steps in physical exam 1) general observation: patient position (i.e. lying still vs. writhing) 2)vitals: postural changes, fe...
steps in physical exam
1) general observation: patient position (i.e. lying still vs. writhing)
2)vitals: postural changes, fever
3)status of hydration
4)cardiovascular/respiratory examination
5)abdominal examination
- observation: distention, scars, visible peristalsis
- auscultation: absent, decreased, normal, increased bowel sounds
- percussion: hypertympanic sounds in bowel obstruction,percussion tenderness indicative of peritonitis
- palpation: tenderness, abdominal masses
6) CVA tenderness
7) specific signs
8)hernias, male genitalia
9)rectal/pelvic exam
Labs
- CBC and differential
- electrolytes, BUN, creatinine
- amylase levels
- liver function tests
- urinalysis
- stool for occult blood
- others as indicated
- ECG, fl-hCG, ABG, septic workup, lactate (ischemic bowel)
Radiology
- 3 views abdomen
- CXR
- others as indicated : U/S, CT, endoscopy, IVP, peritoneal lavage, laparoscopy
Indications for urgent operation
physical findings
- peritonitis
- severe or increasing localized tenderness
- progressive distension
- tender mass with fever or hypotension (abscess)
- septicemia and abdominal findings
- bleeding and abdominal findings
- suspected bowel ischemia (acidosis, fever, tachycardia)
- deterioration on conservative treatment
radiologic
- free air
- massive bowel distention (colon > 12 cm)
- space occupying lesion with fever
endoscopic
- perforation
- uncontrollable bleeding
paracentesis
- blood, pus, bile, feces, urine
