Abdominal Pain and Gastrointestinal Disorders

Abdomen and GI System

• Abdominal pain can be acute or chronic, and may be accompanied by symptoms such as indigestion, nausea, vomiting, loss of appetite, and early satiety.
• Difficulty swallowing or painful swallowing can be a symptom of GI problems.
• Change in bowel function, diarrhea, constipation, and jaundice can also be indicative of GI issues.
• Risk factors for liver disease include family history and certain medical conditions.

Urinary/Renal System

• Suprapubic pain, difficulty urinating, excessive urination, and urinary incontinence can be symptoms of urinary/renal problems.
• Blood in urine and flank pain/ureteral colic can also be indicative of urinary/renal issues.

Abdominal Examination

• General appearance and inspection of the abdomen are important parts of the examination.
• Bowel sounds should be listened to with a stethoscope before palpation or percussion.
• Percussion and palpation of the abdomen should be performed in all four quadrants.
• Deep palpation with two hands can help identify liver or spleen enlargement.

Liver and Spleen

• Liver size can be estimated along the right midclavicular line.
• The liver edge should be palpated and characterized.
• The spleen can be percussed for enlargement along the Traube space.
• The spleen edge should be palpated with the patient in the supine and right lateral decubitus positions.

Kidneys and Urinary Bladder

• Costovertebral angle (CVA) tenderness should be checked using a fist.
• The urinary bladder should be percussed to check for enlargement.

Health Promotion

• Hepatitis A, B, and colon cancer screening are important for health promotion.
• Interpretation of diarrhea and urinary incontinence can help identify underlying causes.

Male Genitalia

• Penile discharge or lesions can be indicative of sexually transmitted infections (STIs).
• Scrotal or testicular swelling/pain can be a symptom of underlying conditions.
• Health promotion is important for testicular cancer, with no specific screening recommendations.
• Sexually transmitted diseases (STDs) are common in males, and screening is important.

Female Genitalia

• Menarche, menopause, and post-menopausal bleeding can be important milestones in female health.
• Vulvovaginal symptoms, pelvic pain, and sexually transmitted diseases (STDs) can be indicative of underlying conditions.
• Pregnancy and cervical cancer prevention are important health promotion topics.

Anus, Rectum, and Prostate

• Change in bowel habits, blood in stool, and pain with defecation can be symptoms of anus, rectum, and prostate problems.
• Weak urinary stream can be a symptom of prostate issues.
• The BPH symptom Score Index can be used to assess prostate health.
• Prostate cancer screening is important, and discussion of individualized risks and benefits is necessary.

Polling Questions

• A liver span of >12 cm at the midclavicular line is consistent with hepatomegaly.
• The USPSTF recommends not screening routinely for colon cancer in patients over 75 years old.
• Rebound tenderness is a sign of peritonitis.
• HPV vaccination is recommended for males between 9-21 years old.
• A spermatocele is a benign, painless, movable cystic mass that transilluminates.
• The transformation zone is the most important area to sample in a Pap smear.
• Family history and African American race are risk factors for prostate cancer.
• Screening modalities for prostate cancer should be discussed between the patient and provider.