Diagnostic Reasoning for Abdominal Pain GU Flashcards
GU related abdominal pains can manifest as
Hematuria
Pain
Protien Urea
Changing voiding patterns
Ask in the pts. History with Abominal suspected GU
FH: Heridetary component , nephritis, DM
PMH: Concurrent morbidity, Urinary pattern
SH: sexual HX. diapram use, # of new partners, STDs
Medication Hx: Sedatives, hynotics, diuretics, anticholenergic drugs,
Ask in the pts. History with Abominal suspected GU , Hx, of present illnes:
Onset of the pain
pain level and discrib the pain
Timing of the pain
Ask in the pts. History with Abominal suspected GU , with Hematuria.
check for urethritis, stricture
Acute abdominal pain frequently requires
urgent investigation and mangement
associated symtoms with a Surgical Abdomen
fever chills wt. loss diarrhea/constipation melena jaundice change in urine or stool or change in diameter of stool.
a Surgical Abdomen what to inquire about PMH:
past abdominal surgeries, abdominal disease, CVD risk
Surgical Abdomen what to inquire about what type of intake
ETOH, and tylenol, ASA, NSAIDS
Acute abdominal pain is
pain for less than a few days and is progressivly worse until the time pt. is seen.
Pain in the abdomen that has not changed for months is
chronic abdominal pain
Abdominal pain that is not acute or chronic is
Subacute.
Two conditions that require urgent referral
Obstruction
Peritonitis
Obstruction s/symtoms
S/S= pain,anorexia, bloating,n/v, P.I observation: distention Auscutation= High pitched bowel sounds Percussion: tympany Palpitation= feel a possible mass tenderness
Peritonitis s/s
s/s= look sick, lie still to minimize the pain and discomfort
P.I poor relief from analgesics,
Auscultation=decrease boewl sounds
percussion=ridgity
palpation= tenderness and pain even when the strcher is touched.
Labs for a surgical abdomen
CBC, Electrolytes BUn, Creatine glucose Lipase U/A/ urine cultures pregnancy test
VS iwth a surgical abdome might see
fever
Other diagnostic test to perform
Abdominal xray, check for free air or obstruction
When the abdominal xray is inconclusive which test is more sensative .
CT scan
What test is best to find the etiology of peritonitis
ultra sound
What is visable with an abdominal ultrasound?
The appenditis, abdominal absess, other intra pelvic pathologies.
Painful pulsatile mass with or with out a bruit should suspect
ruptured aortic mass
Suspected ruputred arotic mass is a
immediate surgical referral.
A 30-year-old alcoholic man with no past medical or surgical history is brought in by ambulance to the ED with severe (7/10) epigastric abdominal pain. The pain started 5 hours after the ingestion of a large meal. It radiates to the back and is associated with nausea and nonbloody, nonbilious emesis. He denies any problems or pain with urinating. On physical examination, he is afebrile, tachycardic, and tender without rebound in the epigastrium and left upper quadrant.
What is the most likely diagnosis?
Pancreatitis
A 48-year-old healthy obese woman comes to your clinic with a 1-day history of nonradiating epigastric burning pain that started 2 hours after eating lunch, which she rates as a 4 on 10-point pain scale. She describes similar pains in the past few months but never as severe. The pain is worse when lying flat in bed at night and has been relieved in the past by antacids. She denies fevers, weight loss, changes in her bowel movements, or radiation to her back. Physical examination demonstrates normal vital signs and is only notable for mild epigastric tenderness.
Which of the following disorders do you suspect?
Peptic ulcer disease
A 41-year-old healthy woman sees you with a 10-month history of abdominal pain, accompanied by an increase in stool frequency and a more watery consistency of her stool. She reports that her pain improves with defecation. She denies fever, bleeding, or weight loss.
What is the most likely diagnosis?
Irritable bowel syndrome (IBS)
A 22-year-old woman comes to clinic complaining of a 4-day history of bloody diarrhea. The patient recently returned from a spring break vacation in Mexico with her college roommates. She reports diffuse abdominal discomfort but no nausea or vomiting. Three of her traveling companions were also complaining of bloody diarrhea.
What is the most likely cause of her bloody stools?
infectious colitis
Liver or biliary tree pain can radiate to the
back
epigastruim
Most pain in the right upper quadrent is related to
the biliary tree
right upper quadrent pain with feverand jaundice is related to
the biliary tree
Acute choleycystitis can present as a person that is
systematically unwell with a low grade fever
Right upper quadrent pain lab test should be
CBC with diff glucose , lipase electroytes, BUN Creatine, Aminotranshease alkatine phoshate bilirubin
High aminotransferases, and a increase in bilirubin with right upper quadrent pain is most likely
choledocholithiasis
other diagnostic test for right upper quadrent pain
endoscopic ultrasound
MRCP
ERCP most invasive
Epigastric pain all of the sudden is suggestive of
pancreatitis
Pancreatitis pain s/s
sudden epigastric pain
N/V
anorexia
pain radiating to the back
signs of dyspepsia
bloating
abdominal fullness
heart burn
nausea
epigastric pain that needs immediate attention
>50 wt. Loss persistant vomiting dysphagia anemia hematemesis palpable mass
Anemia
elevated WBC
elevated Platelet
low ferritain suspect
celeiac
IBS
the initial consideration in abdominal pain should be weather the symtoms are
acute or chonic
patients with a acute abdominal should be assessed for
surgical abdomen
Chronic abdominal pain have begin functional disorders oof
IBS
functional dyspepsia
