March 26, 2022

Health Disorder Empowerment 1400H - 1500H

Course– objective - for Via Zoom
Fundamentals laypeople to have an
and understanding of the
Generalities in FUNDAMENTALS
Medical and GENERALITIES in
Management the MEDICAL
of MANAGEMENT of
ABDOMINAL ABDOMINAL PAIN.
PAIN
[OVERVIEW]
Health Disorder Empowerment
Course– objective - for ROJoson PEP Talk
Fundamentals laypeople to have an
and understanding of the I have a Patient
Generalities in FUNDAMENTALS Empowerment
Medical Program in which I
and GENERALITIES in
Management like to empower the
the MEDICAL lay people or
of MANAGEMENT of patients to take
ABDOMINAL ABDOMINAL PAIN. control in the
PAIN management of
their health.
 There are 3 courses
in the PEP Talk.
I completed the Core
Course on October 9,
2021.
 From October 23,
2021 onwards, I have
been tackling Health
Disorder and Health
Issue Courses. This
may take 3 years or
longer.
Health Disorder Empowerment My PEP TALK today
Course– objective - for is entitled:
Fundamentals laypeople to have an Fundamentals and
and Generalities in
understanding of the
Generalities in Medical
FUNDAMENTALS Management of
Medical and GENERALITIES in ABDOMINAL PAIN
Management the MEDICAL [AN OVERVIEW].
of MANAGEMENT of This is part of the
ABDOMINAL ABDOMINAL PAIN. Health Disorder
PAIN Course.
 Definition of Terms in Title AND Delimitation of
Fundamentals
Coverage of Talk:
and Generalities
in Medical
Fundamentals – simplest and essential facts and
Management of
theories which can serve as a basis or foundation
ABDOMINAL
and support for advanced information
PAIN
Generalities – general statements of info, not
covering specifics and details

