The Curbsiders Internal Medicine Podcast #262 Subacute and Chronic Abdominal Pain: Physical Exam Series
Mar 17, 2021
Learn how the abdominal exam affects imaging choices, when to call a surgeon, and which maneuvers may not be helpful. Discuss the challenges in diagnosing abdominal pain and liver disease, including conditions like cirrhosis and acute pancreatitis. Explore the use of scoring systems in diagnosing cirrhosis. Focus on decision-making and factors to consider in the physical exam for acute abdominal pain.
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Exam Limited In Subacute/Chronic Pain
- Physical exam is often unrevealing in subacute or intermittent abdominal pain.
- Use history and pretest probability to decide imaging or watchful waiting.
Diagnose Pancreatitis With Labs/Imaging
- Diagnose pancreatitis with two of: typical pain, elevated lipase, or consistent imaging.
- Use the exam mainly to exclude alternative causes like cholecystitis or obstruction.
Nephrolithiasis Presents Differently
- Kidney stone pain is classically back/flank pain radiating to the groin and makes patients restless.
- CVA/flank tenderness and the 'can't sit still' presentation strongly point toward stones.