GIM Question 14 Instructor

You are called to the ward because a male patient is complaining of epigastric abdominal pain.

  1. What are your initial steps?

    The approach to abdominal pain in a patient should always begin with a history and physical exam.

    • History
      • Onset pain, provoking/palliating factors, quality, severity, radiation, past episodes of similar pain
      • Review patient chart for past medical history and information on current admission
    • Physical exam
      • Vitals – HR, RR, BP, T, SpO2
      • Cardiac exam – r/o cardiac etiology
      • Resp exam – r/o respiratory etiology
      • Abdo exam + DRE
  2. What is your differential diagnosis?

    Epigastric pain is foregut pain or foregut vascular pain until proven otherwise. The differential diagnosis includes:

    • Esophageal – esophagitis
    • Gastric – Gastritis, peptic ulcer
    • Pancreatic – pancreatitis
    • Biliary – biliary colic, cholecystitis, cholangitis
    • Cardiac – pericarditis, MI (epigastric pain from a cardiac etiology is considered atypical angina, and is rare in male patients, yet more common in women. This can also be seen more commonly in diabetics)
    • Respiratory – pneumonia, PE
    • Vascular – abdominal aortic aneurysm, mesenteric ischemia

Cartwright SL and Knudson MP. Evaluation of Acute Abdominal Pain in Adults. American Family Physician. 2008, 77:971-978.

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