Medical Management – diagnosis and treatment

by physicians
 Fundamentals Contents of ABDOMINAL DISORDERS March 19, 2022
1400H - 1500H
and Generalities [OVERVIEW] Via Zoom
in Medical • What is an abdominal disorder?
Management of • What are the different types of abdominal
ABDOMINAL disorders?
PAIN • What are the causes of abdominal disorders?
• How common are the abdominal disorders?
• Clinical diagnosis of abdominal disorders?
• Paraclinical diagnostic procedures for • Abdominal Pain
abdominal disorders? • Abdominal Mass
• Basic treatment modalities for abdominal • Abdominal Obstruction
disorders? • Abdominal Bleeding
• Jaundice
 Fundamentals Contents of ABDOMINAL PAIN
and Generalities • What is an abdominal pain?
in Medical • What are the different types of abdominal
Management of pain?
ABDOMINAL • What are the causes of abdominal pain?
PAIN • How common are the abdominal pain?
• Clinical diagnosis of abdominal pain?
• Paraclinical diagnostic procedures for
abdominal pain?
• Basic treatment modalities for abdominal
pain?
 • What is an abdominal pain?
Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
 • What is an abdominal pain?
Fundamentals
and Generalities What is an ABDOMINAL PAIN?
in Medical
Management of This phrase defies a simple and straightforward
ABDOMINAL definition.
PAIN It is better to explain it in terms of concept or idea
with interjection of practical meaning and uses.
Abdominal pain –
Reasons:
pain in the
• Different expressions of abdominal pain
abdomen
(different English and local dialect terms used)
• Different degrees of pain with different terms
 • What is an abdominal pain?
Fundamentals
and Generalities Examples of different expressions of abdominal Some of these terms
in Medical pain in Filipino and English languages: are in general forms
Management of • “Sakit ng tiyan” or “sakit sa tiyan”
(e.g. sakit,
• “Sinisikmura”
ABDOMINAL discomfort,
• “Mahapdi”
PAIN • “Humihilap” unpleasant
• “Tinutusok” sensation, pain).
• “Mahangin” or “may kabag”
• “Discomfort”
“Unpleasant or uncomfortable sensation”
• “Ache”
• “Crampy pain” or “colicky pain”
• “Burning pain”
• “Pain”
 • What is an abdominal pain?
Fundamentals
and Generalities Examples of different expressions of abdominal Some of these terms
in Medical pain in Filipino and English languages: are descriptive of the
Management of • “Sakit ng tiyan” or “sakit sa tiyan”
unpleasant sensation
• “Sinisikmura”
ABDOMINAL felt (e.g. mahapdi,
• “Mahapdi”
PAIN • “Humihilap” humihilap, tinutusok,
• “Tinutusok” kabag, crampy or
• “Mahangin” or “may kabag” colicky pain).
• “Discomfort”
“Unpleasant or uncomfortable sensation”
• “Ache”
• “Crampy pain” or “colicky pain”
• “Burning pain”
• “Pain”
 • What is an abdominal pain?
Fundamentals
and Generalities Examples of different expressions of abdominal Some of these terms
in Medical pain in Filipino and English languages: have connotations of
Management of • “Sakit ng tiyan” or “sakit sa tiyan”
severity of the
• “Sinisikmura”
ABDOMINAL unpleasant sensation
• “Mahapdi”
PAIN • “Humihilap” felt (e.g. discomfort –
• “Tinutusok” mild; ache – mild;
• “Mahangin” or “may kabag” pain and sakit – more
• “Discomfort”
severe than ache and
“Unpleasant or uncomfortable sensation”
• “Ache” discomfort).
• “Crampy pain” or “colicky pain”
• “Burning pain”
• “Pain”
 • What is an abdominal pain?
Fundamentals
and Generalities ABDOMINAL PAIN (defies simple straightforward
in Medical definition)
Management of ROJoson’s Recommendations:
ABDOMINAL Abdominal pain is any feeling of unpleasant
PAIN senstation in/on the belly (or abdomen).
Start with this meaning then let the person with
an unpleasant sensation on the abdomen
describe or amplify further on the feeling Abdominal pain –
(allowing whatever descriptions to be given any unpleasant
followed by a best effort to interpret them with sensation in / on the
the aim of identify the source and cause of the belly or abdomen
unpleasant sensation).
 • What is an abdominal pain?
Fundamentals
and Generalities In the real world, oftentimes, it is NOT easy to:
in Medical
Management of • describe precisely the character or nature of
ABDOMINAL the pain that will facilitate identifying the
PAIN cause in the belly.

I will tell you why, later on.

Abdominal pain –
But, my advice is to at least TRY as it may be any unpleasant
helpful in the end, in the diagnosis. sensation in / on the
belly or abdomen
 • What is an abdominal pain?
Fundamentals
and Generalities As an offshoot of the difficulty in describing
in Medical precisely the character or nature of the pain, it is
Management of NOT easy to
ABDOMINAL
PAIN • make a specific diagnosis just based on the
character or nature of the pain.

