Clerkship

EMPHASIS WILL BE PLACED ON:

• Characterization of pain (location, severity, character, pattern)
• Temporal sequence (onset, frequency, duration, progression)
• Alleviating and exacerbating factors (position, food, activity, medications)
• Associated signs and symptoms (nausea vomiting, fever, chills, anorexia, wt. loss, cough, dysphagia, dysuria/frequency, altered bowel function diarrhea, constipation, obstipation, hematochezia, melena, etc.)
• Pertinent medical history: prior surgery or illness, associated conditions (pregnancy, menstrual cycle, diabetes, atrial fibrillation or cardiovascular disease, immunosuppression). Medications: anticoagulation, steroids etc.

DEMONSTRATE THE COMPONENTS OF A COMPLETE ABDOMINAL EXAMINATION INCLUDING RECTAL, GENITAL AND PELVIC EXAMINATIONS.

1. Relate the significance of the various component examinations: observation, auscultation, percussion, palpation as they apply to common abdominal pathologic processes. Examples: distention, visible peristalsis, high pitched or absent bowel sounds, tympany, mass, localized vs. generalized guarding and/or rebound tenderness.
2. Demonstrate and relate the significance of various maneuvers utilized in evaluating acute abdominal pain. Examples: iliopsoas sign, Rovsing's sign, obturator sign, Murphy's sign, cough tenderness, heel tap, cervical motion tenderness.
3. Develop a differential diagnosis for various patients presenting with acute abdominal pain. Differentiate based on:
   • Location: RUQ, epigastric, LUQ, RLQ, LLQ
   • Symptom complex: (examples:periumbilical pain localizing to RLQ, acute onset left flank pain with radiation to the testicle etc)

EXPLAIN THE RATIONALE FOR UTILIZING VARIOUS DIAGNOSTIC MODALITIES IN THE EVALUATION OF ABDOMINAL PAIN.

• Laboratory: CBC, amylase, electrolytes, BUN, creatinine, glucose, urinalysis, beta-HCG, liver profile.
• Diagnostic imaging: Flat and upright abdominal radiographs, upright chest X-ray, ultrasound, CT scan abdomen and pelvis, GI contrast radiography, angiography.
• Special diagnostic/Interventional techniques: upper endoscopy, procto-sigmoidoscopy, colonoscopy, laparoscopy.