Abdominal Pain
Abdominal pain is a challenging complaint: it theoretically suggests true pathology, but we all know it's a red flag to some sketchy behavior. This is especially the case if the patient is a frequent flyer.
Definition
We're completely disappointed in you if you cannot figure out the definition by yourself.
History
The history helps guide the formation of a differential diagnosis, though it is well known that the sensitivity and specificity is poor especially if the patient is lying through his or her teeth. The location of abdominal pain can be helpful, but if the patient gestures towards the entire body when asked where the pain is then move on. Timing is helpful: sudden onset signals something acute whereas initial onset in the year of 1988 suggests a discharge might be imminent. Quality can be useful if the patient says words like "gnawing" or "colicky" but chances are you'll just hear the phrase, "I don't know, it just hurts." Severity can be helpful; however, if the patient describes their pain as greater than 10 out of 10, push drug seeking to the top of the differential and get on with it.[1][2] You could ask if anything triggers the pain, if anything makes it better, if there are any other associated symptoms, or if the patient has any other pertinent past medical history, medications, travel history, sexual history, but you've already devoted way too much time to the history, you're probably getting paged, so it is in the best interest of everyone involved to move on. Note: In the event the abdominal pain is occurring in a young woman of reproductive age, be like medical student Rick Hansen and avoid a pelvic exam at all costs.[3]
Physical Exam
- Vital signs - These should be looked at and if any are abnormal, make sure to slap the monitor and make sure it's real.
- Eye exam - Hippocrates once said that the "Door to the intestines is through the eyes." Never mind, that was our friend Ralph who said it. Ralph's an idiot.
- Abdominal exam - For the most up-to-date primer on how to perform a mediocre abdominal exam, refer to Gomerblog's Physical Exam Tips: The Abdomen.
- Pelvic exam - Remember: Channel your inner Rick Hansen.
- Foot Exam - Ah, don't bother. We thought we had a great quote from Sir William Osler, but it's just our moronic colleague Ralph again.
Labs
Chloride and phosphorus. What more could you need really?
Imaging
A nondiagnostic abdominal X-ray is always a good start.[4]
Other Procedures
Ultimately, you may need endoscopic procedures to help guide your complications.
- Upper endoscopy or EGD - Useful in ruling out GERD, gastritis, and other causes of PPI deficiency.
- Lower endoscopy or colonoscopy - Useful in ruling out colon cancer, IBD, or Pokémon.
- ERCP - Useful in causing pancreatitis.
Related Reading
- Jaundice
- Liver Pain
- Level 1 Drama Algorithm
- Lumbar Triangle
- Nausea
- Pseudoseizures
- Pseudopseudoseizure
- Radiology's Circle of Tests
- The Shawshenk Distension
- Tenderness to Palpation
- Urinary Tract Infection
- Vomiting
References
- ↑ 20 Out of 10 Medical Providers Annoyed by Patients’ Misuse of Pain Scales (Gomerblog)
- ↑ Drug Seeker Fills Entire Emesis Bucket with Noise Before Receiving Dilaudid (Gomerblog)
- ↑ Med Student Avoids Pelvic Exam for Record 1,429th Straight Day (Gomerblog)
- ↑ Ever Wonder How Radiologists Know What Studies to Recommend? (Gomerblog)
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