• One has to gather more data (more symptom Abdominal pain –

data particularly on the presence of other any unpleasant
associated symptoms and also sign data) to be sensation in / on the
able to make a specific diagnosis of the belly or abdomen
abdominal pain.
 • What is an abdominal pain?
Fundamentals
and Generalities REASONS why it is NOT easy to:
in Medical • Describe precisely the character or nature of
Management of the unpleasant sensation that will facilitate
ABDOMINAL identifying the cause in the belly.
PAIN • Essentially, unpleasant sensation can
originate from the
• abdominal wall
• lining of the abdominal cavity or
peritoneum
• solid organs
• hollow organs inside the abdominal
cavity
 • What is an abdominal pain? Question:
Fundamentals
Are the character or
and Generalities REASONS why it is NOT easy to: nature of unpleasant
in Medical • Describe precisely the character or nature of sensations
Management of the unpleasant sensation that will facilitate originating from the
ABDOMINAL identifying the cause in the belly. different sources
PAIN • Essentially, unpleasant sensation can DISTINCT from each
originate from the other?
• abdominal wall
• lining of the abdominal cavity or If YES, it may
peritoneum facilitate diagnosis.
• solid organs In reality,
• hollow organs inside the abdominal OFTENTIMES, not
cavity DISTINCT!
 • What is an abdominal pain? ROJoson GENERAL
Fundamentals
CUES for source of
and Generalities REASONS why it is NOT easy to: unpleasant
in Medical • Describe precisely the character or nature of sensation:
Management of the unpleasant sensation that will facilitate • Abdominal wall –
ABDOMINAL identifying the cause in the belly. constant,
PAIN • Essentially, unpleasant sensation can superficial
originate from the • Peritoneal lining –
• abdominal wall constant, deeper
• lining of the abdominal cavity or • Sold organs –
peritoneum constant, deep
• solid organs • Hollow organs –
• hollow organs inside the abdominal crampy or colicky
cavity
 • What is an abdominal pain? Situations that make
Fundamentals differentiation
and Generalities REASONS why it is NOT easy to: difficult:
in Medical • Describe precisely the character or nature of • Source of
Management of the unpleasant sensation that will facilitate unpleasant
ABDOMINAL identifying the cause in the belly. sensation is not
PAIN • Essentially, unpleasant sensation can just from one, but
originate from the multiple, such as
• abdominal wall hollow organs and
• lining of the abdominal cavity or peritoneum lining;
peritoneum abdominal wall and
• solid organs peritoneal lining;
• hollow organs inside the abdominal solid and hollow
cavity organs; etc.
 • What is an abdominal pain? Situations that make
Fundamentals differentiation
and Generalities REASONS why it is NOT easy to: difficult:
in Medical • Describe precisely the character or nature of • Early stage of
Management of the unpleasant sensation that will facilitate medical condition
ABDOMINAL identifying the cause in the belly. or disease or mild
PAIN • Essentially, unpleasant sensation can medical condition
originate from the in the 4 sources
• abdominal wall usually produces
• lining of the abdominal cavity or NO distinct
peritoneum character or
• solid organs nature. (Just mild
• hollow organs inside the abdominal feeling of
cavity discomfort!)
 • What is an abdominal pain? Situations that make
Fundamentals differentiation
and Generalities REASONS why it is NOT easy to: difficult:
in Medical • Describe precisely the character or nature of • Early stage of
Management of the unpleasant sensation that will facilitate medical condition
ABDOMINAL identifying the cause in the belly. or disease or mild
PAIN At• times, watchful
Essentially, waiting
unpleasant may
sensation can medical condition
allow morefrom
originate distinct
the character or in the 4 sources
nature • abdominal wall
of the unpleasant feeling usually produces
• lining of the abdominal cavity or NO distinct
to show up, thereby facilitating
peritoneum character or
diagnosis.
• solid (usefulness
organs of nature. (Just mild
• hollow
watchful waiting)
organs inside the abdominal feeling of
cavity discomfort!)
 • What is an abdominal pain?
Fundamentals
and Generalities ABDOMINAL PAIN (defies simple straightforward
in Medical definition)
Management of ROJoson’s Recommendations:
ABDOMINAL Abdominal pain is any feeling of unpleasant
PAIN sensation in/on the belly (or abdomen).
Start with this meaning then let the person with
an unpleasant sensation on the abdomen
describe or amplify further on the feeling Abdominal pain –
(allowing whatever descriptions to be given any unpleasant
