I. A 65- YEAR OLD MALE PRESENTS WITH GENERALIZE ABDOMINAL PAIN OF GRADUAL ONSET.
II. Immediate question:
A. ABCs/ Patients Stabilization
* - Is the air way intact?- manage appropriately.
* - What are the Vital sign?
- Does the patient looks acutely ill or toxic? Quick assessment of mental status. Is the patient OBTUNDED? Asses peripheral pulse. Initiate IV and administer fluid bolus if appropriate : CARDIAC MONITOR, PULSE OXIMETER, , SUPPLEMENTAL OXYGEN.
B. What was the timing of onset of symptoms?
- Sudden vs. Gradual, preceded bu anorexia,N/V, CONSTIPATION , diarrhea, fever waxing AND WANNING,OR STEADY.
C. WHERE DOES IT HURT? - Generalized pain, Peritonitis,ischemic bowel,Epi-gastric: Gastritis,duodenal/ gastric ulcer, pancreatitis,aortic pathology , early appendicitis, inferior MI, liver or biliary tract disease. RUQ- liver, or Biliary tract disease, inferior pneumonia or MI, occasionally renal. LUQ- SPLEEN ( SPECIALY IF TRAUMA) , sometimes RENAL,.. LLQ- Diverticular disease , colitis, gynecologic,or genitourinary. RLQ- Appendicitis or gynecologic source.Radiation from BACK/FLANK: RENAL SOURCE. Radiation from abdomen to back: PANCREATITIS /AORTIC ANEURYSM.
D. ARE THERE GENITOURINARY COMPLAINTS?
- Dysuria , Hematuria, Back pain, Penile discharge/ bleeding. sexual history,.
D. WHAT IS THE QUALITY OF THE PAIN?
- Burning/ Epigastric, consider gastritis or peptic ulcer, penetrating or boring, consider pancreatitis,. pain out of proportion to physical findingss, consider ischemic bowel. patient cant find comfortable position or withing on gourney,think colic,. patient avoiding movement, consider peritoneal irritation.
F. ARE THERE ARE GI COMPLAINTS?
- N/V, diarrhea, hematochezia, hamatemesis, prior history of same symptoms, any relation to food.
G. RESPIRATORY COMPLAINTS?
- COUGH, SOB, pleuritic pain.
H. ANY HISTORY OF TRAUMA OR PRIOR SURGERY?
I. OTHER PAST MEDICAL HISTORY? Ex. AAA, BOWEL OBSTRUCTION, CAD, DIABETES, INFLAMATORY BOWEL DISEASE etc.....
J. ADDITIONAL SOCIAL HISTORY.
- Foreign travel, recent questionable food sources, diet history,drug abnuse, possibility of accidental food poison / medicine ingestion.
III. DIFFERENTIAL DIAGNOSIS
A. GENDER / AGE- NEUTRAL
1. Appendicitis- pain preceded by nausea, anorexia, fever , pain open vague initially, then localized to RLQ.
2. BILIARY TRACT DISORDER - Cholelithiasis / cholecystitis , hepatitis,
3. PEPTIC ULCER- Think Viscus perforation or hemorrhage if completely ill.
4. GASTRITIS- Food or medication related: VIRAL
5. PANCREATITIS- ETOH/ Diabetes history: rule out gallstone.
6. BOWEL OBSTRUCTIONS- Distinguish from ILEUS.
7. GENITOURINARY OR RENAL DISORDER -calculi, pyelonephritis, infection of the urethra, bladder and reproductive organs.
8. THORACIC DISEASES- Inferior pneumonias pulmonary embolism, atypial cardiac angina/MI.
9. DIVERTICULITIS - Severe, cramping, LLQ, pain associated with bloody diarrhea.
10. INFLAMMATORY BOWEL DISEASE- Crohn`s disease , ulcerative colitis,( cramping episodic, recurrent pain associated with diarrhea, sometimes bloody).
11. SICKLE CELL CRISIS.
12. DIABETIC KETOACIDOSIS -
13. IRRITABLE BOWEL SYNDROME - Strictly a diagnosis of exclusion. symptoms often only briefly present : a variety of symptoms, often crampy, pain with intermittent diarrhea, and constipation.
14. MESENTERIC ADENITIS , GASTROENTERITIS, CONSTIPATION. DIAGNOSES OF EXCLUSION.....
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