Abdominal Pain

HISTORY_LIST
duration of pain
progression of pain
location of pain at onset
location of pain at present
diffuse or localized pain
character of pain at onset
character of pain at present
radiation of pain to
last bowel movement
pain affected by: eating,
   vomiting, defecation,
   passing of gas, urination,
   inspiration, movement,
   position, belching
fever
chills
nausea
vomiting characteristics:
   bilious
   feculent
   food
   blood
   coffee grounds
vomiting pre/post pain onset
chest pain
vaginal discharge
penile discharge
constipation
change in bowel habit
change in stool caliber
inability to pass gas
diarrhea
hematochezia
melena
anorexia
weight loss
dysphagia
painful swallowing
jaundice
fatty food intolerance
INFECTIOUS DISEASES
hepatitis
CHRONIC DISEASE
SYSTEMIC DISORDERS
hernia
gallstones
coronary disease
kidney stones
ascites
dyspepsia
SURGERY
PREVIOUS HOSPITALIZATIONS
appendectomy
cholecystectomy
aortic graft
PREVIOUS TESTS
endoscopy
abdominal x-rays
TRAUMA OR INJURIES
abdominal trauma
SOCIAL HISTORY
smoking
excessive alcohol intake
caffeine
illicit drugs - cocaine
ALLERGY
medications
foods
seasonal
FAMILY HISTORY
gallstones
coronary disease
kidney stones


MEDS_LAB_TESTS
**** MEDS
aspirin
NSAIDS
opiate narcotics
anticholinergics
tricyclics
antipsychotics
laxatives
antacids
**** LAB
Electrolytes
BUN
creatnine
CBC
LFT
amylase
lipase
UA
**** PROC
CXR
X-ray of abdomen
   (acute abdominal series)
CT of abdomen
MRI of abdomen



REVIEW_OF_SYSTEMS_1
GENERAL
weight changes
appetite changes
anorexia
difficulty sleeping
fever
chills
polyphagia
hypophagia
changes in thirst
sleeping habit change
bowel habit change
fatigue
hypertension
previous physical exams
SKIN
pigmentation changes
texture changes
lesions
eruptions
pruritis
easy bruising
easy bleeding
unusual hair loss
changes in hair distribution
skin masses
finger/toe nail change
rashes
hives
striae
skin atrophy
uremic frost
hirsutism
plethora
neurofibromatosis lesion
HEENT
head trauma
skull fractures
head masses
hearing loss
vertigo
chronic ear infection
ear discharge
ear pain
hearing aid use
loss of vision
recent change in vision
photophobia
diplopia (double vision)
glaucoma
exudates
dry eyes
eye pain
cataracts
eye surgery
itchy eyes
excessive tearing
corrective lenses
nose bleeds
chronic sinusitis
nasal fractures
nasal drainage
polyps
changes in sense of smell
edentulous (without teeth)
partial plate
full plate
recent dental work
oral lesions
tonsillitis
strep throat
tongue problems
voice changes
chronic hoarseness
chronic halitosis
NECK
neck masses
enlarged thyroid gland
brachial cleft cysts
neck injury

REVIEW_OF_SYSTEMS_2
CHEST
chronic coughing
sputum production
hemoptysis
wheezing
pneumonia
bronchitis
TB
TB exposure
SOB (altered by position?)
edema
chest pains
pacemaker
HEART
MI
coronary artery disease
heart murmur
heart valve disease
left ventricular hypertrophy
mistral valve stenosis
pericarditis
palpitations
DOE
paroxysmal nocturnal dyspnea
orthopnea
edema
hypertension
rheumatic fever
cardiomyopathy
ectopic heart beats
arrhythmia
exercise intolerance
claudication
heart medications
ABDOMEN
abdominal pain
nausea
vomiting
diarrhea
constipation
hematochezia
hematemesis
hemorrhoids
GI x-rays
GI scopings
rectal bleeding
ulcers
bowel polyps
bowel incontinence
gall bladder disease
gall stones
hepatitis
cirrhosis
hepatomegaly
splenomegaly
GU
renal insufficiency
renal failure
dialysis
kidney stones
kidney disease
kidney cyst
flank pain
hematuria
pyuria
dysuria
chronic cystitis
nocturia
anuria
hesitancy
enuresis
change in urine color
prostatitis
epididymitis
scrotal problems
TURP
pain on intercourse
genital lesions
genital discharge

REVIEW_OF_SYSTEMS_3
OB/GYN
metorrhagia
menorrhagia
irregular menses
problems in pregnancy
use of contraception
breast masses
nipple discharge
breast skin changes
changes in axillary nodes
monthly breast exam
breast feeding children
EXTREMITIES
difficulty with gait
weakness
joint swelling
joint stiffness
muscle pain
muscle swelling
muscle injuries
sagittal plan scoliosis
coronal plane scoliosis
fractured bones
SLE
osteoarthritis
rheumatoid arthritis
fibromyalgia
NEURO
seizures
head injury
LOC
loss of coordination
difficulty in balance
sciatica
difficulty: fine motor skills
difficulty speaking
CVA (stroke)
weakness in arms
weakness in legs
tingling in legs and feet
tingling in arms
PSYCHIATRIC
depression
bipolar disorder
suicide attempts
hospitalization
   for psychiatric problems
personality disorders
ENDOCRINE
goiter
exophthalmos
dry skin
dry hair
intolerance to heat
intolerance to cold
changes in growth
sterility
impotence
decreased libido
LYMPHATIC AND HEMATOLOGICAL
lymphadenopathy
transfusion
anemia


