Beruflich Dokumente
Kultur Dokumente
DEPARTMENT OF HEALTH
REGIONAL OFFICE NO. 1
EVALUATION OF PATIENTS
PRESENTING WITH
ABDOMINAL PAIN
DEPARTMENT OF COMMUNITY
AND FAMILY MEDICINE
CLINICAL CLERKS:
PRABHURAMMURALIM GIRITHARAN
LABTANG, CHERRY FAITH M.
NARAYANASAMY, MADHUMITHA
TERAIYA, KULDIP
ABDOMINAL PAIN
Y
Evaluate HISTORY OF TRAUMA/RECENT SURGERY
Refer to surgery
N
*OB-Gyne history
MALE FEMALE *Consider
gynecologic causes
(-) (+)
1.General
appearance: Fetal *Evaluate
positioning, *Refer to OB-
Diaphoretic, Gyne
Erroneous VS,
2. Focused Physical Severe SEVERITY OF ABDOMINAL PAIN
exam
3. Peritoneal Signs Mild-Moderate
4. Refer accordingly 1. General appearance:
LOCALIZATION Fetal positioning,
Diaphoretic, Erroneous VS
2. R/O Extra abdominal
causes:Cardiac/ Pulmonary
causes: CXR, ECG
3. Co-Morbids
4. Signs of Abdominal Aortic
Aneurysm
5. Refer
HEPATOBILIARY CAUSES
ASSEESS FOR DISTENTION,
TENDERNESS, RECTAL FULL RECTAL
BLEEDING, DRE VAULT
1. MURPHY’S SIGN
2.CHARCOT’S TRIAD NEPHROLITHIASIS
3. REYNOLDS PENTAD
(-) (+) (-)
URINARY OR
(+) 1. UA, KUB UTZ GYNECOLOGIC PROBLEM
2.REFER ACCORDINGLY
HEPATOBILIARY CAUSES
1. WAUTZ CONSTIPATION
2. CT-SCAN DIVERTICULITIS
3. ENDOSCOPY
4.REFER ACCORDINGLY
FEVER WITH PAIN FROM Dx
PERIUMBILICAL AREA TO RLQ 1. UA,
Pregnancy Test
Y N 2. Vaginal
swab, GSCS,
3. Pap smear
Y
PERITONITIS/
APPENDICITIS PSOAS SIGN, REBOUND Refer
TENDERNNESS,
accordingly
GUARDING
(+) (-)
Rovsing sign, Obturator,
Psoas
URINE, COLON,
PELVIC
EXAMINATION
WHOLE ABDOMEN UTZ
CT
EPIGASTRIC HYPOGASTRIC
COLICKY GYNECOLOGIC
REFER TO FEMALE CAUSES
PT
Y N Y
N
REFER TO COLIC IN URINARY SYMPTOMS,
RUQ
(+) COSTOVERTEBRAL
TENDERNESS, FEVER
GASTRIC CAUSES:
A. PUD UTi:
B. GASTRITIS Cystitis/
C. ACID
Pyelonephritis
RELATED
PANCREATITIS
GASTRIC CAUSE
Pain Relief
Surgery
H2R-Antagonist
Antacids
PUD
PPIs
H2R-Antagonist
Antacids
Cytoprotective agents
Acute Pancreatitis
Analgesics
Fluid resuscitation
NSAIDs
Gynecologic Causes
Infections: Antibiotics
Surgery
c. Monitoring
-Advise follow-up usually after 1 week or when there is progressively,
severe pain.
-For patients with infectious cause, advise follow-up after last dose of
prescribed antimicrobial agent.
d. Disposition
-Check for red flags/alarm signs: recognize need for admission or immediate
surgery.
-Send home patients and advise follow-up for those with stable VS, low-risk,
no known comorbidities patients.