You are seeing Mrs. Park, a 62 year old female, in the ER for recurring abdominal pain that has recently worsened. She would like to know what’s been causing this pain and comes to you for investigations. Please take a focused history and perform a focused physical examination.
History
- Onset and duration of pain
- Location of pain (right upper quadrant)
- Alleviating and aggravating factors
- Quality of pain
- Radiation of pain
- Frequency of pain
- Association of pain with specific food (worse with greasy/fatty foods)
- Associated nausea/vomiting and fever
- Change in appearance of stools (pale)
- Presence of blood in stools
- Change in bowel habit
- Recent weight loss
- Change in urine color (tea colored)
- Decreased appetite
- Previous abdominal surgery
- Past history of similar symptoms
- Personal history of gastrointestinal disease
- Alcohol history
- Effect on daily activities
Physical Examination
Inspection
- Inspects abdomen for masses, scars
- Comments on presence of scleral icterus
- Comments on absence of extra-hepatic stigmata of liver disease
- Percussion/Palpation/Auscultation
- Percusses abdomen and estimates liver span by percussion
- Palpates for tenderness (patient has tenderness in right upper quadrant)
- Monitors patient’s reaction to palpation, commenting on guarding
- Assesses for rebound tenderness
- Palpates for splenomegaly
- States that they would perform a digital rectal examination as part of the abdominal examination
- Assesses for Murphy’s Sign (positive)
- Auscultates in all four quadrants of the abdomen
You are seeing Mrs. Park, a 62 year old female, in the ER for recurring abdominal pain that has recently worsened. She would like to know what’s been causing this pain and comes to you for investigations. Please take a focused history and perform a focused physical examination.
History
- Onset and duration of pain
- Location of pain (right upper quadrant)
- Alleviating and aggravating factors
- Quality of pain
- Radiation of pain
- Frequency of pain
- Association of pain with specific food (worse with greasy/fatty foods)
- Associated nausea/vomiting and fever
- Change in appearance of stools (pale)
- Presence of blood in stools
- Change in bowel habit
- Recent weight loss
- Change in urine color (tea colored)
- Decreased appetite
- Previous abdominal surgery
- Past history of similar symptoms
- Personal history of gastrointestinal disease
- Alcohol history
- Effect on daily activities
Physical Examination
Inspection
- Inspects abdomen for masses, scars
- Comments on presence of scleral icterus
- Comments on absence of extra-hepatic stigmata of liver disease
- Percussion/Palpation/Auscultation
- Percusses abdomen and estimates liver span by percussion
- Palpates for tenderness (patient has tenderness in right upper quadrant)
- Monitors patient’s reaction to palpation, commenting on guarding
- Assesses for rebound tenderness
- Palpates for splenomegaly
- States that they would perform a digital rectal examination as part of the abdominal examination
- Assesses for Murphy’s Sign (positive)
- Auscultates in all four quadrants of the abdomen
Case 4 – Recurrent Abdominal Pain