followed by a best effort to interpret them with sensation in / on the
the aim of identify the source and cause of the belly or abdomen
unpleasant sensation).
 • What is an abdominal pain?
Fundamentals
and Generalities Examples of different expressions of abdominal pain in Filipino and
in Medical English languages: [A ROJoson’s ATTEMPT AT INTERPRETATION]
Management of • “Sakit ng tiyan” or “sakit sa tiyan”; pain [non-specific – usually more severe than
ABDOMINAL discomfort and ache”]
• “Sinisikmura” [epigastric pain – stomach – gastritis, gastric ulcer]
PAIN • “Mahapdi”; “burning pain” [usually, referring to stomach as source]
• “Humihilap”; “crampy or colicky pain” [hollow organ involvement]
• “Tinutusok” [piercing pain, sharp pain, vs dull pain – non-specific]
• “Mahangin” or “may kabag” [bloatedness – intestine involvement]
• “Discomfort” [non-specific, mild]
“Unpleasant/uncomfortable sensation” [non-specific, mild unless otherwise
qualified]
• “Ache” [non-specific, mild compared to pain]
 • What is an abdominal pain? Abdominal pain –
Fundamentals
any unpleasant
and Generalities ABDOMINAL PAIN (defies simple straightforward
sensation in / on the
in Medical definition)
belly or abdomen
Management of ROJoson’s Recommendations:
ABDOMINAL Abdominal pain is any feeling of unpleasant What abdominal
PAIN sensation in/on the belly (or abdomen). pain is NOT?
Start with this meaning then let the person with
an unpleasant sensation on the abdomen It is not the same as
describe or amplify further on the feeling its severity – mild,
(allowing whatever descriptions to be given moderate and
followed by a best effort to interpret them with severe.
the aim of identify the source and cause of the
unpleasant sensation).
 • What is an abdominal pain? Abdominal pain –
Fundamentals
any unpleasant
and Generalities ABDOMINAL PAIN (defies simple straightforward
sensation in / on the
in Medical definition)
belly or abdomen
Management of ROJoson’s Recommendations:
ABDOMINAL Abdominal pain is any feeling of unpleasant What abdominal
PAIN sensation in/on the belly (or abdomen). pain is NOT?
Start with this meaning then let the person with
an unpleasant sensation on the abdomen It is not the same as
describe or amplify further on the feeling its onset and course
(allowing whatever descriptions to be given – acute, chronic,
followed by a best effort to interpret them with recurrent,
the aim of identify the source and cause of the progressive, etc.
unpleasant sensation).
 • What are the different types of abdominal
Fundamentals
pain?
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
 • What are the different types of abdominal
Fundamentals
pain?
and Generalities
in Medical Essentially, the different types will be based on
Management of the origin of the unpleasant sensation:
ABDOMINAL
PAIN • abdominal wall
• lining of the abdominal cavity or
peritoneum
• solid organs
• hollow organs inside the abdominal
cavity
 • What are the different types of abdominal ROJoson GENERAL
Fundamentals
pain? CUES for source of
and Generalities
unpleasant
in Medical Essentially, the different types will be based on sensation:
Management of the origin of the unpleasant sensation: • Abdominal wall –
ABDOMINAL
constant,
PAIN • abdominal wall superficial
• lining of the abdominal cavity or • Peritoneal lining –
peritoneum constant, deeper
• solid organs • Sold organs –
• hollow organs inside the abdominal constant, deep
cavity • Hollow organs –
crampy or colicky
 • What are the different types of abdominal Example:
Fundamentals
pain? Abdominal wall -
and Generalities
Pain can be constant
in Medical Different types of unpleasant abdominal dull or sharp pain.
Management of sensation or pain can also be based on the
ABDOMINAL specific organs with a medical condition or a Colon -
PAIN disease and the nature of the medical condition Pain can be
or disease. bloatedness;
distended abdomen
Example: because of
Stomach - obstruction; colicky
Pain can be burning, bloatedness, colicky, pain, etc.
constant dull or sharp pain, etc. [gastritis, gastric
ulcer, obstruction, etc.]
 Some abdominal
• Clinical diagnosis of abdominal pain? conditions and
Fundamentals diseases have typical
and Generalities Onset and course of pain – aids in clinical courses.
in Medical diagnosis Some have chronic
Management of and recurrent track
ABDOMINAL • Acute or recent - about a week or two records – such as
PAIN • Chronic – lasting for about 3 months duodenal ulcer and
• Recurrent – 3 episodes within 3 months colonic diverticulitis.
• Progressive – increasing in intensity
Others just one bout
or rarely recur.

