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Abdominal Problems Chapter 11 p. 504 case study
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Abdominal Problems Chapter 11 p. 504 case study
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Abdominal ProblemsChapter 11 p. 504
Abdominal Pain p. 504
o Common Complaint
Right Epigastric Left o 90% of visits to the Emergency Department
Hypochondriac Pyloric end of hypochondriac o Acute abdominal pain must be evaluated quickly
Right lobe of stomach Stomach & precisely
liver Duodenum Spleen o Half of patients with abdominal pain do not receive
Gallbladder Pancreas Tail of pancreas an accurate diagnosis
Portion of Portion of liver Upper pole of o Extra-abdominal etiologies include: ovarian
duodenum left kidney cancer, ectopic pregnancy, myocardial infarction
Portion of right Suprarenal • A common complaint that you will encounter
kidney gland in primary care is abdominal pain. This pain
Suprarenal accounts for about 90% of ED visits.
gland • The differential diagnoses for abdominal
pain includes factors that can lead to
Right lumbar Umbilical Left lumbar significant morbidity and to mortality, so it is
Ascending Omentum Descending imperative that acute abdomen be evaluated
colon Mesentery colon quickly and precisely.
Lower half of Lower part of Lower half of • There may be extra-abdominal etiologies
right kidney duodenum left kidney that may be the cause of abdominal pain.
Portion of Jejunum and Portions of • Disorders such as ovarian cancer,
duodenum and ileum jejunum and ectopic pregnancy, and myocardial
jejumum ileum infarction need to be considered
Right inguinal Hypogastric Left inguinal when evaluating the patient with
Cecum Ileum Sigmoid colon abdominal pain.
Appendix Bladder Left ureter Exam & testing
Lower end of Uterus in Left spermatic o Physical exam
ileum pregnancy cord • Abdominal exam—inspection, auscultation,
Right ureter Left ovary percussion, palpation
Right spermatic • Digital rectal exam
cord (May be Issues related to these areas
Right ovary may be the source of the abdominal
pain.)
• Vaginal/genital exam
(May be Issues related to these areas may be the source of the abdominal pain.)
o
o Tests
• CBC
• Liver function tests (LFTs)
• Chemistry profile (which should include an amylase & lipase)
• Urinalysis
• Stool for occult blood
• Pregnancy test
• Any female of childbearing years (menarche to menopause) should have a pregnancy test
(even if she says “there’s no way I could be pregnant”!
You do not want to set a patient up for tests such as an xray without knowing pregnancy
status.
Additionally, pregnancy may be the cause of the abdominal pain!
• There is a flow chart on pages 505-508 in the text.
• This algorithm directs you towards a differential diagnosis according to the
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, • type of pain, locus of pain, associated symptoms, precipitating or aggravating factors,
relieving factors, physical findings, and diagnostic studies. It is important to evaluate
all of these factors when formulating your differential diagnoses for the patient
• When performing your exam on the patient, the location of the pain per quadrant is an important clue
to your differential diagnoses.
• RUQ:
• Chol
ecys
titis/
chol
elithi
asis.
• RLQ:
•appe
ndici
tis,
• inflammatory bowel disease
• ectopic
pregnancy,
• endometriosi
s.
LLQ •
•
generalized abdominal pain, left
lower quadrant (LLQ)
tenderness – Differential diagnosis think GI and GYN
• Diverticulitis,
• Inflammatory Bowel diseases,
• ectopic pregnancy,
• endometriosis,
• colon cancer.
• PID, Ovarian cyst,
• Spermatic cord
Diarrhea p.512-513, 1018
• Diarrhea is a common complaint addressed in primary care.
• Increased frequency and volume of fluid content of bowel movement
• Knowing the classification can clue you in as to what the patient may have going on.
• Acute/Chronic
• Types
o Osmotic
▪ lactase deficiency,
▪ ingestion of poorly absorbed solutes (such as magnesium sulfate),
▪ small bowel injury.
o Secretory
• bacterial infections,
o cholera
o E. coli,
2
, • laxative abuse,
• bile salt malabsorption,
• endocrine tumors
o diarrhea associated with morphological changes,
• such as with inflammatory bowel diseases.
Differential diagnoses
• These factors should be considered in your differential diagnosis list.
complaints of diarrhea.
• ???? Irritable bowel syndrome
• Inflammatory bowel disease
• Ischemic bowel disease (especially with peripheral vascular disease [PVD])
• Partial bowel obstruction
• Pelvic abscess
• Chronic pancreatitis
• Complications of diabetes mellitus
Appendicitis568-570, 682
• Inflammation of the appendix
• Obstruction or infection
• It most commonly occurs between the ages of 10-30
• occurs more frequently in men
• *****Most common cause
of RLQ pain requiring surgery
Clinical presentation
• It most
commonly occurs
between the ages
of 10-30
• occurs more
frequently in
men
• acute onset of
mild to severe
colicky, epigastric
or periumbilical
pain.
• Vague abdominal
pain early on
24 hours • localizes over the
• pain may be exacerbated by walking and coughing RLQ within about
• may have nausea and vomiting and a mildly elevated temperature
Physical exam
• Evaluation for Rovsing’s sign, psoas sign, Obturator sign, and McBurney’s sign. vague belly pain at
what point with appendicitis
• Lab tests are not diagnostic for appendicitis.
• history and physical exam that lead you to your diagnosis.
• Be sure to rule out pregnancy in women of child bearing years.
Testing
• An Xray may be done & may show a fecalith or obstruction or other issues associated with appendicitis.
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