Approach to Abdominal Pain

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)
  • Severity
  • 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)

Physical Exam:

  • 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