Abdominal Pain :: PLAB 2 Symptomatic Differential Stations

• Acute Appendicitis +/- Peritonitis

  • Other presenting symptoms: 

    • Fever, nausea, vomiting

    • RIF pain radiating to the umbilicus

  • Past history and PMAFTOSA: 

    • Menstrual history

  • Social: 

  • Exam and Invs:

    • GPE, vitals

    • Abdominal examination

    • Murphy’s sign

    • Rovsing’s sign

    • PR, PV

    • Routine bloods, Abdominal X-ray

    • Urine pregnancy

    • USG, CT

  • Referral:

    • Surgery admission

  • Treatment: 

    • Antibiotics, painkillers

    • IV fluids, NPO

    • Laparotomy to remove appendix

  • Warning signs:

    • Symptoms getting worse, drowsiness

• Intestinal obstruction

  • Other presenting symptoms: 

    • Nausea, vomiting

    • Upper abdomen pain

    • Constipation, not passing flatus

  • Past history and PMAFTOSA: 

    • Past surgical history

    • Medication history

  • Social: 

  • Exam and Invs:

    • GPE, vitals

    • Abdominal examination

    • Murphy’s sign

    • Rovsing’s sign

    • Abdominal and Chest Xray

    • PR

    • Routine bloods

    • Urine pregnancy

    • USG, CT

  • Referral:

    • Surgery admission

  • Treatment: 

    • Antibiotics, painkillers

    • IV Morphine, IV Metoclopramide 

    • IV fluids, NPO

    • NG tube

  • Warning signs:

    • Symptoms getting worse, drowsiness

• Acute/Acute on Chronic Pancreatitis

  • Other presenting symptoms: 

    • Nausea, vomiting

    • Upper abdomen pain long history

    • Pain relieves by leaning forward

    • Pain radiates to the back

  • Past history and PMAFTOSA: 

    • Alcohol history

    • Life effect history

  • Social: 

  • Exam and Invs:

    • GPE, vitals

    • Abdominal examination

    • Murphy’s sign

    • Rovsing’s sign

    • Abdominal and Chest Xray

    • PR

    • Routine bloods, lipase, amylase

    • Urine pregnancy

    • USG, CT

  • Referral:

    • Surgery admission

  • Treatment: 

    • Antibiotics, painkillers

    • IV Morphine, IV Metoclopramide 

    • IV fluids, NPO

    • NG tube

  • Warning signs:

    • Symptoms getting worse, drowsiness

    • Might require ICU admission

• Ectopic pregnancy

  • Other presenting symptoms: 

    • Nausea, vomiting

    • RIF pain

    • Pregnant

    • History if IUCD/STI

  • Past history and PMAFTOSA: 

    • Menstrual history

    • Sexual history

    • P questions

  • Social: 

  • Exam and Invs:

    • GPE, vitals

    • Abdominal examination

    • Murphy’s sign

    • Rovsing’s sign

    • Abdominal and Chest Xray

    • PR

    • Routine bloods

    • Urine pregnancy

    • USG, CT

  • Referral:

    • OG immediate referral 

    • Send in ambulance

  • Treatment: 

    • IV Painkillers, IV Metoclopramide 

    • IV fluids, NPO

    • laparoscopy

  • Warning signs:

    • Symptoms getting worse, drowsiness

• Acute Cholecystitis/Cholangitis

  • Other presenting symptoms: 

    • Nausea, vomiting

    • Upper abdomen pain

    • Colicky, coming in waves

    • Radiates to the right shoulder

    • Fever, Jaundice

  • Past history and PMAFTOSA: 

    • Alcohol history

    • Medication history

  • Social: 

  • Exam and Invs:

    • GPE, vitals

    • Abdominal examination

    • Murphy’s sign

    • Rovsing’s sign

    • Abdominal and Chest Xray

    • PR

    • Routine bloods, amylase, lipase

    • Urine pregnancy

    • USG/CT

  • Referral:

    • Surgery admission

  • Treatment: 

    • Antibiotics, painkillers

    • IV Morphine, IV Metoclopramide 

    • IV fluids, NPO

    • NG tube

    • Cholecystectomy after the inflammation has settled down

  • Warning signs:

    • Symptoms getting worse, drowsiness, bleeding anywhere

• Chronic PID

  • Other presenting symptoms: 

    • Lower abdomen pain

    • Intermittent crampy, long history

    • Foul-smelling vaginal discharge

    • Fever

  • Past history and PMAFTOSA: 

    • Past surgical history

    • Sexual history

    • Menstrual history

  • Social: 

    • Mood, life effects, relationships

    • Plans to have kids

  • Exam and Invs:

    • GPE, vitals

    • Abdominal examination

    • PV

    • Routine bloods

    • Urine pregnancy

    • Vaginal swab

  • Referral:

    • GUM clinic

  • Treatment 

    • Antibiotics

    • Avoid sex till treatment complete

    • Safe sex

    • Partner notification program

    • Talk about possible complications:

      • Infertility

      • Dyspareunia, Dysmenorrhea

  • Warning signs:

    • Symptoms getting worse, high fever

• Biliary Colic

  • Other presenting symptoms: 

    • Nausea, vomiting

    • Upper abdomen pain

    • Colicky, coming in waves

    • No fever, No jaundice

  • Past history and PMAFTOSA: 

    • Alcohol history

    • Medication history

  • Social: 

    • Life effects

  • Exam and Invs:

    • GPE, vitals

    • Abdominal examination

    • Murphy’s sign

    • Rovsing’s sign

    • Abdominal and Chest Xray

    • PR

    • Routine bloods, amylase, lipase

    • Urine pregnancy

    • USG/CT

  • Referral:

    • Surgery referral

  • Treatment: 

    • painkillers

    • Cholecystectomy after the inflammation has settled down

  • Warning signs:

    • Symptoms getting worse, drowsiness, bleeding anywhere