Assessing Abdominal Pains

[AnthonyM83]

Now I know there's not strict pattern and set rules for a lot these, but wondering if people wanted to discuss different differential diagnosis they might come upon based on different presentations of abdominal pain.

For example, lately I've gotten a few where pain starts at umbilicus and then moves to right flank. I've also had some that start on one flank and move to umbilicus.

Of course there's some like RUQ suspect cholecystitis, live problems, etc. RLQ appendix.

Then there's stuff on onset of symptoms. Sudden versus gradual. Constant versus on/off or worsening in waves.

And there's other s/s that might go along with them . . N/V, Diarrhea, Weak/Dizzy, Fever, Dec. Urine output, etc...

I'd just like to have more to consider when reassessing my abd pain patients that are BLS'ed. Might as well...don't have much else to do.

[Arizonaffcep]

Now I know there's not strict pattern and set rules for a lot these, but wondering if people wanted to discuss different differential diagnosis they might come upon based on different presentations of abdominal pain.

For example, lately I've gotten a few where pain starts at umbilicus and then moves to right flank. I've also had some that start on one flank and move to umbilicus.

Of course there's some like RUQ suspect cholecystitis, live problems, etc. RLQ appendix.

Then there's stuff on onset of symptoms. Sudden versus gradual. Constant versus on/off or worsening in waves.

And there's other s/s that might go along with them . . N/V, Diarrhea, Weak/Dizzy, Fever, Dec. Urine output, etc...

I'd just like to have more to consider when reassessing my abd pain patients that are BLS'ed. Might as well...don't have much else to do.

The "text book classic" description of appendicitis is pain that starts around the umbilicus, guarded abd, and as the infection gets worse, the pain moves down and to the right, eventually ending up right over the appendix. Of course, if it sudenly feels better, it probably just burst! Hello sepsis!

[fiznat]

A few signs I've picked up and now look for:

Cullen's Sign: Periumbilical discoloration indicative of retroperitoneal hemorrhage (could be AAA or hemorrhagic pancreas etc)

Grey- Turner's Sign: Discoloration at the flank, a sign of retroperitoneal hemorrhage as well)

Murphy's Sign: Provide direct pressure to the RUQ and ask patient to inhale deeply. A positive sign is an abrupt interruption of inspiration due to pain. This pain is usually indicative of an inflamed gallbladder descending and coming in contact with your hand.

McBurney's Sign: Tenderness located 2/3rd the distance from the umbilicus to the anterior iliac spine on R side. Associated with appendicitis.

Kehr's Sign: Severe left shoulder pain. Associated with spenic ruptures and ectopic pregnancies.

Rebound Tenderness: Tenderness on the removal rather than the application of ABD pressure. Associated with peritonitis.

[zzyzx]

Anthony wrote, "For example, lately I've gotten a few where pain starts at umbilicus and then moves to right flank. I've also had some that start on one flank and move to umbilicus."

You'd want to consider AAA or appendicitis, of course, but this sounds like a kidney stone to me. Nausea?

[crotchitymedic1986]

Fiznat gave you some great info, but even with that information, many abdominal pain signs and symptoms are shared by many ailments. I have seen to many critical pancreatitis or ileus patients who were not transported by EMS. The good news is that most of these ailments are not life-threatening, so as long as you have your AAA signs and symptoms down pat, and you do transport all of them, you will probably not get burned by sending them via BLS unit. It is when you choose not to transport them that they will get burned (this assumes you mean EMTI, where the BLS unit can start an IV). But even in the event of a AAA, it may be better to do a rapid BLS transport (with maybe an ALS intercept) versus waiting on the scene for an ALS transport -- there is little that ALS can fix once the AAA ruptures.

[firedoc5]

Anthony wrote, "For example, lately I've gotten a few where pain starts at umbilicus and then moves to right flank. I've also had some that start on one flank and move to umbilicus."

You'd want to consider AAA or appendicitis, of course, but this sounds like a kidney stone to me. Nausea?

Kidney stones or renal choleic was one thing I was going to mention. There's so many organs and "plumbing" in these areas it's hard for EMS to nail down a definite possible diagnosis. URQ, the first thing you think of is liver or gall bladder, ULQ you can guess AAA, cardiac, hernia. LLQ you can think of AAA, Spleen, well you get the picture. In EMS there's no telling of an absolute problem.

The main things you are looking at rebounding, increase in pain upon palpation. N/V upon palpation. Any distention, guarding, discoloration.