Symptom Finder - Abdominal Pain
Abdominal Pain
The purpose here is not to enter into a thorough discussion of inspection, palpation, percussion, and auscultation of the abdomen but to emphasize portions of a good examination that are often overlooked. No matter what portion of the abdomen is involved in the complaint, the
physician must look for rebound tenderness. If present, it is a clear indication of peritonitis or a ruptured viscus. One applies pressure to the
abdomen where the pain is located and then suddenly releases it. If the patient winces, there is rebound tenderness and a serious abdominal condition. Guarding and rigidity usually indicate the same thing.
It is necessary to listen for bowel sounds for at least 3 minutes. If they are absent, there may be peritonitis or paralytic ileus. If they are
hyperactive and high-pitched, there may be a bowel obstruction. In male patients, look for retraction of the testicles. If the right testicle is retracted, there is a possibility of a ruptured appendix. When both testicles are retracted, peritonitis from a perforated peptic ulcer or pancreatitis is likely.
One should look for Murphy sign. Place your thumb under the right subcostal margin and have the patient take a deep breath. If the patient
winces, the sign is present. Do not forget to check for inguinal and femoral hernias as well as umbilical and incisional hernias. A rectal and pelvic
examination must be done in any case of abdominal pain. They are essential in diagnosing a pelvic appendix, ruptured ectopic pregnancy,
pelvic inflammatory disease (PID), and endometriosis. The finding of occult blood in the stool may point to intussusception or mesenteric
infarct, as well as peptic ulcer disease and neoplasm.
If appendicitis is suspected, it is essential to look for a Rovsing sign. Applying pressure in the left lower quadrant causes pain in the right lower
quadrant. Do not forget to look for psoas sign.
The purpose here is not to enter into a thorough discussion of inspection, palpation, percussion, and auscultation of the abdomen but to emphasize portions of a good examination that are often overlooked. No matter what portion of the abdomen is involved in the complaint, the
physician must look for rebound tenderness. If present, it is a clear indication of peritonitis or a ruptured viscus. One applies pressure to the
abdomen where the pain is located and then suddenly releases it. If the patient winces, there is rebound tenderness and a serious abdominal condition. Guarding and rigidity usually indicate the same thing.
It is necessary to listen for bowel sounds for at least 3 minutes. If they are absent, there may be peritonitis or paralytic ileus. If they are
hyperactive and high-pitched, there may be a bowel obstruction. In male patients, look for retraction of the testicles. If the right testicle is retracted, there is a possibility of a ruptured appendix. When both testicles are retracted, peritonitis from a perforated peptic ulcer or pancreatitis is likely.
One should look for Murphy sign. Place your thumb under the right subcostal margin and have the patient take a deep breath. If the patient
winces, the sign is present. Do not forget to check for inguinal and femoral hernias as well as umbilical and incisional hernias. A rectal and pelvic
examination must be done in any case of abdominal pain. They are essential in diagnosing a pelvic appendix, ruptured ectopic pregnancy,
pelvic inflammatory disease (PID), and endometriosis. The finding of occult blood in the stool may point to intussusception or mesenteric
infarct, as well as peptic ulcer disease and neoplasm.
If appendicitis is suspected, it is essential to look for a Rovsing sign. Applying pressure in the left lower quadrant causes pain in the right lower
quadrant. Do not forget to look for psoas sign.
