Abdominal Pains
Abdominal Pain History Abdominal Pain History
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Example2
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CC Site: where? Does it radiate anywhere else? Onset: first time? when? Sudden\gradual? Continuous\intermittent? Getting better\worse? Duration: how long does it last? Timing: specific time of day\night? How frequent? Character of pain: sharp, dull, cramping? Character of stool: Amount? Watery? Blood? Mucous? Greasy\difficult to flush? Relieving\aggravating factors: certain foods (gluten, lactose)? Medication? Severity: 1-10 scale? Wakes you up from sleep? Interfering w\ ADL? Food hx: recent suspect food? Food poisoning? Associated sx: Constitutional: fever, wt loss, loss of appetite, night sweats, chills? GI: abdominal pain, diarrhea\constipation, N\V, heartburn, jaundice? GU: dysuria, hematuria? Anemia: fatigue, dizziness, palpitation, headache? IBS: relieved after defecation, abdominal pain, diarrhea\constipation, flatulence\bloating, associated with stress\spicy food\menstruation? IBD: bloody diarrhea, rash, mouth ulcer, joint pain? PMHx: Diseases: Chronic ds (HTN, DM, DLP) GI ds Medications: NSAIDs, abx, laxatives, herbals Surgery, hospitalization, trauma Blood transfusions, IV drug use, tattoos Allergies FMHx: Similar complaint? Same diseases as in PMHx? Social Hx: Occupation, marital status, children? Smoking, alcohol, recreational drugs? Travel Hx, contact with sick pts Diet, exercise
Abdominal Physical Exam
WIPE, blah blah 🙂 “Take vital signs” Position: flat, arms on the side, pillow below the head Proper exposure: from xiphoid to mid-thigh General inspection of the pt and surrounding
Third Example
Peripheral signs: Nails: Capillary refill Clubbing Cyanosis Koilonychia Leukonychia Hands: Palmar erythema Pulse Tremor Arms: Purpura BP Eyes: Pallor Jaundice Mouth: Central cyanosis Dry mucous membrane Dental hygiene Ulcers Neck: JVP Lymphadenopathy Abdomen inspection: (stand at the end of the bed) Symmetry and contour Abdominal distention + flank fullness Scars, skin changes\discoloration, rashes, straie Obvious masses or swelling Dilated veins\caput medusa Visible pulsations Umbilicus (inverted\everted?) Hernias (ask pt to cough) Palpation + percussion: (ask pt if they have any pain? Be at the level of the pt’s abdomen) Superficial and deep: “abdomen soft and lax, no tenderness, no masses” Liver span (6-12 cm) Gallbladder (Murphy’s sign) Spleen (turn the pt towards you -normally non-palpable!) Kidneys Bladder Ascites: shifting dullness + fluid thrill Auscultation: Bowel sounds Bruits: Aortic, renal, femoral To complete: Digital rectal exam (PR) Genital exam Fecal occult blood test
Stigmata of chronic liver disease:
Clubbing Leukonychia Palmar erythema Dupuytren’s contracture Scratch marks Astrexis Parotid enlargement Gynecomastia Caput medusa Ascites Splenomegaly Testicular atrophy LL edema ## Another paragraph <a name="paragraph2"></a>
Fourth Example
How to differentiate between a renal mass vs a splenic mass on physical exam?
Spleen Kidney Can’t get above it Can get above it Has a notch Round, no notch Moves w\ resp (towards Rt iliac fossa) Ballotable Dull on percussion Resonant on percussion