Abdominal Pain
Objectives
| Key Feature | Skill | Phase |
|---|---|---|
| 1. Given a patient with abdominal pain, paying particular attention to its location and chronicity: | ||
| a) Distinguish between acute and chronic pain. | Clinical Reasoning | History |
| b) Generate a complete differential diagnosis (ddx). | Clinical Reasoning | Hypothesis generation, Diagnosis |
| c) Investigate in an appropriate and timely fashion. | Clinical Reasoning | Selectivity Investigation |
| 2. In a patient with diagnosed abdominal pain (e.g., gastroesophageal reflux disease, peptic ulcer disease, ulcerative colitis, Crohn's disease), manage specific pathology appropriately (e.g., with medication, lifestyle modifications). | ||
| a) Manage appropriately | Clinical Reasoning | Treatment |
| 3. In a woman with abdominal pain: | ||
| a) Always rule out pregnancy if she is of reproductive age. | Clinical Reasoning | Hypothesis generation, Investigation |
| b) Suspect gynecologic etiology for abdominal pain. | Clinical Reasoning | Hypothesis generation |
| c) Do a pelvic examination, if appropriate. | Clinical Reasoning | Physical Diagnosis |
| 4. In a patient with acute abdominal pain, differentiate between a surgical and a non-surgical abdomen. | ||
| a) Differentiate appropriately | Clinical Reasoning Selectivity | Physical Diagnosis |
| 5. In specific patient groups (e.g., children, pregnant women, the elderly), include group-specific surgical causes of acute abdominal pain in the ddx. | ||
| a) Include appropriate causes | Clinical Reasoning Selectivity | Hypothesis generation, Diagnosis |
| 6. Given a patient with a life-threatening cause of acute abdominal pain (e.g., a ruptured abdominal aortic aneurysm or a ruptured ectopic pregnancy): | ||
| a) Recognize the life-threatening situation. | Selectivity | Diagnosis |
| b) Make the diagnosis. | Clinical Reasoning | Diagnosis |
| c) Stabilize the patient. | Selectivity, Clinical Reasoning | Treatment |
| d) Promptly refer the patient for definitive treatment. | Selectivity | Diagnosis, Referral |
| 7. In a patient with chronic or recurrent abdominal pain: | ||
| a) Ensure adequate follow-up to monitor new or changing symptoms or signs. | Clinical Reasoning | Follow-up |
| b) Manage symptomatically with medication and lifestyle modification (e.g., for irritable bowel syndrome). | Clinical Reasoning, Communication | Treatment |
| c) Always consider cancer in a patient at risk. | Clinical Reasoning | Hypothesis generation, Diagnosis |
| 8. Given a patient with a diagnosis of inflammatory bowel disease (IBD) recognize an extra intestinal manifestation. | ||
| a) Recognize manifestations | Clinical Reasoning | Hypothesis generation, Diagnosis |
1. Assessment of Abdominal Pain Based on Location and Chronicity
Given a patient with abdominal pain, paying particular attention to its location and chronicity:
a) Distinguishing Acute vs Chronic Pain
Distinguish between acute and chronic pain.
b) Differential Diagnosis Generation
Generate a complete differential diagnosis (ddx).
c) Investigation Approach
Investigate in an appropriate and timely fashion.
2. Management of Diagnosed Abdominal Conditions
In a patient with diagnosed abdominal pain (e.g., gastroesophageal reflux disease, peptic ulcer disease, ulcerative colitis, Crohn's disease), manage specific pathology appropriately (e.g., with medication, lifestyle modifications).
a) Appropriate Management
Manage appropriately
3. Abdominal Pain in Women
In a woman with abdominal pain:
a) Pregnancy Consideration
Always rule out pregnancy if she is of reproductive age.
b) Gynecologic Etiology
Suspect gynecologic etiology for abdominal pain.
c) Pelvic Examination
Do a pelvic examination, if appropriate.
4. Surgical vs Non-surgical Abdomen
In a patient with acute abdominal pain, differentiate between a surgical and a non-surgical abdomen.
a) Appropriate Differentiation
Differentiate appropriately
5. Special Patient Groups
In specific patient groups (e.g., children, pregnant women, the elderly), include group-specific surgical causes of acute abdominal pain in the ddx.
a) Group-Specific Causes
Include appropriate causes
6. Life-threatening Causes of Acute Abdominal Pain
Given a patient with a life-threatening cause of acute abdominal pain (e.g., a ruptured abdominal aortic aneurysm or a ruptured ectopic pregnancy):
a) Recognition
Recognize the life-threatening situation.
b) Diagnosis
Make the diagnosis.
c) Patient Stabilization
Stabilize the patient.
d) Referral
Promptly refer the patient for definitive treatment.
7. Chronic or Recurrent Abdominal Pain
In a patient with chronic or recurrent abdominal pain:
a) Follow-up
Ensure adequate follow-up to monitor new or changing symptoms or signs.
b) Symptomatic Management
Manage symptomatically with medication and lifestyle modification (e.g., for irritable bowel syndrome).
c) Cancer Consideration
Always consider cancer in a patient at risk.
8. Inflammatory Bowel Disease (IBD)
Given a patient with a diagnosis of inflammatory bowel disease (IBD) recognize an extra intestinal manifestation.
a) Extra Intestinal Manifestations
Recognize manifestations