Abdo Pain


History

Pain
Site
- shifted / changed?
Onset / Progression
- Sudden vs gradual
Character
Radiation
Alleviating / Aggravating factors.
- cramp up, lie still or sit forward
Time course?
- improving, worsening
- coming and going
Ever before?
Severity
- interference with daily activities.

Associated Symptoms
Anorexia, nausea, vomiting.
- haematemesis?
Fevers / sweats chills
Bowel Habit
- change, PR bleeding?
Weight loss
GU systems inquiry.
- Obs / Gynae / Sexual
- Pregnant?
- Dysuria, frequency.

Past History
- past abdo surgery
- intercurrent illnesses
- traumas
Meds / Alcohol
Social
Family


Exam

Inspection
General

Jaundice, pallor, pigmentation, wasting, sweating etc.
Mental state.
Position of patient.
Obs - fever, hypotension.
Hands
Nails (e.g. clubbing, leukonychia).
Palmar erythema.
Dupuytren's contracture.
Arthropathy.
Hepatic flap.
Arms
Wasting, bruising, scratching, spider naevi.
Eyes
Sclera yellow, pale conjunctiva.
Mouth
Fetor, alcohol, fetor hepaticus, lips, gums, tongue, teeth.
Neck
Lymphadenopathy
Chest
Spider naevi, body hair, gynaecomastia.
Abdo
Scars, distension, veins, striae, bruising, visible masses, visible peristalsis.
Legs
Bruising, odema.

Palpation
Lie supine
Have pt first indicate site of pain
Ask them to cough - ?exacerbation
Superficial
Tenderness, rigidity, guarding, masses, lymph nodes (Sister-Mary-Joseph node).
Percussion tenderness
Deep
Masses, organomegaly (liver, kidneys, spleen, bladder).
AAA

Percussion
Outline viscera.
Ascites
- shifting dullness (roll to right)
- really need 30 seconds for fluid to move.

Auscultation
Bowel sounds.
Bruits

Specific Tests
Groin
Inspect with cough, palpate for herniae, lymph nodes.Hip rotation / extension
Murphy's sign
PR
PV/ testicular exam