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Acute abdominal pain

Clinical Discipline(s)/Organ System(s)
Digestive System, Gastroenterology & Hepatology, General Surgery, Obstetrics & Gynaecology, Emergency Medicine, General Practice
Progress Test Topic(s)
Digestive, Seriously ill patient
Description
You are on your surgical placement when a 40 year old NZ European woman presents to the Emergency Department with sudden onset abdominal pain. She finds the pain severe and she has been vomiting. She has no relevant medical history. You go to see her with the surgical registrar.
Progress Test-Type Questions:   Question 1 | Question 2 | Question 3
Applied Science for Medicine 
   - Anatomy of the abdomen, pelvis, femoral and inguinal canals
   - Physiology behind patterns of pain: visceral vs parietal pain
   - Pathophysiology of perforated viscus, intra-abdominal sepsis, pelvic inflammatory disease, ovarian cyst accident and a ruptured abdominal aortic aneurysm
   - Mechanism of action of penicillins, extended spectrum penicillins, aminoglycosides, clavulanic acid, metronidazole, gyrase inhibitors, opioids, paracetamol and ondansetron
Clinical and Communication Skills 
   - Elicit an acute abdomen history
   - Empathic communication with patient in severe pain whilst also taking time-efficient history
   - Perform and record an examination of the abdomen and pelvis: include genitalia, hernial orifices and rectal examination. Recognise signs of peritonism
   - Differential diagnosis of abdominal pain; recognise patterns of referred pain
   - Perform ECG, urine dipstick and pregnancy test
   - Indications for abdominal CT, abdominal ultrasound, transvaginal ultrasound, diagnostic laparoscopy
   - Interpret blood cultures, erect chest X-ray, abdominal X-ray, ECG, serum amylase
   - Management of pain and management of common medical, surgical and gynaecological causes of abdominal pain
   - Treatment of patient with sepsis
   - Complications of intra-abdominal disease
   - Prognosis of common abdominal pathologies
Personal and Professional Skills 
   - Consent for intimate examination and use of a chaperone; consent issues in anaesthetised patients
   - Interdisciplinary care of women of reproductive age with acute abdominal pain (surgeon and gynaecologist)
   - Awareness of own reaction to someone in severe pain
Hauora Māori 
   - Appropriate engagement and consultation with whānau particularly around health issues such as reproduction/cancer
   - Understanding of inequities in access to health services and quality of medical care for Māori (e.g. higher rates of surgical error for Māori females compared with non-Māori females);application to clinical decision making and management
   - Consideration of access to cultural/spiritual support for patient and whānau including return of body parts
Population Health 
   - Epidemiology and prevention of sexually transmitted infections, gallstones and urinary tract infection
   - Prevention of infertility in women of reproductive age
   - Radiation risk from imaging for women of reproductive age
Conditions to be considered relating to this scenario
Common
ectopic pregnancy, ovarian cyst accident (torsion, rupture, haemorrhage), acute appendicitis, biliary colic/gallstones, cholecystitis, pelvic inflammatory disease, peptic ulcer disease, pyelonephritis, urinary tract infection, endometriosis, bowel obstruction, diverticulitis, renal calculi, pancreatitis
Less common but 'important not to miss'
ruptured abdominal aortic aneurysm, aortic dissection, malignancy, diabetic ketoacidosis, myocardial infarction, pericarditis, acute mesenteric insufficiency, embolic disease from atrial fibrillation, renal infarction, liver abscess
Uncommon
porphyria, chronic mesenteric insufficiency