Progressive connotes
serious diagnosis.
 Some abdominal
• What are the different types of abdominal conditions and
Fundamentals diseases have typical
pain?
and Generalities severity score.
in Medical Another way of classifying the different types of
Management of unpleasant abdominal sensation or pain that will Some are usually
ABDOMINAL be useful in diagnosis and urgency of treatment is mild. Some usually
PAIN based on severity: moderate in pain.
• Mild Some usually severe.
• Moderate
• Severe (of greatest urgency) Example: pain caused
by gallbladder stones
causing acute
obstruction will have
severe pain.
 • What are the different causes of abdominal
Fundamentals
pain?
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
 • What are the different causes of abdominal
Fundamentals
pain?
and Generalities
in Medical CAUSES
Management of So many causes in terms of medical conditions
ABDOMINAL and diseases that I will not be able to cover in this
PAIN PEP Talk.

Will just focus on fundamentals and generalities.

 • What are the different causes of abdominal
Fundamentals
pain?
and Generalities
in Medical CAUSES
Management of TRAUMA
ABDOMINAL • Penetrating injuries (stab wound, gunshot)
PAIN • Blunt injuries (vehicular accidents, mauling)

NON-TRAUMA
• Cancers on abdominal wall and internal organs
• Non-cancers on the abdominal wall and
internal organs
 • What are the different causes of abdominal
Fundamentals
pain?
and Generalities
in Medical NON-TRAUMA
Management of • Abdominal MASS (cancers / non-cancers)
ABDOMINAL • Abdominal OBSTRUCTION (gastrointestinal /
PAIN biliary / ureteral – tumors / non-tumors, e.g.
stones)
• Abdominal BLEEDING (from gastrointestinal
masses / ulcerative diseases)
• Abdominal INFLAMMATION / INFECTION
(gastroenteritis / abscess)
PERITONITIS – inflammation of peritoneal lining
(may be seen in TRAUMA and NON-TRAUMA)
 • What are the different causes of abdominal
Fundamentals
pain?
and Generalities
in Medical What are the mechanisms of abdominal pain?
Management of Pain from solid organs
ABDOMINAL • Stretching of the capsule of the organs
PAIN • Inflammation

Pain from hollow organs

• Stretching or distention of the lumen
• Inflammation

Pain on peritoneal lining – inflammation

Pain on abdominal wall - inflammation
 • How common are the abdominal pain?
Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
 • How common are the abdominal pain?
Fundamentals NO DATA
and Generalities VERY COMMON
in Medical However, I surmise PAIN
Management of is most common in the
Where do you think PAIN occurs most frequently ABDOMEN (if we include
ABDOMINAL among the different regions of the body? even the mildest form of
PAIN discomfort). Why?
• Head and Neck such as HEADACHE? Because of the varying
kinds of foods that we
• Chest such as CHEST PAIN? eat 3x – 6x a day which
• Abdomen – ABDOMINAL PAIN? always have potential
• Extremities – BONE and JOINT PAIN? side-effects.
 • Clinical diagnosis of abdominal pain?
Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
 • Clinical diagnosis of abdominal pain? BASIC PROCESSES
Fundamentals
and Generalities Processes used in clinical diagnosis of
in Medical abdominal pain:
Management of • Pattern recognition process means realization
ABDOMINAL that the patient’s presentation conforms to a
PAIN
previously learned picture or pattern of
disease.
• Prevalence process means choice of a diagnosis
is based on the frequency of occurrence of the
disease in a certain locality, in a certain age and
sex group, and in the affected organ and
system.
 • Clinical diagnosis of abdominal pain?
Fundamentals
and Generalities TIPS:
in Medical SYMPTOM-BASED
Management of BASIC EVALUATION METHODS: EVALUATION
ABDOMINAL
PAIN • HISTORY TAKING – TO GET SYMPTOMS
• PHYSICAL EXAMINATION – TO GET SIGNS SIGN-BASED
EVALUATION

