Abdominal Pain HISTORY_LIST duration of pain progression of pain location of pain at onset location of pain at present diffuse or localized pain character of pain at onset character of pain at present radiation of pain to last bowel movement pain affected by: eating, vomiting, defecation, passing of gas, urination, inspiration, movement, position, belching fever chills nausea vomiting characteristics: bilious feculent food blood coffee grounds vomiting pre/post pain onset chest pain vaginal discharge penile discharge constipation change in bowel habit change in stool caliber inability to pass gas diarrhea hematochezia melena anorexia weight loss dysphagia painful swallowing jaundice fatty food intolerance INFECTIOUS DISEASES hepatitis CHRONIC DISEASE SYSTEMIC DISORDERS hernia gallstones coronary disease kidney stones ascites dyspepsia SURGERY PREVIOUS HOSPITALIZATIONS appendectomy cholecystectomy aortic graft PREVIOUS TESTS endoscopy abdominal x-rays TRAUMA OR INJURIES abdominal trauma SOCIAL HISTORY smoking excessive alcohol intake caffeine illicit drugs - cocaine ALLERGY medications foods seasonal FAMILY HISTORY gallstones coronary disease kidney stones MEDS_LAB_TESTS **** MEDS aspirin NSAIDS opiate narcotics anticholinergics tricyclics antipsychotics laxatives antacids **** LAB Electrolytes BUN creatnine CBC LFT amylase lipase UA **** PROC CXR X-ray of abdomen (acute abdominal series) CT of abdomen MRI of abdomen REVIEW_OF_SYSTEMS_1 GENERAL weight changes appetite changes anorexia difficulty sleeping fever chills polyphagia hypophagia changes in thirst sleeping habit change bowel habit change fatigue hypertension previous physical exams SKIN pigmentation changes texture changes lesions eruptions pruritis easy bruising easy bleeding unusual hair loss changes in hair distribution skin masses finger/toe nail change rashes hives striae skin atrophy uremic frost hirsutism plethora neurofibromatosis lesion HEENT head trauma skull fractures head masses hearing loss vertigo chronic ear infection ear discharge ear pain hearing aid use loss of vision recent change in vision photophobia diplopia (double vision) glaucoma exudates dry eyes eye pain cataracts eye surgery itchy eyes excessive tearing corrective lenses nose bleeds chronic sinusitis nasal fractures nasal drainage polyps changes in sense of smell edentulous (without teeth) partial plate full plate recent dental work oral lesions tonsillitis strep throat tongue problems voice changes chronic hoarseness chronic halitosis NECK neck masses enlarged thyroid gland brachial cleft cysts neck injury REVIEW_OF_SYSTEMS_2 CHEST chronic coughing sputum production hemoptysis wheezing pneumonia bronchitis TB TB exposure SOB (altered by position?) edema chest pains pacemaker HEART MI coronary artery disease heart murmur heart valve disease left ventricular hypertrophy mistral valve stenosis pericarditis palpitations DOE paroxysmal nocturnal dyspnea orthopnea edema hypertension rheumatic fever cardiomyopathy ectopic heart beats arrhythmia exercise intolerance claudication heart medications ABDOMEN abdominal pain nausea vomiting diarrhea constipation hematochezia hematemesis hemorrhoids GI x-rays GI scopings rectal bleeding ulcers bowel polyps bowel incontinence gall bladder disease gall stones hepatitis cirrhosis hepatomegaly splenomegaly GU renal insufficiency renal failure dialysis kidney stones kidney disease kidney cyst flank pain hematuria pyuria dysuria chronic cystitis nocturia anuria hesitancy enuresis change in urine color prostatitis epididymitis scrotal problems TURP pain on intercourse genital lesions genital discharge REVIEW_OF_SYSTEMS_3 OB/GYN metorrhagia menorrhagia irregular menses problems in pregnancy use of contraception breast masses nipple discharge breast skin changes changes in axillary nodes monthly breast exam breast feeding children EXTREMITIES difficulty with gait weakness joint swelling joint stiffness muscle pain muscle swelling muscle injuries sagittal plan scoliosis coronal plane scoliosis fractured bones SLE osteoarthritis rheumatoid arthritis fibromyalgia NEURO seizures head injury LOC loss of coordination difficulty in balance sciatica difficulty: fine motor skills