Timing (relation to meals)
Exacerbating and alleviating factors
Prior hx of similar symptoms
Alcohol and drug use
Atherosclerotic vascular disease
Abdominal exam (incl. guarding, rebound, Murphy's sign, CVA palpation)
Pelvic exam in women
Peptic ulcer disease
Peptic ulcer perforation
Ascending cholangitis (Charcot's triad)
Suppurative cholangitis (Reynold's pentad)
Acute calculous cholecystitis
Small bowel or colon cancer
Irritable bowel syndrome
Renal cell carcinoma
Pelvic inflammatory disease
Ruptured ectopic pregnancy
Ruptured ovarian cyst
Abdominal aortic aneurysm
Rectal exam, stool for occult blood
Elicits pain on the right side of the abdomen in acute appendicitis, though not very specific
Look for cervical motion tenderness, discharge, uterine size, adnexal masses or tenderness
To look for evidence of hepatocellular injury, biliary obstruction, or pancreatitis
May show gallstones, pericholecystic fluid, thickened gallbladder wall, sonographic Murphy's sign
May identify lesions of: peptic ulcer, gastritis, and/or gastric cancer. Bx is required for gastric cancer dx and sometimes for H.pylori dx.
Can document obstruction of the cystic duct in acute cholecystitis; a positive scan shows absence of filling of the gallbladder. Usually ordered after U/S if it does not establish dx of acute cholecystitis.
H. pylori serologies
Adequate for diagnosis but not to document cure.
Urease breath test
Useful to confirm H. pylori eradication in PUD
Positive in pregnancy
Urine and serum are equally sensistive, but obtaining quantitative levels via serum can help dx ectopic pregnancy
N. gonorrhoeae and C. trachomatic, the main causes of PID are detected via PCR
To rule out UTI
Nonspecific, but leukocytosis can suggest infection or appendicitis
Can help dx appendiceal or ovarian pathology.
Transvaginal u/s can identify an intrauterine gestational sac when the time elapsed since the LMP is 35 days (this corresponds to a beta-hCG of about 1500)
Fluid in the cul-de-sac is nonspecific and may suggest ectopic pregnancy or a ruptured ovarian cyst
Can detect presence of appendiceal inflammation, abscess in appendicitis, or signs of other GI or gynecologic pathology
Can dx ectopic pregnancy (gold standard), ruptured ovarian cyst, ovarian torsion, PID, tubo-ovarian abscess, appendicitis, etc.