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Abdominal Pain: LSU Medical Student Clerkship, New Orleans, LA
Abdominal Pain: LSU Medical Student Clerkship, New Orleans, LA
Abdominal Pain: LSU Medical Student Clerkship, New Orleans, LA
O- onset
P-provocation /palliation
Q- quality/quantity
R- region/radiation
S- severity/scale
T- timing/time of onset
Physical Exam
General Appearance and Vitals (sick vs
Not sick)
Abdominal exam
-Inspection (scars, masses, ecchymosis,
distention)
-Auscultation (bowel sounds, bruits),
-Percussion (organomegaly, dullness)
-Palpation (tenderness, guarding, rebound,
referred pain, masses)
-Don't forget GU, Rectal and Pelvic
Visceral Pain
Disadvantages:
Only useful in certain conditions – otherwise
low yield, difficult to position sick patients.
Radiology: Plain Films
When are they useful?
Obstruction/Ileus
Volvulus (cecal and sigmoid)
Free air
Radiopaque foreign bodies
Constipation?
Plain Films: Small bowel obstruction
Cecal Volvulus and Sigmoid Volvulus
Pneumoperitoneum
Iron Overdose:
Remember the radiopaque
foreign bodies mneumonic:
BAT CHIPS:
Barium
Antihistamines
Tricyclic antidepressants
Chloral hydrate, calcium,
cocaine
Heavy metals
Iodine
Phenothiazine, potassium
Slow-release (enteric
coated)
Radiology: Ultrasound
Advantages: Can be done at bedside, easy to
learn, repeatable, no radiation, cheap, can be
used in pregnancy, patient does not need to
leave the department
Gallbladder disease
AAA
Hydronephrosis
Volume status
Ob/Gyn (Ectopic, IUP, Ovarian pathology)
Appendicitis (particularly in children)
Ultrasound: Cholecystitis
Ultrasound: AAA
Ultrasound: Appendicitis
Radiology: CT
Advantages: Highly diagnostic for most disease
processes. High yield exam. Helpful with
multiple, competing diagnoses.