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44yo lady epigastric pain for past 4 weeks (chronic abdominal pain) (PE…
44yo lady epigastric pain for past 4 weeks
(chronic abdominal pain)
History
Location of Pain
Epigastric and Upper Abdo
Esophagus
GERD
stomach
gastritis
gastroparesis
duodenal
ulcer
gallbladder
cholecystitis
pancreatic
pancreatitis
Lower Abdo Pain
Large Bowel
Left sided diverticulitis
Crohn's Ileocolitis
Appendicitis
Pelvic Pain
Gynecological origin
ovarian cysts
Pelvic Inflammatory Disease
Chronic Pelvic Pain
Interstitial Cystitis
Endometriosis
Urethral syndrome
Dysfunction of pelvic muscles
Localized point of maximal pain in anterior abdo
chronic abdo wall pain
abdo cutaneous nerve entrapment syndrome
Aggravating Factors
Pain worse by eating
(post prandial pain)
gastric ulcer
chronic pancreatitis
gall stones
abdo ischemia
functional disorders
Irritable bowel syndrome
gastroparesis
functional dyspepsia
postprandial distress syndrome
Accentuated by physical activity
pain in anterior abdo indicate chronic abdo wall pain or abdo cutaneous nerve entrapment
Relieving Factor
Pain relieved by eating
duodenal peptic ulcer disease
Pain relieved by defecation
irritable bowel syndrome
Associated Factors
pain associated with menstrual cycle
gynecological origin
endometriosis symptoms
dyspareunia
dysmenorrhoea
pain with defecation
infertility
pain associated with urinary urgency + frequent urination
interstitial cystitis
Others
Fever
Chills
Night Sweats
Nausea and Vomitting
Diarrhea
Constipation
Bloody Stools
Anemia
Change in appetite or bowel
Weight Loss/ Gain
Psychosocial
PTSD
Abuse
Somatisation
Anxiety
Depression
PE
Acute Illness
Fever
Tachycardia
Tachypnoea
hypotension
Non Specific Signs
Head and Neck Exam
Temporal Wasting
Sunken Eyes
Prominent Clavicles
(suggestive significant weight loss)
dry mucosal membranes
(volume depletion)
Icteric sclera
(hepatobiliary disease)
Pale conjunctiva
(anemia)
Peripheral Vascular Disease
Dimished pulses
may coexist with intestinal angina or mesenteric ischema
Intra Abdo Patholgy
rebound tenderness in lower right quadrant
(pain on removal of pressure)
appendicitis
ulcerative colitis
Guarding
abdo wall pain
precise location of pain in anterior abdo
Carnett's Sign
increased pain when abdo muscle is tensed
(ask patient to lift head when lying down)
increased pain (+ve test)
abdo wall issues
Pelvic/ Lower Abdo Pain
Rectal Exam
Pelvic Exam
Bleeding
Diarrhea
Discharge/Mucus
Tenderness
Rectal Mass
Obstruction
Non specific Findings
Skin and Mouth
Ulcers
Vesicles
Angiomata
Bleeding or Bruising
pelvic girdle, lower back, ribs and spine