#262 Subacute and Chronic Abdominal Pain: Physical Exam Series
Mar 17, 2021
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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.
Assessing the severity of symptoms and overall discomfort is crucial in determining the urgency of evaluation and potential intervention for acute abdominal pain.
A combined approach of physical exam findings and relevant lab results can aid in diagnosing and managing biliary tract disorders.
Deep dives
Differentiating between sick and non-sick patients
When assessing a patient with acute abdominal pain, it is crucial to determine if the patient is sick or non-sick. This can be evaluated based on the severity of symptoms and overall discomfort. Acute right upper quadrant pain may require urgent care, as it could indicate conditions that are likely to worsen in the next day or two and potentially require intervention, such as antimicrobial therapy, imaging, or surgery. On the other hand, subacute or chronic abdominal pain may not require urgent evaluation and can be further assessed over time.
Assessing for biliary tract disease
In cases of right upper quadrant pain, indicating potential biliary tract disease, a physical exam can help guide further evaluation and determine the need for labs and specific imaging. Combining the physical exam findings with relevant lab results, such as bilirubin levels, can aid in diagnosing conditions like acute cholecystitis or gallstones. A right upper quadrant ultrasound is often the next step in evaluation, specifically focusing on the gallbladder, cystic duct, common bile duct, and liver size. This combined approach can help distinguish between different biliary tract disorders and guide appropriate management.
Practice and feedback to improve precision
Mastering the physical exam for assessing abdominal pain requires practice and feedback. Developing the ability to confidently determine if a patient has acute peritonitis or other urgent conditions comes with experience and repetition. Regularly palpating abdomens, assessing for rigidity, guarding, and percussion tenderness, and receiving feedback enable clinicians to make accurate judgments and prompt appropriate actions. Practice helps refine precision, especially in acute care settings where prompt decision-making is crucial.
In this part 2 of 2, learn how the abdominal exam affects our imaging choices, when to call a surgeon, and which classical maneuvers may not be so helpful. You may find it gut-wrenching! In this evidence-based physical exam series, we discuss how to approach abdominal pain with Dr. Andrew Olson (Minnesota), the leader of the DX: Diagnostic Excellence Project. Stay tuned for part 2 with Dr. Olson on subacute and chronic abdominal pain later this week!