CLINICAL DIAGNOSIS
CLINICAL DIAGNOSIS
 • Clinical diagnosis of abdominal pain? SYMPTOM-based
Fundamentals
evaluation
and Generalities TIPS in evaluating / diagnosing ABDOMINAL PAIN
of upon onset of pain (any unpleasant sensation)
ABDOMINALin
Medical • Determine the location of the pain.
Management • Try to determine the type of pain as best as
PAIN you can.
• Feel for any associated symptoms like fever,
nausea vomiting, diarrhea, etc.
• Recall any antecedent /precipitating events
that may lead to the pain.
• Monitor closely the pain – course and its
associated symptoms.
 • Clinical diagnosis of abdominal pain?
Fundamentals
and Generalities TIPS in evaluating / diagnosing ABDOMINAL PAIN
in Medical upon onset of pain (any unpleasant sensation)
Management of
ABDOMINAL • Determine the location of the pain.
PAIN • Try to determine the type of pain as best as
you can.
• Feel for any associated symptoms like fever,
nausea, vomiting, diarrhea, etc.
• Recall any antecedent /precipitating events
that may lead to the pain.
• Monitor closely the pain – course and its
associated symptoms.
 • Clinical diagnosis of abdominal pain?
Fundamentals
and Generalities TIPS in evaluating / diagnosing ABDOMINAL PAIN
in Medical upon onset of pain (any unpleasant sensation)
Management of
ABDOMINAL • Determine the location of the pain.
PAIN • Try to determine the type of pain as best as
you can.
• Feel for any associated symptoms like fever,
nausea, vomiting, diarrhea, etc.
• Recall any antecedent /precipitating events
that may lead to the pain.
• Monitor closely the pain – course and its
associated symptoms.
 • Clinical diagnosis of abdominal pain? Location of pain as
Fundamentals
cue for diagnosis
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
 • Clinical diagnosis of abdominal pain? Location of pain as
Fundamentals
cue for diagnosis
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
 • Clinical diagnosis of abdominal pain? Try your best – it
Fundamentals
may not be easy.
and Generalities TIPS in evaluating / diagnosing ABDOMINAL PAIN
in Medical upon onset of pain (any unpleasant sensation) Initially, it may just a
Management of
discomfort without
ABDOMINAL • Determine the location of the pain.
distinct
PAIN • Try to determine the type of pain as best as
characteristics.
you can.
• Feel for any associated symptoms like fever,
Monitor until you
nausea, vomiting, diarrhea, etc. can be definite on
• Recall any antecedent /precipitating events
the type of pain, that
that may lead to the pain. is, if the pain
• Monitor closely the pain – course and its
persists.
associated symptoms.
 • Clinical diagnosis of abdominal pain? A simple classification
Fundamentals
of pain that may have
and Generalities TIPS in evaluating / diagnosing ABDOMINAL PAIN diagnostic import:
in Medical upon onset of pain (any unpleasant sensation)
Management of
Crampy / colicky pain
ABDOMINAL • Determine the location of the pain.
– hollow organ
PAIN • Try to determine the type of pain as best as
involvement
you can.
• Feel for any associated symptoms like fever,
Non-crampy / colicky
nausea, vomiting, diarrhea, etc. pain - may be from
• Recall any antecedent /precipitating events
any source even
that may lead to the pain. hollow organ
• Monitor closely the pain – course and its
involvement
associated symptoms.
 • Clinical diagnosis of abdominal pain? Associated symptoms
Fundamentals
may give clues to the
and Generalities TIPS in evaluating / diagnosing ABDOMINAL PAIN diagnosis such as
in Medical upon onset of pain (any unpleasant sensation)
Management of • Fever – an
ABDOMINAL • Determine the location of the pain.
inflammation /
PAIN • Try to determine the type of pain as best as
infection may be
you can. going on
• Feel for any associated symptoms like fever, • Vomiting – possible
nausea, vomiting, diarrhea, etc. obstruction
• Recall any antecedent /precipitating events • Diarrhea – possible
that may lead to the pain. gastroenteritis
• Monitor closely the pain – course and its • etc.
associated symptoms.