PHYSICAL_EVAL_1
VITALS
BP
Pulse
Temp
Heart rate
GENERAL
mild abdominal pain
moderate abdominal pain
severe abdominal pain
poor nutritional status
SKIN
turgor
jaundice
vesicles/bullae on
   extensors (porphyria)
dependent purpura: emboli,
    mesenteric infarct)
petechia (gonococcemia)
HEENT
oral thrush
gingival lead lines
atherosclerotic retinopathy
"sliver wire" retinal arteries

PHYSICAL_EVAL_2
NECK
flat jugular neck vein
ABDOMEN
scars
stria
contusions
echymosis
visible peristalsis
distention
absent bowel sounds
high pitched rushes
bruits
rebound tenderness
hepatomegaly
splenomegaly
abdominal masses
abdominal hernia
incisional hernia
inguinal hernia
femoral hernia
pulsating mass
costovertebral angle tenderness
bulging flanks
shifting dullness
ascites
fluid wave
spider angiomatta
periumbilical collateral veins
   (Caput Medusae)
Murphy's sign
   (cholecystitis)
McBurney point tenderness
   (point halfway between
   umbilicus & ASIS,
   appendicitis
Iliopsoas sign
   (elevation of legs against
   resistance causes pain,
   appendicitis)
Obturator sign 
   (flexion of R thigh &
   ext rotation of leg
   causes pelvic pain,
   appendicitis)
Rovsing's sign
   (pressure to L colon causes
   referred pain at McBurney's
   point, appendicitis)
Cullen's sign
   (bluish periumbilical 
   discoloration,
   peritoneal hemorrhage)
Grey Turner's sign
   (flank ecchymosis,
   retroperitoneal hemorrhage)
Sister Joseph's nodule
   (umbilical nodule, metastatic CA)
Carnett's sign
   (tenderness disappears
   when abdominal muscles are
   contracted,
   intra-abdominal pain)
Charcot's sign
   (RUQ pain, jaundice, 
   & fever; gallstones)
Courvoisier's sign 
   (palpable, nontender
   gallbladder with jaundice,
   pancreatic/biliary CA)
loss of liver dullness
liver span
spleen span
GU
rectal fissure (Crohn's dz.)
rectal masses, tenderness, fecees
gross blood
occult blood
testicular atrophy
OB/GYN
gynecomastia
EXTREMITIES
femoral pulse
leg and ankle edema




DIFF_DIAGNOSIS
GENERALIZED PAIN
intestinal infarct
peritonitis
intestinal obstruction
diabetic ketoacidosis
sickle crisis
adrenal insufficiency
   from steroid withdrawal
acute porphyria
RUQ PAIN
biliary colic
hepatitis
cholecystitis
cholangitis
gastritis
pancreatitis
hepatomegaly with heart failure
hepatic metastases
gonococcal perihepatitis
   (Fitz-Hugh-Curtis syndrome)
retrocecal appendicitis
pneumonia
pneumothroax
pulmonary embolism
peptic ulcer
GERD
pyelonephritis
EPIGASTRIC PAIN
pancreatitis
gastritis
peptic ulcer
esophagitis
gastroenteritis
perforated viscus
colitis
mesenteric thrombosis
inflammatory bowel dz.
intestinal obstruction
ileus (narcotic ileus)
MI
aortic aneurysm
pericarditis
LUQ PAIN
peptic ulcer
gastritis
esophagitis
GERD
pancreatitis
pericarditis
MI
pneumonia
pneumothroax
pulmonary embolism
splenic enlargement
splenic rupture/infarct
nephrolithiasis
LLQ PAIN
diverticulitis
intestinal obstruction
strangulated hernia
inflammatory bowel dz.
nephrolithiasis
mesenteric lymphadenitis
colitis
irritable bowel syndrome
gastroenteritis
pyelonephritis
mesenteric thrombosis
aortic aneurysm/rupture
volvulus
intussusception
sickle crisis
salpingitis
Mittelschmerz
ovarian cyst
ectopic pregnancy
ketoacidosis
herpes zoster
spinal carcinoma
arthritis
testicular torsion
psychogenic
RLQ PAIN
appendicitis
strangulated hernia
intestinal obstruction
inflammatory bowel dz.
mesenteric lymphadenitis
colitis
irritable bowel syndrome
pyelonephritis
nephrolithiasis
mesenteric thrombosis
orthrombosis
volvulus
intussusception
sickle crisis
salpingitis
Mittelschmerz
ovarian cyst
ectopic pregnancy
ketoacidosis
herpes zoster
spinal carcinoma
arthritis
testicular torsion
psychogenic
HYPOGASTRIC/ PELVIC PAIN
cystitis
distended bladder
diverticulitis
appendicitis
salpingitis
nephrolithiasis
hernia
ovarian cyst or mass
endometriosis
ectopic pregnancy
inflammatory bowel dz.
prostatitis
carcinoma



