Severe abdominal pain, lies still in bed, abdominal distension, vomiting, fever Tachycardia, diffuse tenderness, tympanic note, hyperactive bowel sound, PR examination – emptyĮlderly age, RF: peptic ulcer, intestinal ulcers, carcinoma Local complications: acute local fluid collection, pseudocyst, necrosis, abscessĪny age, RF: h/o previous abdominal surgeryĬrampy abdominal pain, nausea, vomiting, constipation, abdominal distension Helical CT with contrast, ultrasonography for biliary tract pathology Severe epigastric pain following meal, radiating to back, nausea, vomiting, fever, tachycardia, tachypnoea, hypotension, hyperthermia, epigastric tenderness, guarding, Cullen’s sign, Grey Turner’s signĬBC, S. Jaundice, RUQ tenderness, rebound tenderness, Murphy’s signĪge: 45–60 years, varies with aetiology M>F, aetiology: gallstones, alcohol Ultrasonography – most sensitive, CT scan in extrahepatic biliary obstruction, hepatobiliary scintigraphy Severe epigastric pain 2–5 h after meals or at night, nausea, vomiting, early satietyĪge: 40–60 years, F>M, RF: childbearing age, obese, alcohol, OC pillsĮpigastric/RUQ pain, radiating to right shoulder/subscapular, postprandial pain, nausea, fever Gastro-oesophageal reflux disease, perforationĮpigastric tenderness, no rebound tendernessĪge >50 years, M>F, RF: H. Bedside ultrasound facilitates visualisation of increased abdominal aortic diameter and determines further surgical/medical management.Įpigastric burning pain, associated with food, increases on supine position Elderly patients with history of recent abdominal/flank/low back pain, known hypertension, pulsatile abdominal mass and feeble/absent distal pulses are suggestive of abdominal aortic aneurysm/dissection. Ībdominal aorta, liver and spleen sizes can be evaluated by palpation. Typical rebound tenderness is no longer considered an important examination tool due to painful procedure. Due to lax abdominal wall musculature, guarding and rigidity may be absent in the elderly. Guarding could be voluntary or involuntary. Patients with peritoneal irritation show tenderness, guarding/rigidity and pain with coughing. pain of renal calculus extends from lumbar region to the iliac fossa and groin. However, one can have diffuse abdominal pain spreading to more than one quadrant, i.e. Localisation of tenderness guides physician to generate differential diagnosis pertaining to that area. Abdomen is divided into right upper, right lower, left upper and left lower quadrants. J.Palpation: Focus on locating the site of tenderness, signs of peritonism and palpation of masses. Table 3-11 lists the differential diagnoses for Mr. It will also be important to determine whether he has unexplained hypotension or abdominal distention during his exam. However, the combination of the location of the pain and the loud intestinal sounds that accompany the pain makes bowel obstruction the leading hypothesis. The associated nausea and vomiting can be seen with any of those diseases. The syndromes associated with pain of this quality include ureteral obstruction secondary to kidney stones, biliary obstruction, or intestinal obstruction (large or small bowel). J’s severe crampy abdominal pain suggests some type of visceral obstruction. Gastroenteritis is also unlikely given the absence of diarrhea and the severity of the pain. Furthermore, diabetic ketoacidosis is unlikely (unless this is his presentation of diabetes). Typically, IBS and IBD do not cause acute pain. This allows us to further limit the differential diagnosis to those diseases causing acute periumbilical pain. The second useful pivotal point to consider is the time course of Mr. A variety of diseases present with pain in this location, including AAA, appendicitis (early), bowel ischemia, bowel obstruction, diabetic ketoacidosis, gastroenteritis, IBS, and IBD ( Figure 3-1). J’s abdominal pain is its periumbilical location.
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