4337324..............................ppt

Ttttt

1. Abdominal Pain
•Scope of the problem
•Anatomic Essentials
–Visceral Pain
–Parietal Pain
–Referred Pain

2. History
•Where is your pain? Has it always been there?
•Does the pain radiate anywhere?
•How did the pain begin (sudden vs. gradual onset)? How
long have you had the pain?
•What were you doing when the pain began?
•What does the pain feel like?
•On a scale of 0–10, how severe is the pain?
•Does anything make the pain better or worse?
•Have you had the pain before?

4. History (continued)
•Associated symptoms
–Gastrointestinal
–Genitourinary
–Gynecologic
–Cardiopulmonary
•Past medical

5. Physical Examination -
Directed
•General appearance
•Vital Signs
•Abdomen
–Inspection
–Auscultation
–Percussion
–Palpation

8. Physical Examination -
Directed
•Pelvic
•Genital
•Back
•Rectal
•Head-to-toe

9. Differential Diagnosis
•Appendicitis
•Biliary colic, cholecystitis,
cholangitis
•Bowel obstruction
•Diverticulitis
•Ectopic pregnancy
•Gastroenteritis
•Intussuception
•Mesenteric Ischemia
•Ovarian torsion
•Pancreatitis
•Pelvic Inflammatory
Disease (PID)
•Perforated peptic ulcer
•Ruptured or leaking
abdominal aortic
aneurysm (AAA)
•Testicular torsion
•Ureteral colic
•Volvulus

10. Diagnostic Testing
•Laboratory Studies
–CBC
–Urinalysis
–Pregnancy
–Amylase/Lipase
–Other
•Electrocardiogram

11. Diagnostic Testing - continued
•Radiologic Studies
–Plain Films
–Ultrasound
–Computed Tomography

14. General Treatment Principles
•Volume repletion
•Pain relief
•Antibiotics
•Other

15. Special Patients
•Elderly
•Pediatric
•Immune compromised

17. Disposition
•Surgical consultation
•Serial evaluation
•Discharge

18. Pearls, Pitfalls and Myths
•Do not restrict the diagnosis solely by the
location of the pain.
•Consider appendicitis in all patients with
abdominal pain and an appendix,
especially in patients with the presumed
diagnosis of gastroenteritis, PID or UTI.
•Do not use the presence or absence of
fever to distinguish between surgical and
medical causes of abdominal pain.
•The WBC count is of little clinical value in
the patient with possible appendicitis.
•Any woman with childbearing potential
and abdominal pain has an ectopic
pregnancy until her pregnancy test comes
back negative.
•Pain medications reduce pain and suffering
without compromising diagnostic
accuracy.
•An elderly patient with
abdominal pain has a high
likelihood of surgical disease.
•Obtain an ECG in elderly
patients and those with cardiac
risk factors presenting with
abdominal pain.
•A patient with appendicitis by
history and physical
examination does not need a CT
scan to confirm the diagnosis;
they need an operation.
•The use of abdominal
ultrasound or CT may help
evaluate patients over the age of
50 with unexplained abdominal
or flank pain for the presence of
AAA.