- Abdominal Pain
- Back Pain
- Diarrhea
- Hematuria
- Vaginal Bleeding (Non-Pregnant)
Abdominal Pain
Rapid Review
- Differentials
- Gastrointestinal
- Pancreatitis
- Hepatitis
- Gastritis
- Peptic Ulcer Disease
- Cholecystitis
- Chiledocholithiasis
- Cholangitis
- Diverticulitis
- Crohn’s disease
- Ulcerative colitis
- Bowel obstruction
- Hernia
- Constipation
- Vascular
- Mesenteric ischemia
- Ischemic colitis
- Renal/Urinary
- Pyelonephritis
- Urinary tract infection
- Urologic
- Testicular torsion
- Epididymitis
- Gynecologic
- Pelvic inflammatory disease
- Ovarian torsion
- Ovarian cyst rupture
- Endometriosis
- Uterine fibroid
- Referred pain
- ACS
- Pulmonary embolism
- Pneumonia
- Gastrointestinal
- History
- Which region does the pain hurt most
- Differentials vary based on location
- Fever/chills
- Suggests infectious process
- Urinary symptoms
- Suggests pyelonephritis, cystitis, nephrolithiasis
- Melena/hematochezia
- Consider GI bleed
- Alcohol use
- Consider hepatitis or pancreatitis
- Exacerbated or relieved with foods
- Consider gastric or duodenal ulcers
- Hx of unprotected sex or recent STI
- Consider PID
- Which region does the pain hurt most
- Physical Exam
- Murphy’s sign
- Suggests biliary process
- Rigid abdomen
- Suggests peritonitis
- Rebound Tenderness/Rovsing’s/Obturator/Psoas Signs
- Suggests appendicitis
- CVA tenderness
- Suggests pyelonephritis or nephrolithiasis
- Murphy’s sign
- Work-Up
- Labs
- CBC, CMP, Lipase
- Lactate (if suspect mesenteric ischemia, sepsis, strangulated hernia)
- Imaging
- Abdominal X-ray
- RUQ ultrasound
- CT abdomen/pelvis
- Labs
Pearls
Back Pain
Rapid Review
- Differentials
- “CRAFTI”
- Compression
- Cauda equina
- Conus medullaris
- Epidural hematoma
- Renal stone
- Aortic aneurysm/dissection
- Fracture
- Tumor
- Infection/Inflammatory
- Pyelonephritis
- Perinephric abscess
- Epidural abscess
- Osteomyelitis
- Discitis
- Transverse myelitis
- Compression
- Other common causes
- Mechanical low back pain
- Sciatica/Radiculopathy
- “CRAFTI”
- History
- Recent injury
- Consider fracture, strain
- Recent unintentional weight loss
- Consider malignancy
- IV drug use
- Consider epidural abscess
- Syncopal episode
- Consider aortic dissection, aneurysm
- Urinary incontinence or saddle anesthesia
- Consider cauda equina
- Fever/chills
- Consider infectious process
- Recent injury
- Physical Exam
- Spinal tenderness. Step-off deformity.
- Consider fracture
- CVA tenderness
- Consider nephrolithiasis or pyelonephritis
- Sphincter dysfunction
- Consider cauda equina
- Spinal tenderness. Step-off deformity.
- Work-Up
- Labs
- CBC, BMP, ESR, CRP
- Urinalysis
- Beta-hCG
- Post-Void Residual
- Imaging
- X-ray (spinal)
- CT Spine (non-contrast)
- Labs
Pearls
Deep Dive
Diarrhea
Rapid Review
- Differentials
- Bacterial
- C. difficile
- Campylobacter
- Shigella
- Salmonella
- E. coli
- Viral
- HIV
- Enteroviruses
- Parasitic
- Entamoeba histolytica
- Giardia lamblia
- Other
- Inflammatory bowel disease
- Ulcerative colitis
- Diverticulitis
- Medications
- Alcoholism
- Bacterial
- History
- Frequency and volume of stools
- Watery, large volume stools likely viral
- Recent antibiotics
- Consider C. difficile
- Exposure to poultry, livestock, turtles
- Consider salmonella
- Travel to developing countries
- Consider bacterial/parasitic infections
- Consumption of raw, undercooked meats
- Consider bacterial organisms
- Frequency and volume of stools
- Physical Exam
- Dry mucous membranes
- Suspect dehydration
- Abdominal tenderness
- Suspect inflammatory process (pancreatitis, cholecystitis, appendicitis)
- Bloody stools
- Suggest bacterial/parasitic
- Dry mucous membranes
- Work-Up
- Labs
- CBC, BMP, hepatic panel
- C. diff PCR
- Hepatic panel
- Stool culture
- Stool ova/parasites
- Imaging
- CT Abdomen pelvis (if concern for acute abdomen)
- Labs
Pearls
Deep Dive
Hematuria
Rapid Review
- Differentials
- Urinary tract infection
- Nephrolithiasis
- Bladder/Kidney cancer
- Nephropathy
- Foreign Body
- BPH
- History
- Ingestion of new foods or medications
- Consider pseudohematuria
- Clots
- Consider nonglomerular etiology (bladder)
- Beginning, middle, or end of stream
- Helps identify source of bleeding
- Recent procedures or trauma
- Consider urethral injuries
- Ingestion of new foods or medications
- Physical Exam
- CVA tenderness
- Suggests pyelonephritis or nephrolithiasis
- Suprapubic tenderness
- Suggests cystitis
- External lesions/lacerations
- Evidence of urethral injury
- CVA tenderness
- Work-Up
- Labs
- CBC, BMP, Coags, CK
- Urinalysis
- Urine culture
- Imaging
- CT (may be useful for identifying pyelonephritis vs nephrolithiasis)
- Labs
Pearls
Vaginal Bleeding (Non-Pregnant)
Rapid Review
- Differentials
- Menstruation w/ coagulopathy
- Uterine fibroids
- Polyps
- Breakthrough bleeding w/ OCPs
- Atrophic vaginitis
- Foreign Body
- Endometrial/Cervical cancer
- History
- Amount of blood (in pads or tampons)
- Helps quantify severity of bleeding
- Recently started contraceptives
- Consider breakthrough bleeding
- Family history of malignancy
- Consider endometrial or cervical cancer
- Abdominal/Pelvic pain
- Consider ectopic pregnancy
- Amount of blood (in pads or tampons)
- Physical Exam
- Signs of trauma
- Consider vaginal or uterine injury
- Abdominal/Pelvic tenderness
- Consider ectopic pregnancy or ovarian cyst
- Signs of trauma
- Work-Up
- Labs
- CBC, CMP, Type and Cross
- Beta-hCG
- DIC panel (fibrinogen, coags, reticulocyte count, d dimer)
- Imaging
- Transvaginal ultrasound
- Labs
Pearls
Physician assistant graduate from Duke University (Class of 2022). Army National Guard Medic. Former paramedic. Devoted to learning and sharing evidence-based medicine.
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