guest speaker Dr Lundberg A&P final :Evaluating Chest and Abdominal Pain

Myocardial Infarction (MI)

Acute coronary occlusion causing heart tissue necrosis.

Unstable Angina

Chest pain at rest, unrelieved by nitroglycerin.

Stable Angina

Chest pain with exertion, relieved by rest.

Transient Myocardial Ischemia

Temporary insufficient blood supply to heart tissue.

Pulmonary Embolism (PE)

Blockage in pulmonary artery causing pleuritic pain.

Pneumothorax

Lung collapse resulting in sudden sharp chest pain.

Gastroesophageal Reflux Disease (GERD)

Acid reflux causing burning chest pain.

Peptic Ulcer Disease (PUD)

Epigastric pain radiating to the chest, worsened by meals.

Costochondritis

Inflammation of rib cartilage causing localized tenderness.

Cholecystitis

Gallbladder inflammation presenting with RUQ pain.

Appendicitis

Peri-umbilical pain migrating to the RLQ.

Diverticulitis

Inflammation of diverticula, common in older adults.

Acute Abdominal Pain

Suggests surgical emergencies like appendicitis.

Chronic Abdominal Pain

Often linked to functional or structural conditions.

Red Flags for Chest Pain

Severe pain, difficulty breathing, or unrelieved pain.

Red Flags for Abdominal Pain

Sudden severe pain, rebound tenderness, jaundice.

ECG

Diagnostic tool for assessing heart conditions.

Cardiac Enzymes

Biomarkers indicating myocardial damage.

Quadrant Localization

Identifies organ-related pain based on abdominal regions.

Right Upper Quadrant (RUQ)

Commonly associated with liver and gallbladder issues.

Left Upper Quadrant (LUQ)

Involves spleen and pancreas pathologies.

Right Lower Quadrant (RLQ)

Typically indicates appendicitis or ectopic pregnancy.

Left Lower Quadrant (LLQ)

Commonly linked to diverticulitis and IBS.

Epigastric Pain

Pain in upper abdomen, often related to GERD.

Diagnostics for Abdominal Pain

Ultrasound and CT scans for organ evaluation.

CBC

Complete blood count, assesses overall health.

CMP

Comprehensive metabolic panel, evaluates organ function.

Lipase/Amylase

Enzymes indicating pancreatic inflammation.

Beta-hCG

Hormone test for pregnancy-related abdominal issues.

Labored Breathing

Indicates potential respiratory distress or cardiac issues.

Posture and Movement

Patients may avoid movements due to pain.

Breathing Patterns

Short, shallow breaths suggest pleuritic pain.

Ambulation

Unsteady gait may indicate systemic illness.

Clinical Prioritization

Focus on worst-case scenarios in chest pain.

Angina Pectoris

Classic heart ischemia presentation, often pressure-like.

Triggers for Ischemic Pain

Exercise, stress, cold weather, and large meals.

Cardiac Causes

First to evaluate due to life-threatening potential.

Pericarditis

Inflammation causing positional chest pain relief.

Cardiomyopathies

Heart muscle disorders impairing blood pumping.

Chronic Obstructive Pulmonary Disease (COPD)

Exacerbations lead to chest discomfort and dyspnea.

Gastrointestinal Causes

Conditions like GERD mimic cardiac chest pain.

Symptoms of Angina

Heavy sensation, radiation to arms or jaw.

Prinzmetal's Angina

Coronary artery spasm causing chest pain at rest.

Symptoms of Myocardial Infarction

Severe, persistent chest pain with associated signs.

Risk Factors for Pneumothorax

Young, tall, thin individuals or trauma cases.

Associated Symptoms of MI

Sweating, nausea, shortness of breath common.

Key Point on MI

Treat for MI until proven otherwise.

Triggers for Angina

Physical or emotional stress often initiates symptoms.

Symptoms of Pleuritic Pain

Sharp pain worsening with deep breathing.

Warning Signs of Unstable Angina

Pain at rest or unexpected onset is concerning.

Clinical Pearl for PE

Unexplained anxiety may indicate pulmonary embolism.

Mechanism of Stable Angina

Narrowed arteries fail to meet oxygen demand.

Example of Stable Angina

Pain after exertion, relieved by rest.

GERD

Acid reflux causing esophageal irritation and heartburn.

Cholelithiasis

Gallstones causing biliary colic and chest pain.

Trauma

Rib fractures causing pain with deep breathing or coughing.

Tension Pneumothorax

Lung collapse causing respiratory distress and sharp pain.

Aortic Dissection

Severe tearing chest pain radiating to the back.

Diaphoresis

Excessive sweating often linked to cardiac events.

Radiation of Pain

Cardiac pain often radiates to arms, neck, or back.

Hypertension

Increased risk for aortic dissection and cardiac events.

Diabetes

Often presents with atypical or silent ischemia.

Smoking

Major risk factor for coronary artery disease.

Vital Signs

Monitor for hypotension, tachycardia, and hypoxemia.

Red Flags

Symptoms indicating potential life-threatening conditions.

Focused Physical Exam

Includes heart and lung auscultation, chest palpation.

Key Questions

Inquire about pain onset, duration, and radiation.

Severe Chest Pain

Pain with difficulty breathing requiring immediate attention.

Persistent Pain

Unrelieved by rest or nitroglycerin indicates severity.

Associated Symptoms

Look for sweating, nausea, or anxiety with pain.

New-Onset Pain

Urgent evaluation needed in high-risk individuals.

Sudden, Severe Pain

Intense pain often signals serious underlying issues.

Chronic Pain

Develops over weeks to months, impacting life quality.

Pain Quality

Describes pain as sharp, dull, cramping, etc.

Timing of Pain

When pain starts; relates to meals or night.

Localization

Identifying pain location aids in diagnosis.

Epigastric Region

Includes stomach, pancreas, duodenum.

Suprapubic Region

Contains bladder, uterus, rectum.

Onset of Pain

Determines if pain is sudden or gradual.

Duration of Pain

Pain can be constant or intermittent.

Pain Intensity

Measured on a scale of 1-10.

Aggravating Factors

Eating or movement may worsen pain.

Posture Observation

Stillness indicates peritonitis; writhing suggests colic.

Facial Expressions

Grimacing indicates severe pain during palpation.

Skin Changes

Jaundice suggests liver dysfunction; pallor indicates shock.

Inspection

Look for distension, scars, bruising, hernias.

Auscultation

Listening for bowel sounds before palpation.

Percussion

Differentiates between air-filled and solid structures.

Palpation

Assess tenderness and rigidity in abdomen.

Complete Blood Count (CBC)

Elevated white blood cells indicate infection.

Comprehensive Metabolic Panel (CMP)

Evaluates liver and kidney function.

Ultrasound

First-line imaging for gallbladder and pelvic issues.

CT Scan

Best for evaluating appendicitis and bowel obstruction.

X-rays

Detects free air indicating perforation.

Gallbladder Disease

Includes cholelithiasis and cholecystitis.

Ectopic Pregnancy

RLQ pain in women with missed periods.

Crohn's Disease

Chronic RLQ pain with diarrhea, weight loss, and fatigue.

Irritable Bowel Syndrome (IBS)

Chronic LLQ cramping relieved by defecation, alternating diarrhea and constipation.

Ovarian Cysts or Torsion

Sudden, sharp LLQ pain, often with nausea or vomiting.

Acute Pancreatitis

Severe epigastric pain radiating to the back, often with nausea and vomiting.