullness, appetite and previous ulcer or reflux treatment must still be characterised.	Integrated Medical Foundations; chapter 49, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 72190f16a231d5a1d56414c0497199e79d77d42b054d7518fa891ec45d9772d7; editorial review pending	imf lang::en chapter::049 module::049-01 review::pending
IMF-049-01-0007-en	What distinguishes bright blood coating stool from blood mixed through it, and what is the limit of that distinction?	The two patterns differ, but neither reliably excludes proximal disease.	Integrated Medical Foundations; chapter 49, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 72190f16a231d5a1d56414c0497199e79d77d42b054d7518fa891ec45d9772d7; editorial review pending	imf lang::en chapter::049 module::049-01 review::pending
IMF-049-01-0008-en	A patient reports black stool while taking iron. Why does this not by itself establish melaena?	Melaena is black, sticky and offensive, but iron and bismuth darken stool without bleeding.	Integrated Medical Foundations; chapter 49, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 72190f16a231d5a1d56414c0497199e79d77d42b054d7518fa891ec45d9772d7; editorial review pending	imf lang::en chapter::049 module::049-01 review::pending
IMF-049-01-0009-en	A patient with previous abdominal surgery presents with obstruction. How should the surgical history be weighed?	Previous surgery increases adhesion risk but does not prove adhesional obstruction.	Integrated Medical Foundations; chapter 49, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 72190f16a231d5a1d56414c0497199e79d77d42b054d7518fa891ec45d9772d7; editorial review pending	imf lang::en chapter::049 module::049-01 review::pending
IMF-049-01-0010-en	Why is a specific medicine review central to gastrointestinal history?	Medicines can cause ulceration, bleeding, dysmotility, diarrhoea, constipation, pancreatitis, hepatitis and microbiome disruption.	Integrated Medical Foundations; chapter 49, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 72190f16a231d5a1d56414c0497199e79d77d42b054d7518fa891ec45d9772d7; editorial review pending	imf lang::en chapter::049 module::049-01 review::pending
IMF-049-01-0011-en	How should dietary questioning be conducted, and what should it cover?	Neutrally and specifically, covering food access, restriction, supplements, alcohol, fluid, fibre, lactose or gluten avoidance, cultural practice, and eating-disorder behaviour when relevant.	Integrated Medical Foundations; chapter 49, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 72190f16a231d5a1d56414c0497199e79d77d42b054d7518fa891ec45d9772d7; editorial review pending	imf lang::en chapter::049 module::049-01 review::pending
IMF-049-01-0012-en	Before detailed examination, what immediate threats are sought, and why is airway included?	Shock, sepsis, major bleeding, dehydration, perforation, obstruction, acute liver failure and metabolic disturbance; haematemesis or reduced consciousness creates airway risk.	Integrated Medical Foundations; chapter 49, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 72190f16a231d5a1d56414c0497199e79d77d42b054d7518fa891ec45d9772d7; editorial review pending	imf lang::en chapter::049 module::049-01 review::pending
IMF-049-01-0013-en	Why does a normal haemoglobin early in acute haemorrhage not exclude major blood loss?	Plasma and red cells are initially lost together, so concentration does not yet fall.	Integrated Medical Foundations; chapter 49, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 72190f16a231d5a1d56414c0497199e79d77d42b054d7518fa891ec45d9772d7; editorial review pending	imf lang::en chapter::049 module::049-01 review::pending
IMF-049-01-0014-en	What can chronic liver signs on examination contribute, and what can they not?	They support the clinical context but neither establish the cause nor reliably measure severity.	Integrated Medical Foundations; chapter 49, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 72190f16a231d5a1d56414c0497199e79d77d42b054d7518fa891ec45d9772d7; editorial review pending	imf lang::en chapter::049 module::049-01 review::pending
IMF-049-01-0015-en	Why should bowel sounds not be used alone to diagnose ileus or obstruction?	Their interpretation has limited accuracy: absent sounds alone do not diagnose ileus, and high-pitched sounds do not prove obstruction.	Integrated Medical Foundations; chapter 49, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 72190f16a231d5a1d56414c0497199e79d77d42b054d7518fa891ec45d9772d7; editorial review pending	imf lang::en chapter::049 module::049-01 review::pending
