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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