1: Abdominal pain

Question 1

What questions should you ask about a patient’s abdominal pain?

Answer 1

SOCRATES:

Site

Onset (when? acute/gradual? how long? has it been getting better or worse?)

Character

Radiation

Associated symptoms

Timing (specific times of day? activities?)

Exacerbating / alleviating symptoms

Severity

Question 2

Name the abdominal regions.

Answer 2

Right hypochondrial | Epigastric | Left hypochondrial

Right lumbar | Umbilical | Left lumbar

Right iliac | Hypogastric | Left iliac

Question 3

peritonitis - pain associated with laughing, coughing, bumps

gallbladder - right hypochondral

pancreas - radiating thru to the back

& so on

Question 4

Appendicitis pain starts in the umbilicus and (shifts / spreads) to the right iliac fossa.

Answer 4

shifts

Question 5

What pain is associated with ruptured duodenal ulcers, burst appendix etc?

Answer 5

Spreading pain

Question 6

Where is midgut pain felt?

Answer 6

Epigastric

Umbilical

Pelvic

regions i.e the midline

Question 7

Why does visceral abdominal pain spread to become somatic abdominal pain?

Answer 7

Inflammation of the peritoneum

Question 8

What is Murphy’s sign and what is it associated with?

Answer 8

If your hand is on the right hypochondral region and the patient takes a big breath, pain

Inflamed gallbladder pushed up by liver and lungs onto hand producing pain

Question 9

tender to percussion - peritonism

Question 10

rigid abdomen - true abdominal peritonitis

usually a result of ruptured/perforated ulcers, cancer

Question 11

learn classic presentations of appendicitis, cholecystitis, diverticulitis