IMF-049-01-0016-en	How should abdominal palpation begin, and which palpation is unsafe?	Gently and away from the pain while watching the face; forceful palpation of a suspected aneurysm is unsafe.	Integrated Medical Foundations; chapter 49, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 72190f16a231d5a1d56414c0497199e79d77d42b054d7518fa891ec45d9772d7; editorial review pending	imf lang::en chapter::049 module::049-01 review::pending
IMF-049-01-0017-en	When is rebound testing not required?	When percussion, cough, movement or light palpation already demonstrates peritoneal irritation.	Integrated Medical Foundations; chapter 49, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 72190f16a231d5a1d56414c0497199e79d77d42b054d7518fa891ec45d9772d7; editorial review pending	imf lang::en chapter::049 module::049-01 review::pending
IMF-049-01-0018-en	What governs whether digital rectal examination is performed, and how is it done?	It is selective, done only when it will affect care; explain, obtain consent, use a chaperone per policy, inspect first, then assess tenderness, mass, stool, blood and sphincter.	Integrated Medical Foundations; chapter 49, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 72190f16a231d5a1d56414c0497199e79d77d42b054d7518fa891ec45d9772d7; editorial review pending	imf lang::en chapter::049 module::049-01 review::pending
IMF-049-01-0019-en	Why may pelvic, testicular, cardiovascular or respiratory examination be essential in a patient with abdominal symptoms?	Abdominal symptoms often arise outside the abdomen.	Integrated Medical Foundations; chapter 49, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 72190f16a231d5a1d56414c0497199e79d77d42b054d7518fa891ec45d9772d7; editorial review pending	imf lang::en chapter::049 module::049-01 review::pending
IMF-049-01-0020-en	Why must laboratory results be interpreted with trends and pretest probability rather than as single values?	A normal lactate does not exclude early mesenteric ischaemia, mild lipase elevation occurs outside pancreatitis, and positive faecal occult blood does not localise bleeding.	Integrated Medical Foundations; chapter 49, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 72190f16a231d5a1d56414c0497199e79d77d42b054d7518fa891ec45d9772d7; editorial review pending	imf lang::en chapter::049 module::049-01 review::pending
IMF-049-01-0021-en	An erect chest film shows no free subdiaphragmatic gas. Why does this not exclude perforation?	The film may show free gas when present, but a negative film does not exclude perforation.	Integrated Medical Foundations; chapter 49, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 72190f16a231d5a1d56414c0497199e79d77d42b054d7518fa891ec45d9772d7; editorial review pending	imf lang::en chapter::049 module::049-01 review::pending
IMF-049-01-0022-en	What distinguishes the roles of ultrasound, computed tomography and computed tomographic angiography in abdominal imaging?	Ultrasound suits gallstones, biliary dilation, ascites, portal flow and many pelvic questions; CT evaluates obstruction, inflammation, perforation, abscess, cancer and trauma; CT angiography is urgent for active bleeding or mesenteric ischaemia.	Integrated Medical Foundations; chapter 49, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 72190f16a231d5a1d56414c0497199e79d77d42b054d7518fa891ec45d9772d7; editorial review pending	imf lang::en chapter::049 module::049-01 review::pending
IMF-049-01-0023-en	Why is withholding analgesia to preserve abdominal signs not justified?	Analgesia does not meaningfully conceal important signs when examination is repeated.	Integrated Medical Foundations; chapter 49, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 72190f16a231d5a1d56414c0497199e79d77d42b054d7518fa891ec45d9772d7; editorial review pending	imf lang::en chapter::049 module::049-01 review::pending
IMF-049-01-0024-en	Why is reassessment after treatment part of diagnosis, particularly in frail, pregnant or immune-suppressed patients?	These patients may show muted signs, so recorded changes in pain, observations, examination, urine, laboratory trends and response reveal what a single examination misses.	Integrated Medical Foundations; chapter 49, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 72190f16a231d5a1d56414c0497199e79d77d42b054d7518fa891ec45d9772d7; editorial review pending	imf lang::en chapter::049 module::049-01 review::pending