أبو أحـمد
03-13-2007, 07:21 PM
Assessment of Abdominal Pain
I. History
A. Abdominal Pain characteristics
1. Time of onset
2. Pain localization and radiation
3. Palliative and provocative factors
B. Associated Symptoms
1. Nausea or Vomiting
2. Fever
3. Anorexia
4. Diarrhea or Constipation
5. Bloody stool
C. Past Medical History
1. Abdominal surgery, procedures or trauma
2. Cholelithiasis
3. Diverticulitis
4. Cardiovascular disease
5. Diabates Mellitus (Diabetic Ketoacidosis)
6. Human Immunodeficiency Virus (HIV)
7. Sickle Cell Anemia
8. Inflammatory Bowel Disease
D. Medications
E. Recent Travel (Parasitic infection)
F. Review of Symptoms
1. Pharyngitis (may mimic surgical abdomen)
2. Genitourinary
a. Menstrual History
b. Obstetrical history
c. Urinary Symptoms (Dysuria, Hematuria, frequency)
II. Examination
A. General appearance
1. Acutely or chronically ill appearing patient
2. Malnourished patient
3. Positioning
a. Retroperitoneal irritation: Thighs flexed
b. Peritonitis: Lie very still
c. Bowel Obstruction or Nephrolithiasis: Restless
B. Cardiopulmonary examination
1. Assess for Myocardial Infarction
2. Assess for Cardiac arrhythmia
C. Abdominal examination
1. Pearls
a. Do not test rebound tenderness by rapid release
b. Stethoscope applies pressure and observe response
2. Observation
a. Distention, Asymetry or Peristalsis
b. Scars
c. Hernia
d. Reduced chest excursion (due to guarding)
3. Auscultation
a. Borborygmi: Bowel Obstruction
b. Silent: surgical abdomen
4. Palpation
a. Maximal tenderness
b. Pulsation
c. Abnormal fullness
d. Muscle tone
D. Genitourinary examination
1. Examine for Femoral Hernia
2. Rectal exam in all patients with abdominal pain
a. Pain on palpation
b. Occult or frankly bloody stool
3. Pelvic exam in all women
I. History
A. Abdominal Pain characteristics
1. Time of onset
2. Pain localization and radiation
3. Palliative and provocative factors
B. Associated Symptoms
1. Nausea or Vomiting
2. Fever
3. Anorexia
4. Diarrhea or Constipation
5. Bloody stool
C. Past Medical History
1. Abdominal surgery, procedures or trauma
2. Cholelithiasis
3. Diverticulitis
4. Cardiovascular disease
5. Diabates Mellitus (Diabetic Ketoacidosis)
6. Human Immunodeficiency Virus (HIV)
7. Sickle Cell Anemia
8. Inflammatory Bowel Disease
D. Medications
E. Recent Travel (Parasitic infection)
F. Review of Symptoms
1. Pharyngitis (may mimic surgical abdomen)
2. Genitourinary
a. Menstrual History
b. Obstetrical history
c. Urinary Symptoms (Dysuria, Hematuria, frequency)
II. Examination
A. General appearance
1. Acutely or chronically ill appearing patient
2. Malnourished patient
3. Positioning
a. Retroperitoneal irritation: Thighs flexed
b. Peritonitis: Lie very still
c. Bowel Obstruction or Nephrolithiasis: Restless
B. Cardiopulmonary examination
1. Assess for Myocardial Infarction
2. Assess for Cardiac arrhythmia
C. Abdominal examination
1. Pearls
a. Do not test rebound tenderness by rapid release
b. Stethoscope applies pressure and observe response
2. Observation
a. Distention, Asymetry or Peristalsis
b. Scars
c. Hernia
d. Reduced chest excursion (due to guarding)
3. Auscultation
a. Borborygmi: Bowel Obstruction
b. Silent: surgical abdomen
4. Palpation
a. Maximal tenderness
b. Pulsation
c. Abnormal fullness
d. Muscle tone
D. Genitourinary examination
1. Examine for Femoral Hernia
2. Rectal exam in all patients with abdominal pain
a. Pain on palpation
b. Occult or frankly bloody stool
3. Pelvic exam in all women