Abdominal Pain History:
- Position/palliating and provoking factors
- Quality (sharp, dull, sore, burning, cramping)
- Region, radiation, referral
- Ask patient to use one finger to confirm location
- Referred pain: Kehr’s sign (diaphragmatic irritation can cause shoulder pain), Ipsilatral scapula (biliary disease)
- Temporal factors (time/mode of onset, progression, previous episodes)
- Remember to ask about recent surgeries or procedures, new medications, social history (tobacco use in AAA, ob/gyn history)
- Palpation strategies/questions: Work from least to most painful areas, do not be afraid to push, care the complaints out of proportion to exam, when did they get pain meds?
- Peritonitis: Perforation, malignancy, mesenteric ischemia, strangulated hernia
- Evaluation Techniques: Cough test, Inspiration test, peritoneal irritation (tapping heel, bumping bed)
- Specific Maneuvers:
- Murphy’s Sign- Inspiratory arrest during pressure to RUQ while patient taking a deep breath.
- Psoas Sign- pain with passive hip extension
- Obturator Sign- pain with passive internal/external rotation of right hip
- Rovsing Sign- pain in RLQ when there is pressure exerted in LLQ