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IMF-049-02-0001-en	Why is visceral pain poorly localised, and how does embryological region predict its site?	Afferents converge across spinal segments; foregut structures tend to give epigastric pain, midgut periumbilical pain, and hindgut lower abdominal pain.	Integrated Medical Foundations; chapter 49, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 0da3ce892f5b437308d7938c46ef728a9c813b01997630a0018d54ca5cacd3c2; editorial review pending	imf lang::en chapter::049 module::049-02 review::pending
IMF-049-02-0002-en	Why is pain out of proportion to early palpation findings a warning for mesenteric ischaemia?	Mucosa and muscle become hypoxic before the peritoneum is inflamed, so pain precedes peritoneal signs.	Integrated Medical Foundations; chapter 49, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 0da3ce892f5b437308d7938c46ef728a9c813b01997630a0018d54ca5cacd3c2; editorial review pending	imf lang::en chapter::049 module::049-02 review::pending
IMF-049-02-0003-en	What do colicky waves of pain imply mechanically, and how does biliary pain differ?	Contraction against intermittent or fixed resistance in bowel, ureter or biliary tract; biliary pain is often steady after onset.	Integrated Medical Foundations; chapter 49, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 0da3ce892f5b437308d7938c46ef728a9c813b01997630a0018d54ca5cacd3c2; editorial review pending	imf lang::en chapter::049 module::049-02 review::pending
IMF-049-02-0004-en	How does severe potassium depletion from vomiting create a self-worsening problem?	It impairs gut motility and cardiac conduction, which worsens obstruction and vomiting.	Integrated Medical Foundations; chapter 49, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 0da3ce892f5b437308d7938c46ef728a9c813b01997630a0018d54ca5cacd3c2; editorial review pending	imf lang::en chapter::049 module::049-02 review::pending
IMF-049-02-0005-en	Why can the colour of gastrointestinal blood not reliably indicate the bleeding site or severity?	Coffee-ground material can coexist with active bleeding, melaena can arise from small bowel or right colon, and brisk upper haemorrhage can cause bright rectal blood.	Integrated Medical Foundations; chapter 49, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 0da3ce892f5b437308d7938c46ef728a9c813b01997630a0018d54ca5cacd3c2; editorial review pending	imf lang::en chapter::049 module::049-02 review::pending
IMF-049-02-0006-en	Why should blood loss not be calculated from a single haemoglobin value during resuscitation?	The rate of haemoglobin decline also reflects dilution by infused fluid, so trends must be read in a time series.	Integrated Medical Foundations; chapter 49, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 0da3ce892f5b437308d7938c46ef728a9c813b01997630a0018d54ca5cacd3c2; editorial review pending	imf lang::en chapter::049 module::049-02 review::pending
IMF-049-02-0007-en	How can voluntary guarding be distinguished from involuntary rigidity at the bedside?	Voluntary guarding lessens with reassurance and slow expiration, whereas involuntary rigidity persists.	Integrated Medical Foundations; chapter 49, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 0da3ce892f5b437308d7938c46ef728a9c813b01997630a0018d54ca5cacd3c2; editorial review pending	imf lang::en chapter::049 module::049-02 review::pending
IMF-049-02-0008-en	Why should a reassuring lactate never override a high-risk anatomical pattern?	Lactate reflects hypoperfusion and metabolism but can remain normal during early mesenteric ischaemia.	Integrated Medical Foundations; chapter 49, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 0da3ce892f5b437308d7938c46ef728a9c813b01997630a0018d54ca5cacd3c2; editorial review pending	imf lang::en chapter::049 module::049-02 review::pending
IMF-049-02-0009-en	Why is pregnancy testing part of abdominal diagnosis, and why not rely on relationship status or reported contraception?	Ectopic pregnancy, miscarriage, torsion and pregnancy physiology change imaging and treatment, and history alone cannot exclude pregnancy, so it is asked and tested respectfully.	Integrated Medical Foundations; chapter 49, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 0da3ce892f5b437308d7938c46ef728a9c813b01997630a0018d54ca5cacd3c2; editorial review pending	imf lang::en chapter::049 module::049-02 review::pending
IMF-049-02-0010-en	Why is computed-tomographic angiography, rather than routine CT, urgent in suspected mesenteric ischaemia or active bleeding?	Ordinary portal-phase imaging may miss the vascular anatomy.	Integrated Medical Foundations; chapter 49, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 0da3ce892f5b437308d7938c46ef728a9c813b01997630a0018d54ca5cacd3c2; editorial review pending	imf lang::en chapter::049 module::049-02 review::pending
IMF-049-02-0011-en	Why is closed-loop obstruction particularly dangerous?	Obstruction at two points traps a segment whose distension rapidly compromises venous and then arterial flow.	Integrated Medical Foundations; chapter 49, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 0da3ce892f5b437308d7938c46ef728a9c813b01997630a0018d54ca5cacd3c2; editorial review pending	imf lang::en chapter::049 module::049-02 review::pending
IMF-049-02-0012-en	How does bowel distension progress to perforation, and what change in pain signals this?	Raised wall tension impedes venous and lymphatic flow, increasing oedema and secretion until the mucosal barrier fails; pain changing from colicky to constant suggests ischaemia.	Integrated Medical Foundations; chapter 49, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 0da3ce892f5b437308d7938c46ef728a9c813b01997630a0018d54ca5cacd3c2; editorial review pending	imf lang::en chapter::049 module::049-02 review::pending
IMF-049-02-0013-en	Why does the absence of free subdiaphragmatic gas not settle whether a perforation needs intervention?	Gas may be absent with contained, retroperitoneal or small perforations, and the real question is whether contamination, sepsis, leak and tissue viability can be controlled without operation.	Integrated Medical Foundations; chapter 49, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 0da3ce892f5b437308d7938c46ef728a9c813b01997630a0018d54ca5cacd3c2; editorial review pending	imf lang::en chapter::049 module::049-02 review::pending
IMF-049-02-0014-en	Why is improvement in pain not sufficient for safe discharge after undifferentiated abdominal symptoms?	The patient must also tolerate intake, stay hydrated, mobilise, understand medication and lack evolving warnings, with explicit return triggers and owners for pending results.	Integrated Medical Foundations; chapter 49, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 0da3ce892f5b437308d7938c46ef728a9c813b01997630a0018d54ca5cacd3c2; editorial review pending	imf lang::en chapter::049 module::049-02 review::pending