Make a comprehensive list of relevant information to gather when assessing abdominal pain.
How do you assess for masses in the abdomen and how you would document such findings?
Describe your findings on a previous patient that you have encountered where you have palpated a mass in the abdomen.
Musculoskeletal
Define, Compare, and Contrast the following conditions:
Osteoarthritis
Rheumatoid Arthritis
Comprehensive list of relevant information to gather when assessing abdominal pain.
Full Answer Section
- Family history: Any family history of abdominal disorders?
- Medications: Are there any medications that might be causing or exacerbating the pain?
- Allergies: Are there any known allergies to medications or other substances?
Physical Examination:
- Vital signs: Temperature, blood pressure, heart rate, respiratory rate, and oxygen saturation.
- General appearance: Assess for signs of distress, dehydration, or jaundice.
- Abdominal examination:
- Inspection: Look for distention, masses, or visible peristalsis.
- Auscultation: Listen for bowel sounds (hyperactive, hypoactive, or absent).
- Percussion: Assess for tenderness, guarding, or rebound tenderness.
- Palpation: Gently examine the abdomen for masses, tenderness, or organ enlargement.
Additional Considerations:
- Risk factors: Consider any risk factors for abdominal pain, such as age, gender, lifestyle, and medical history.
- Differential diagnosis: Consider possible causes of abdominal pain, such as appendicitis, cholecystitis, pancreatitis, diverticulitis, or intestinal obstruction.
- Diagnostic testing: Order appropriate diagnostic tests, such as blood tests, imaging studies (X-rays, CT scan, MRI), or endoscopy, to confirm the diagnosis.
Assessing for Masses in the Abdomen
Palpation:
- Systematic approach: Palpate the abdomen in a clockwise or counterclockwise pattern, starting in the right lower quadrant.
- Gentle pressure: Apply gentle pressure with your fingertips to detect any masses or enlargements.
- Location: Note the location of any masses, including their size, shape, and consistency (e.g., hard, soft, tender).
- Mobility: Assess whether the mass is fixed or mobile.
- Tenderness: Determine if the mass is tender to palpation.
Documentation:
- Location: Specify the quadrant or region where the mass is located.
- Size: Estimate the size of the mass in centimeters.
- Shape: Describe the shape of the mass (e.g., round, oval, irregular).
- Consistency: Indicate whether the mass is hard, soft, or fluid-filled.
- Tenderness: Note if the mass is tender to palpation.
- Mobility: Describe whether the mass is fixed or mobile.
- Associated symptoms: Document any associated symptoms, such as pain, nausea, or vomiting.
Example of Palpating a Mass in the Abdomen
- Patient: A 55-year-old woman with a history of hypertension and obesity.
- Finding: On palpation of the right upper quadrant, a firm, nontender mass was felt approximately 10 cm in diameter. The mass was not mobile and was associated with mild right upper quadrant discomfort.
Musculoskeletal Conditions
Osteoarthritis:
- Definition: A degenerative joint disease characterized by the breakdown of cartilage, leading to joint pain, stiffness, and decreased range of motion.
- Comparison: Typically affects weight-bearing joints (e.g., knees, hips, spine).
- Contrast: Usually progresses slowly and is not associated with systemic symptoms like fever or fatigue.
Rheumatoid Arthritis:
- Definition: A systemic autoimmune disease characterized by inflammation of the synovium, leading to joint pain, swelling, and stiffness.
- Comparison: Can affect any joint in the body, but often begins in the hands and feet.
- Contrast: Often associated with systemic symptoms like fatigue, fever, weight loss, and anemia.
Sample Answer
History of Present Illness:
- Location: Where is the pain located? Does it radiate?
- Quality: Is the pain sharp, dull, cramping, or stabbing?
- Severity: How intense is the pain on a scale of 1-10?
- Timing: When did the pain start? Is it constant or intermittent?
- Aggravating factors: What makes the pain worse?
- Relieving factors: What makes the pain better?
- Associated symptoms: Are there any other symptoms, such as nausea, vomiting, diarrhea, constipation, fever, or weight loss?
- Past medical history: Any history of abdominal surgery, inflammatory bowel disease, or other abdominal conditions?