1. Abdominal Assessment

2. 1.1Demonstrate an understanding of the epidemiology of the patient’s non conveyance to a treatment centre. 1.2Recognise the contents and conditions associated within each quadrant of the abdomen. 1.3Identify the red flags of serious signs and symptoms of the abdomen. 1.4Undertake a holistic assessment of pain and the drug regimes associated with abdominal conditions. 1.5 Complete a physical assessment of an abdomen and associated questioning. 1.6 Identify common presentations associated with abdominal conditions. 1.7 Demonstrate the management and referral of patients presenting with conditions of the abdomen. Learner Outcomes

3. History Take PMH – Bowel diseases, Abdominal surgery, associated conditions DH – ask about any new drugs started including OTC, Homeopathic or Recreational Smoking - ↑ risk of peptic ulcers, Oesophageal cancer, Colorectal Cancer Alcohol – CAGE questions Family History – IBS, Coeliac, Ulcers, Liver disease Social History – Tattoos, Illicit drug use, foreign travel Dietary History – Fibre in diet, ? Lactose intolerant, change in symptoms with certain food groups

4. Systemic Enquiry  Dysphagia & Odynophagia  Dyspepsia & Indigestion  Nausea & Vomiting  Flatulence  Bowel Habits  Constipation & Diarrhoea  Abdominal Pain  G.U. symptoms  Weight loss

5. Hypotension Confusion/impaired consciousness Signs of shock Systemically unwell/septic-looking Signs of dehydration Rigid abdomen Tenderness to percussion Patient lying very still or writhing Absent or altered bowel sounds Associated testicular pathology Marked involuntary guarding/rebound tenderness History of haematemesis / melaena Suspicion of medical cause for abdominal pain GI Red Flags Simon et al (2005).Oxford Handbook of General Practice. Oxford. Oxford University Press.

6. Patients left at home 1 st January 09- 31 st March 09 380 patients attended by EMAS 36% not conveyed to a treatment centre 45% of these patients were revisited 2/3 conveyed to hospital UTI’S that were left at home- 40% had return ambulance Abdominal pain/problems- 15% admitted to hospital on the return visit D&V- 40% had a return ambulance Of all the patients that were left at home, 40% were left inappropriately- 32% of patients left, were due to an inappropriate assessment

7. Abdominal Contents Group task: On the paper provided list the contents of the abdomen.

8. Abdominal contents

9. Framework for Abdominal Examination General Inspection The Hands The Arms The Axillae The Face The Chest Inspection of the Abdomen Auscultation Palpation –Light –Deep –Specific Organs –Hernial Orifices Percussion

10. Physical Examination Patient positioning – lying flat with one pillow. Arms resting loosely by sides Make sure patient and your hands are warm. Expose to groin, maintain modesty

11. Physical Examination Inspection Auscultation Palpation Percussion

12. Additional Examinations Rovsings sign McBurney’s point Murphy’s sign

13. Location of Abdominal Pain Myocardial ischemia Dyspepsia / Gastritis Splenic enlargement or rupture Acute Cholecystitis or Biliary colic Ulcers Pancreatitis Renal colic Diverticulitis Hepatitis Appendicitis UTI

14. Patient Outcome With the exception of a urinary pregnancy test and urine dipstick, there are few tests that are useful in the community assessment of the patient with acute abdominal pain. The outcome for most patients will be acute admission via: A & E or by direct admission by the appropriate clinician.

15. Differential Diagnosis ΔΔ Group task: List as many of the possible differential diagnosis of a patient with abdominal pain.

16. Documentation Remember: ‘If it’s not written down, it’s not been done!’

17. Any questions ?