Hx
Location
Quality
Intensity
Duration
Radiation
Timing (relation to meals)
Associated sx
Constitutional
GI
Cardiac
Pulmonary
Renal
Pelvic
Other
Exacerbating and alleviating factors
Prior hx of similar symptoms
Medications
Alcohol and drug use
Domestic violence
PMHx
Abdominal surgeries
Gallstones
Renal stones
Atherosclerotic vascular disease
PE
Vital signs
CV exams
Abdominal exam (incl. guarding, rebound, Murphy's sign, CVA palpation)
Rectal exam
Pelvic exam in women
Ddx
Gastrointestinal
GERD
Mallory-Weiss tear
Food poisoning
Gastroenteritis
Gastritis
Gastric cancer
Functional/nonulcer dyspepsia/indigestion
Peptic ulcer disease
Peptic ulcer perforation
Acute hepatitis
Alcoholic hepatitis
Sclerosing cholangitis
Biliary disease
Cholelithiasis
Ascending cholangitis (Charcot's triad)
Suppurative cholangitis (Reynold's pentad)
Acute cholecystitis
Acute calculous cholecystitis
Emphysematous cholecystitis
Acute pancreatitis
Chronic pancreatitis
Pancreatic cancer
Ileus
Intestinal obstruction
Volvulus
Appendicitis
Diverticulitis
Crohn's disease
Ulcerative colitis
Small bowel or colon cancer
Irritable bowel syndrome
Renal
Renal cell carcinoma
Nephrolithiasis
Pyelonephritis
Gynecologic
Abortion
Septic abortion
Ectopic pregnancy
Endometriosis
Pelvic inflammatory disease
Ovarian torsion
Ruptured ectopic pregnancy
Ruptured ovarian cyst
Fitz-Hugh-Curtis syndrome
Vascular
Abdominal aortic aneurysm
Mesenteric ischemia
Splenic rupture
Other
Intraabdominal abscess
Hernia
Workup (general)
Rectal exam, stool for occult blood
Elicits pain on the right side of the abdomen in acute appendicitis, though not very specific
Pelvic exam
Look for cervical motion tenderness, discharge, uterine size, adnexal masses or tenderness
AST/ALT/bilirubin/ALP, lipase
To look for evidence of hepatocellular injury, biliary obstruction, or pancreatitis
U/S-abdomen
May show gallstones, pericholecystic fluid, thickened gallbladder wall, sonographic Murphy's sign
Upper endoscopy
May identify lesions of: peptic ulcer, gastritis, and/or gastric cancer. Bx is required for gastric cancer dx and sometimes for H.pylori dx.
HIDA scan
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
Urine hCG
Positive in pregnancy
Urine and serum are equally sensistive, but obtaining quantitative levels via serum can help dx ectopic pregnancy
Cervical cx
N. gonorrhoeae and C. trachomatic, the main causes of PID are detected via PCR
UA
To rule out UTI
CBC
Nonspecific, but leukocytosis can suggest infection or appendicitis
US-abdomen/pelvis
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
CT-abdomen/pelvis
Can detect presence of appendiceal inflammation, abscess in appendicitis, or signs of other GI or gynecologic pathology
Laparoscopy
Can dx ectopic pregnancy (gold standard), ruptured ovarian cyst, ovarian torsion, PID, tubo-ovarian abscess, appendicitis, etc.
