Western Med - Regional Conditions

Each Region of the body and what conditions may present there

Acute - Epigastric/ Left upper Quadrant Differentials

Gastric Ulcer - Worse when eating, vomiting blood and black stools

Duodenal Ulcer - Better when eating, vomiting blood and black stools

GERD - Worse when lying down, sour taste in mouth

Infection/Gastroenteritis

Acute Pancreatitis - Radiating to back, worse after eating or drinking, improves when leaning forward, worsens when lying flat, bruising on flanks and around belly button

Acute Cholecystitis - Usually RUQ pain but can radiate, fever nausea and jaundice

Cholelithiasis - Radiate to shoulder and back, pain after fatty meals 30 mins - 2 hours following

Acute Coronary Syndrome/Myocardial infarction - radiate to arm or jaw, sweating or pallor

Acute - Epigastric/ Left upper Quadrant PNTBM

Gastric/Duodenal perforation

Pancreatic Cancer

Aortic Dissection

Lower lobe pneumonia

Pulmonary embolism

Chronic - Epigastric/ Left Upper Quadrant Differentials

Gastric Ulcer - Worse when eating, vomiting blood, black stools

Duodenal Ulcer - Better when eating, vomiting blood, black stools

GERD - Worse when lying down, sour taste in mouth

Inflammatory Bowel Disease - Diarrhoea, cramping, bloody stool, fatigue

Chronic Pancreatitis - Worsen after eating or drinking alcohol, fatty stools, weight loss

Chronic Cholecystitis - Usually RUQ pain but can radiate, fever, nausea, jaundice

Cirrhosis - Fatigue, jaundice, palmar erythema, ascites

Hepatitis - Fever, fatigue, nausea, jaundice, dark urine, clay coloured stools

Coronary Heart Disease/Angina - Pain on exertion, SOB, dizziness/vomitting

Chronic - Epigastric/ Left Upper Quadrant PNTBM

Gastric cancer

Pancreatic cancer

Lower lobe pneumonia

Abdominal Aortic Aneurysm (AAA)

Acute - Right Upper Quadrant Differentials

Acute Cholecystitis - Fever, nausea, jaundice and Murphy’s Sign

Cholelithiasis - Radiate to shoulder and back, pain after fatty meals 30 mins - 2 hours

Hepatitis - Fever, fatigue, nausea, jaundice, dark urine, clay-coloured stools

Duodenal Ulcer - Better when eating, vomiting blood, black stools

Acute - Right Upper Quadrant Differentials PNTBM

Pulmonary embolism

Myocardial infarction

Appendicitis

Liver mass

Chronic - Right upper quadrant differentials

Chronic Cholecystitis- usually RUQ pain but can radiate, fever, nausea, jaundice

Hepatitis- fever, fatigue, nausea, jaundice, dark urine, clay-coloured stools

Duodenal Ulcer- Better when eating, vomiting blood, black stools

IBD- diarrhoea, cramping, bloody stool, fatigue

Chronic Pyelonephritis- Flank pain, hypertension, nocturia, Polyuria.

Chronic Kidney Disease- Fatigue, peripheral oedema, itchy skin, muscle cramps, hypertension, anemia.

Chronic - Right upper quadrant PNTBM

Tumour

Acute - Left Lower Quadrant Differentials

IBD- diarrhoea, cramping, bloody stool, fatigue

Diverticulitis- >50 years, fever, change in bowel habits, tender mass.

Gastroenteritis- crampy pain, diarrhoea, vomiting.

Ectopic pregnancy

Ovarian torsion/ruptured ovarian cyst

UTI- Fever, abnormal urine, increased frequency, dysuria (pain)

Nephrolithiasis- colicky pain, hematuria, urgency and frequency.

Acute pyelonephritis- flank pain, costovertebral angle tenderness,fever

Acute - Left Lower Quadrant PNTBM

Bowel obstruction

Colorectal cancer

Perforated ulcer

Chronic - Left Lower Quadrant Differentials

IBD- diarrhoea, cramping, bloody stool, fatigue

Colorectal cancer

Endometriosis

UTI- Fever, abnormal urine, increased frequency, dysuria (pain)

Chronic Pyelonephritis- pain is more typically flank or loin.

Chronic Kidney Disease- pain is more typically flank or loin.

Acute - Right Lower Quadrant Differentials

Appendicitus- Nausea, vomiting, low-grade fever.