difficulty speaking CVA (stroke) weakness in arms weakness in legs tingling in legs and feet tingling in arms PSYCHIATRIC depression bipolar disorder suicide attempts hospitalization for psychiatric problems personality disorders ENDOCRINE goiter exophthalmos dry skin dry hair intolerance to heat intolerance to cold changes in growth sterility impotence decreased libido LYMPHATIC AND HEMATOLOGICAL lymphadenopathy transfusion anemia PHYSICAL_EVAL_1 VITALS BP Pulse Temp Heart rate GENERAL mild abdominal pain moderate abdominal pain severe abdominal pain poor nutritional status SKIN turgor jaundice vesicles/bullae on extensors (porphyria) dependent purpura: emboli, mesenteric infarct) petechia (gonococcemia) HEENT oral thrush gingival lead lines atherosclerotic retinopathy "sliver wire" retinal arteries PHYSICAL_EVAL_2 NECK flat jugular neck vein ABDOMEN scars stria contusions echymosis visible peristalsis distention absent bowel sounds high pitched rushes bruits rebound tenderness hepatomegaly splenomegaly abdominal masses abdominal hernia incisional hernia inguinal hernia femoral hernia pulsating mass costovertebral angle tenderness bulging flanks shifting dullness ascites fluid wave spider angiomatta periumbilical collateral veins (Caput Medusae) Murphy's sign (cholecystitis) McBurney point tenderness (point halfway between umbilicus & ASIS, appendicitis Iliopsoas sign (elevation of legs against resistance causes pain, appendicitis) Obturator sign (flexion of R thigh & ext rotation of leg causes pelvic pain, appendicitis) Rovsing's sign (pressure to L colon causes referred pain at McBurney's point, appendicitis) Cullen's sign (bluish periumbilical discoloration, peritoneal hemorrhage) Grey Turner's sign (flank ecchymosis, retroperitoneal hemorrhage) Sister Joseph's nodule (umbilical nodule, metastatic CA) Carnett's sign (tenderness disappears when abdominal muscles are contracted, intra-abdominal pain) Charcot's sign (RUQ pain, jaundice, & fever; gallstones) Courvoisier's sign (palpable, nontender gallbladder with jaundice, pancreatic/biliary CA) loss of liver dullness liver span spleen span GU rectal fissure (Crohn's dz.) rectal masses, tenderness, fecees gross blood occult blood testicular atrophy OB/GYN gynecomastia EXTREMITIES femoral pulse leg and ankle edema DIFF_DIAGNOSIS GENERALIZED PAIN intestinal infarct peritonitis intestinal obstruction diabetic ketoacidosis sickle crisis adrenal insufficiency from steroid withdrawal acute porphyria RUQ PAIN biliary colic hepatitis cholecystitis cholangitis gastritis pancreatitis hepatomegaly with heart failure hepatic metastases gonococcal perihepatitis (Fitz-Hugh-Curtis syndrome) retrocecal appendicitis pneumonia pneumothroax pulmonary embolism peptic ulcer GERD pyelonephritis EPIGASTRIC PAIN pancreatitis gastritis peptic ulcer esophagitis gastroenteritis perforated viscus colitis mesenteric thrombosis inflammatory bowel dz. intestinal obstruction ileus (narcotic ileus) MI aortic aneurysm pericarditis LUQ PAIN peptic ulcer gastritis esophagitis GERD pancreatitis pericarditis MI pneumonia pneumothroax pulmonary embolism splenic enlargement splenic rupture/infarct nephrolithiasis LLQ PAIN diverticulitis intestinal obstruction strangulated hernia inflammatory bowel dz. nephrolithiasis mesenteric lymphadenitis colitis irritable bowel syndrome gastroenteritis pyelonephritis mesenteric thrombosis aortic aneurysm/rupture volvulus intussusception sickle crisis salpingitis Mittelschmerz ovarian cyst ectopic pregnancy ketoacidosis herpes zoster spinal carcinoma arthritis testicular torsion psychogenic RLQ PAIN appendicitis strangulated hernia intestinal obstruction inflammatory bowel dz. mesenteric lymphadenitis colitis irritable bowel syndrome pyelonephritis nephrolithiasis mesenteric thrombosis orthrombosis volvulus intussusception sickle crisis salpingitis Mittelschmerz ovarian cyst ectopic pregnancy ketoacidosis herpes zoster spinal carcinoma arthritis testicular torsion psychogenic HYPOGASTRIC/ PELVIC PAIN cystitis distended bladder diverticulitis appendicitis salpingitis nephrolithiasis hernia ovarian cyst or mass endometriosis ectopic pregnancy inflammatory bowel dz. prostatitis carcinoma