What is visceral pain caused by? parietal?
- stimulation of the visceral pain fibers
2. stimulated of the somatic pain fibers
What’s the most important OLDCARTS for abdominal pain?
Location
What is different between General ROS and Focused ROS?
general is the same every time
focused is based on chief complaint
What medications should you not miss?
blood thinners, NSAIDS, Narcotics, steroids
- ex. Tylenol kills our liver
- ex. narcotics cause slowed down gut motility
Why do we care if they smoke?
smoking irritates lining of stomach and lead to peptic ulcer disease
What does MJ cause?
cyclic vomiting syndrome
What is the order of the physical exam?
inspection, auscultation, percussion, palpation
If a man comes with stress marks, without history of obesity, what do we worry about?
cushions
What is ecchymosis around the umbilicus called? around the flank?
- cullens sign
2. gray turners sign
How long do you have to listen to declare absent bowel sounds?
greater than 2 minutes
What do high pitched bowel sounds indicate?
early intestinal obstruction
*sound like rain on metal
What does a friction rub indicate?
inflammation of the peritoneal surface of an organ
- sounds like grating sounds with respiration
- *listen over liver and spleen
What does a venous hum indicate?
increased collateral circulation b/t portal and systemic venous systems
- sounds like soft humming noise
- *listen over epigastric/umbilical region
What is the normal vertical span of the liver?
6-12cm
What can cause splenomegaly?
portal HT, blood malignancies, HIV, splenic infant, hematoma, monoculeosis
Ascites
- fluid in the peritoneal cavity
- shifting dullness test or test for fluid wave
Appendicitis
- infected appendix
- McBurney’s point tenderness*, Rousing’s sign**, Psoas sign, and Obturator sign
- the best
- *second best
Biliary Colic Test
Murphy’s sign
Kidney Inflammation/Distension Test
Lloyd’s sign (punch)
Peritoneal inflammation
“acute abdomen”
-Guarding, Rigidity , Rebound tenderness
*stiff, board like abdomen –> they need surgery
VINDICATE
Vascular Infectious/inflammatory Neoplasm Drugs/degenerative Idiopathic/iatrogenic Congenital AI/Allergic/Anatomic Trauma Endocrine/Environment
What is the process for developing a DDX?
develop broad DDX–> Narrow DDX–> Develop working DDX–> Pursue working DDX–> Assessment and Plan
