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Abdo Pain
#fm
Objective

  • General inspection

    • Change in mental status (infection - UTI)

    • Shock (perforated viscera, GI hemorrhage, severe pancreatitis, MI, sepsis)

  • Vitals

  • Upper abdo pain - pay attention to Cardiac (ischemia) & lung (pneumonia) exams

    • Tachypneic (pneumonia)

  • Abdo

    • peritoneal signs

    • Carnett’s sign (high ppv for abdo wall pain)

      • ↑ pain when supine pt raises head & shoulder, tensing abdo wall

    • Murphy’s sign (high ppv for choleycystitis)

    • Psoas sign (high ppv for appendicitis)

    • Sever pain out of proportion (ischemic bowel, pancreatitis)

    • restless/writhing (biliary/renal colic, testicular torsion)

    • LLQ tenderness (diverticulitis)

  • Rectal & pelvic exams if lower abdo & pelvic pain

    • DRE - fecal impaction, palpable mass, occult blood in stool

      • Tenderness & fullness on R of rectum suggests retrocecal appendix

    • Pelvic - vaginal discharge (vaginitis), cervical motion tenderness & peritoneal signs (ectopic pregnancy or other gyne complications e.g. tubo-ovarian abscess)

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Abdo Pain
Cholecystitis (highest to lowest PPV) RUQ pain, fever, jaundice IBS algorithm <span>Objective General inspection Change in mental status (infection - UTI) Shock (perforated viscera, GI hemorrhage, severe pancreatitis, MI, sepsis) Vitals Upper abdo pain - pay attention to Cardiac (ischemia) & lung (pneumonia) exams Tachypneic (pneumonia) Abdo peritoneal signs Carnett’s sign (high ppv for abdo wall pain) ↑ pain when supine pt raises head & shoulder, tensing abdo wall Murphy’s sign (high ppv for choleycystitis) Psoas sign (high ppv for appendicitis) Sever pain out of proportion (ischemic bowel, pancreatitis) restless/writhing (biliary/renal colic, testicular torsion) LLQ tenderness (diverticulitis) Rectal & pelvic exams if lower abdo & pelvic pain DRE - fecal impaction, palpable mass, occult blood in stool Tenderness & fullness on R of rectum suggests retrocecal appendix Pelvic - vaginal discharge (vaginitis), cervical motion tenderness & peritoneal signs (ectopic pregnancy or other gyne complications e.g. tubo-ovarian abscess) S&S of surgical abdo Fever Protracted (prolonged) vomiting syncope/pre-syncope Evidence of GI blood loss


Summary

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last reprioritisation on suggested re-reading day
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