Abdominal Pain
Rovsing’s sign (TRUMPS ALL!!!): Appendicitis
LLQ tenderness and Suprapubic mass (TRUMPS Duodenal ulcer): Diverticulitis
perforation
Pneumoperitoneum or + NSAIDS or H.pylori: Perforated Duodenal Ulcer
Confusion, Abdominal bruit, alcohol abuse AND elevated lipids: Mesenteric
Infarction
+ Murphy’s sign, hx gallstones, RUQ mass/pain: Acute Cholecystitis
+ Icto Test or icteric skin: Choledocolithiasis
Grey Turner Sign, Decreased calcium, increased lipase: Pancreatitis
Stair step fluid pattern, prior surgery (rule OUT appendicitis): Small bowel
obstruction
Watch out for this case…Perforated Duodenal Ulcer
HX: A 54 year old male presents with abdominal pain for approximately 2 hours. The pain is acute in onset,
severe and unchanging. The patient locates the pain in the upper abdomen. The discomfort radiates to the
middle of the back. The discomfort started around 3 AM. Associated findings: sweating. Past Medical History:
alcohol abuse.
PE/GENERAL APPEARANCE is unremarkable except for a tendency to remain very still. VITAL SIGNS:
Temperature 98.4, Cardiac rate: 119, Respirations: 18 and BP: 116/83.
HEENT: normal. CARDIAC exam: normal. RESPIRATORY exam: normal. ABDOMINAL exam: epigastric
tenderness, decreased bowel sounds, a tympanic abdomen, diffuse tenderness, involuntary guarding and
rigidity. NEUROLOGICAL exam: normaml. SKIN: normal.
LABS/CBC: 15 thousand WBC's. UA: an increased specific gravity. BLOOD CHEMISTRY abnormalities: a
decreased albumin. ABG: WNL.
RADIOLOGY/Plain abdominal X-rays reveal: the loss of a flank strip