7/13/2020 Family Medicine 20: 28-year-old female with abdominal pain - United States University College of Nursing
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FNP590-Introduction to Aquifer Family Medicine 20: 28-year-old female with abdominal pain
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Authors: Joanne Williams-Cooper, MD, MPH, and Martha Seagrave, PA-C; Associate Editor: Tomoko Sairenji, MD, MS
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INTRODUCTION co rc TEACHING
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LAB VALUES
DIAGNOSES FINDINGS NOTES BOOKMARKS
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7/13/2020 Family Medicine 20: 28-year-old female with abdominal pain - United States University College of Nursing
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Dr. Nayar informs you about your next patient.
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You are working in Dr. Nayar's family medicine o ce. He informs you, "The next patient on the schedule is Ms. Amanda Bell. She is a 28-year-old
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female here with a chief concern of abdominal pain of a few weeks' duration. I'm going to have you go take her history and start her physical
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exam. Before you see her, let's take a moment to think about the questions you will want to ask her. How would you approach someone with a
chief concern of abdominal or pelvic pain?"
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TEACHING POINT
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Signi cance of the Location of Abdominal Pain
The location of the abdominal pain is important, as it can help narrow your di erential diagnosis. For example, di use abdominal pain may
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represent gastroenteritis, whereas localized right lower quadrant pain is classic for but not limited to appendicitis. Think about what is in the
various quadrants of the abdomen when considering the di erential diagnosis of abdominal pain.
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Question
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LAB VALUES
DIAGNOSES FINDINGS NOTES BOOKMARKS
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7/13/2020 Family Medicine 20: 28-year-old female with abdominal pain - United States University College of Nursing
Dr. Nayar continues, "You don't want to miss any life-threatening diseases that can cause abdominal pain. Can you tell me four red ags
from the history and physical exam that could suggest a life-threatening condition in a patient with abdominal or pelvic pain?" MENU
The suggested answer is shown below.
Abrupt onset of severe pain
Shock with hypotension and tachycardia Distension
Peritoneal irritation signs
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Rigid abdomen
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Pulsatile abdominal mass
Absent bowel sounds
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Fever
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Vomiting
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Diarrhea
Weight loss
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Menstrual changes
Trauma, prior surgeries, or operative scars History/presence of blood in emesis History/presence of blood in stool
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Letter Count: 409/1000
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SUBMIT
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Answer Comment
TEACHING POINT co rc
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Red Flags of Life-Threatening Condition in Patient with Abdominal/Pelvic Pain
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There are more than many signs and symptoms of a life-threatening condition in a patient with abdominal or pelvic pain. Examples
include:
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Abrupt onset of severe pain
Shock with hypotension and tachycardia
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Distension
Peritoneal irritation signs
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Rigid abdomen
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Pulsatile abdominal mass
LAB VALUES
DIAGNOSESAbsent bowel soundsFINDINGS NOTES BOOKMARKS
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7/13/2020 Family Medicine 20: 28-year-old female with abdominal pain - United States University College of Nursing
Fever
Vomiting MENU
Diarrhea
Weight loss
Menstrual changes
Trauma, prior surgeries, or operative scars
History/presence of blood in emesis
History/presence of blood in stool
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Severity of the pain
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Ecchymoses/bruising
Rebound tenderness
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Mass or ascites
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References
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Cartwright SL, Knudson MP. Evaluation of acute abdominal pain in adults. Am Fam Physician. 2008 Apr 1;77(7):971-978.
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GATHERING OBSTETRICAL HISTORY HISTORY
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Dr. Nayer suggests, "Before you go and meet Ms. Bell, let us take a look at her chart in the electronic medical record (EMR) together."
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Because you are aware of the importance of a patient's surgical history in the evaluation of abdominal pain, you review her chart for prior
surgeries and nd that her only past surgeries were a tonsillectomy and adenoidectomy at age 17.
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You investigate the chart further and nd that Ms. Bell is "G1T1P0A0L1". Her pregnancy was four years ago, and Dr. Nayar had performed the
vaginal delivery of a full term male infant without complications.
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TEACHING POINT
Obstetrical History
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G Gravida or number of pregnancies
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LAB VALUES
DIAGNOSES FINDINGS NOTES BOOKMARKS
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T Number of Term pregnancies
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7/13/2020 Family Medicine 20: 28-year-old female with abdominal pain - United States University College of Nursing
P Number of Preterm infants MENU
A Number of spontaneous or induced Abortions
L Number of Living children
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CONTINUE
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LAB VALUES
DIAGNOSES FINDINGS NOTES BOOKMARKS
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