Case 13 - 48 yo F with abdominal pain

Question 1

Information gathering

Answer 1

CC
Onset
Constant/intermittent
Frequency
Progression
Severity
Location
Radiation
Quality
Exacerbating and alleviating factors
Types of food that exacerbate pain
Timing of eating to pain
Prior episodes
N/V/D/C
Description of vomitus
Blood in vomitus
Weight and appetite changes
Change in stool color
PMHx
PSHx
FHx
Social Hx (occupation, smoking, alcohol, drug use, diet, exercise, sexual activity)
Current medications
Drug allergies

Question 2

Physical examination

Answer 2

CV exam
Pulmonary exam
Abdominal exam (inspection, auscultation, palpation, including Murphy’s sign, percussion

Question 3

Closure

Answer 3

Mentioned need for rectal exam

An upper endoscopy uses a tiny camera passed through your mouth to view your stomach

Question 4

Murphy’s sign

Answer 4

Pain to palpation at right subcostal margin upon inspiration

Question 5

Differential diagnosis

Answer 5

Cholecystitis
Peptic ulcer disease
Gastritis

Question 6

Diagnostic work-up

Answer 6

CBC with differential
AST/ALT/bilirubin/alkaline phosphatase, lipase
US - abdomen
Upper endoscopy
H. pylori antibody testing
Rectal exam, stool for occult blood