Transcript Document

Abdominal Pain
• Scope of the problem
• Anatomic Essentials
– Visceral Pain
– Parietal Pain
– Referred Pain
History
• Where is your pain? Has it always been there?
• Does the pain radiate anywhere?
• How did the pain begin (sudden vs. gradual onset)? How
long have you had the pain?
• What were you doing when the pain began?
• What does the pain feel like?
• On a scale of 0–10, how severe is the pain?
• Does anything make the pain better or worse?
• Have you had the pain before?
History (continued)
• Associated symptoms
– Gastrointestinal
– Genitourinary
– Gynecologic
– Cardiopulmonary
• Past medical
Physical Examination Directed
• General appearance
• Vital Signs
• Abdomen
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Inspection
Auscultation
Percussion
Palpation
Physical Examination Directed
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Pelvic
Genital
Back
Rectal
Head-to-toe
Differential Diagnosis
• Appendicitis
• Biliary colic, cholecystitis,
cholangitis
• Bowel obstruction
• Diverticulitis
• Ectopic pregnancy
• Gastroenteritis
• Intussuception
• Mesenteric Ischemia
• Ovarian torsion
• Pancreatitis
• Pelvic Inflammatory
Disease (PID)
• Perforated peptic ulcer
• Ruptured or leaking
abdominal aortic
aneurysm (AAA)
• Testicular torsion
• Ureteral colic
• Volvulus
Diagnostic Testing
• Laboratory Studies
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CBC
Urinalysis
Pregnancy
Amylase/Lipase
Other
• Electrocardiogram
Diagnostic Testing - continued
• Radiologic Studies
– Plain Films
– Ultrasound
– Computed Tomography
General Treatment Principles
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Volume repletion
Pain relief
Antibiotics
Other
Special Patients
• Elderly
• Pediatric
• Immune compromised
Disposition
• Surgical consultation
• Serial evaluation
• Discharge
Pearls, Pitfalls and Myths
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Do not restrict the diagnosis solely by the
location of the pain.
Consider appendicitis in all patients with
abdominal pain and an appendix,
especially in patients with the presumed
diagnosis of gastroenteritis, PID or UTI.
Do not use the presence or absence of
fever to distinguish between surgical and
medical causes of abdominal pain.
The WBC count is of little clinical value in
the patient with possible appendicitis.
Any woman with childbearing potential
and abdominal pain has an ectopic
pregnancy until her pregnancy test comes
back negative.
Pain medications reduce pain and suffering
without compromising diagnostic
accuracy.
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An elderly patient with
abdominal pain has a high
likelihood of surgical disease.
Obtain an ECG in elderly
patients and those with cardiac
risk factors presenting with
abdominal pain.
A patient with appendicitis by
history and physical
examination does not need a CT
scan to confirm the diagnosis;
they need an operation.
The use of abdominal
ultrasound or CT may help
evaluate patients over the age of
50 with unexplained abdominal
or flank pain for the presence of
AAA.