IBD- diarrhoea, cramping, bloody stool, fatigue

Ectopic pregnancy- abdominal pain, dizziness, breast tenderness, shoulder tip pain.

Ovarian torsion/ruptured ovarian cyst

UTI- Fever, abnormal urine, increased frequency, dysuria (pain)

Acute pyelonephritis- flank pain, costovertebral angle tenderness,fever

Nephrolithiasis- colicky pain, hematuria, urgency and frequency.

Acute - Right Lower Quadrant PNTBM

Inguinal hernia

Gynecological cancer

Bowel obstruction

Perforated ulcer

Chronic - Right Lower Quadrant Differentials

IBD-diarrhoea, cramping, bloody stool, fatigue

Colorectal cancer

Endometriosis

UTI- Fever, abnormal urine, increased frequency, dysuria (pain)

Chronic Pyelonephritis- pain is more typically flank or loin.

Chronic Kidney Disease- pain is more typically flank or loin.

Acute - Pelvic

Ectopic pregnancy- abdominal pain, dizziness, breast tenderness, shoulder tip pain.

Ovarian cyst rupture/ovarian torsion

Appendicitis

IBD (Acute flare up)

UTI- Fever, abnormal urine, increased frequency, dysuria (pain)

Acute pyelonephritis- flank pain, costovertebral angle tenderness,fever

Nephrolithiasis- colicky pain, hematuria, urgency and frequency.

Chronic - Pelvic

Endometriosis

Ovarian cyst

UTI-Fever, abnormal urine, increased frequency, dysuria (pain)

Chronic Pyelonephritis- pain is more typically flank or loin.

IBD- diarrhoea, cramping, bloody stool, fatigue

Chronic - Pelvic PNTBM

Colorectal cancer

Bladder cancer

Acute - Flank ddx

Acute Kidney Injury

Acute pyelonephritis- flank pain, costovertebral angle tenderness,fever

Nephrolithiasis- colicky pain, hematuria, urgency and frequency.

UTI-Fever, abnormal urine, increased frequency, dysuria (pain)

Ectopic pregnancy- abdominal pain, dizziness, breast tenderness, shoulder tip pain.

Acute Cholecystitis- Fever, nausea, jaundice, Murphy’s sign.

Appendicitis

Acute - Flank PNTBM

Abdominal Aortic Aneurysm (AAA)

 

Kidney trauma

Chronic - Flank ddx

Chronic Pyelonephritis- pain is more typically flank or loin.

Chronic Kidney Disease- pain is more typically flank or loin.

Nephrolithiasis- colicky pain, hematuria, urgency and frequency.

 

Endometriosis

Ovarian cyst

 

IBD- diarrhoea, cramping, bloody stool, fatigue

Chronic - Flank PNTBM

Retroperitoneal mass or tumour

Renal tumour

Vertebral metastasis

Acute - Chest ddx

Acute Coronary Syndrome- sudden crushing chest pain, radiating to arm or jaw, sweating.

Pulmonary Embolism- sudden SOB, chest pain, coughing blood

Aortic Dissection- tearing pain radiating to the back

 

Pneumothorax- pleuritic pain, SOB, tracheal deviation.

Pneumonia- fever and crepitations, SOB, pleuritic chest pain.

Acute Bronchitis- cough (starts dry becomes productive), sputum, chest tightness.

Pericarditis- pleuritis pain, worse lying down, better sitting forward.

GERD- Worse when lying down, sour taste in mouth

Acute - Chest PNTBM

Oesophageal rupture

Chronic - Chest ddx

Coronary Heart Disease (Angina)- exertional pain, SOB, palpitations

 

GERD

Chronic - Chest PNTBM

Tumour

Pulmonary hypertension

Heart Failure

Temperature Assessment Value

Lower than average less than 35

Normal: (36.0-37.0)

Higher than average or mild fever (37.1-38.0)

Fever (38.1-42.2)

Blood Pressure

Hypotension: less than 90/ less than 60

Normal: Around 120/ around 80

Elevated: 120-129/ less than 80

Stage 1 hypertension: 130-139/ 80-89

Stage 2 hypertension: 140 or higher/ 90 or higher

Hypertension crisis: over 180/ over 120

Heart Rate

Heart rate too low: less than 60

Normal: 60-100

Heart rate too high: more than 100

Respiratory Rate

Abnormally low: less than 12 breaths per min

Normal: 12-18 breaths per min

Abnormally high: Over 25 breaths per min