 • Clinical diagnosis of abdominal pain? An antecedent /
Fundamentals precipitating event
and Generalities TIPS in evaluating / diagnosing ABDOMINAL PAIN may give clues to the
in Medical upon onset of pain (any unpleasant sensation) diagnosis such as
Management of
ABDOMINAL • Determine the location of the pain. • History of recent
PAIN • Try to determine the type of pain as best as vehicular accident -
you can. possible blunt
• Feel for any associated symptoms like fever, injury
nausea, vomiting, diarrhea, etc.
• Recall any antecedent /precipitating events • History of recent
that may lead to the pain. binge-eating –
• Monitor closely the pain – course and its possible food
associated symptoms. indigestion
 • Clinical diagnosis of abdominal pain? After onset,
Fundamentals monitoring closely the
and Generalities TIPS in evaluating / diagnosing ABDOMINAL PAIN course of the
in Medical upon onset of pain (any unpleasant sensation) abdominal pain may
Management of give clues to the
ABDOMINAL • Try to determine the type of pain as best as diagnosis such as
PAIN you can.
• Feel for any associated symptoms like fever, • Over time, the type
nausea, vomiting, diarrhea, etc. of pain may be
• Recall any antecedent /precipitating events clearer in character
that may lead to the pain. to enable pattern
• Monitor closely the pain – course and its recognition of a
associated symptoms. medical condition
or disease.
 • Clinical diagnosis of abdominal pain? After onset,
Fundamentals monitoring closely the
and Generalities TIPS in evaluating / diagnosing ABDOMINAL PAIN course of the
in Medical upon onset of pain (any unpleasant sensation) abdominal pain may
Management of give clues to the
ABDOMINAL • Try to determine the type of pain as best as diagnosis such as
PAIN you can. • Over time, the
• Determine the location of the pain. appearance of
• Feel for any associated symptoms like fever, associated
nausea, vomiting, diarrhea, etc. symptoms may
• Recall any antecedent /precipitating events enable pattern
that may lead to the pain. recognition of a
• Monitor closely the pain – course and its medical condition
associated symptoms. or disease.
 • Clinical diagnosis of abdominal pain? SIGN-based
Fundamentals
evaluation
and Generalities TIPS in evaluating / diagnosing ABDOMINAL PAIN
in Medical upon onset of pain (any unpleasant sensation)
Management of
ABDOMINAL PHYSICAL EXAMINATION
PAIN
LOOK AND PALPATE
 • Clinical diagnosis of abdominal disorders?
Fundamentals
and Generalities TIPS:
in Medical BASIC EXAMINATION OF THE ABDOMEN:
Management of LOOK AND PALPATE
ABDOMINAL
PAIN • LOOK for unusual bulge that may suggest mass.
• LOOK for abdominal distention that may
suggest intestinal obstruction, mass or fluid.
• PALPATE for possible presence of mass.
• PALPATE for presence of tenderness (pain on
pressure) – if present, location and severity. An abdominal mass
can cause abdominal
pain.
 • Clinical diagnosis of abdominal disorders?
Fundamentals
and Generalities TIPS:
in Medical BASIC EXAMINATION OF THE ABDOMEN:
Management of LOOK AND PALPATE
ABDOMINAL
PAIN • LOOK for unusual bulge that may suggest mass.
• LOOK for abdominal distention that may
suggest intestinal obstruction, mass or fluid.
• PALPATE for possible presence of mass.
• PALPATE for presence of tenderness (pain on
pressure) – if present, location and severity. An abdominal
distention, obstruction,
mass and fluid can cause
abdominal pain.
 • Clinical diagnosis of abdominal disorders?
Fundamentals
and Generalities TIPS:
in Medical BASIC EXAMINATION OF THE ABDOMEN:
Management of LOOK AND PALPATE
ABDOMINAL
PAIN • LOOK for unusual bulge that may suggest mass.
• LOOK for abdominal distention that may
suggest intestinal obstruction, mass or fluid.
• PALPATE for possible presence of mass.
• PALPATE for presence of tenderness (pain on
pressure) – if present, location and severity. If an abdominal mass is
present, it may be the
cause of the abdominal
pain.
 • Clinical diagnosis of abdominal disorders?
Fundamentals
and Generalities TIPS:
in Medical BASIC EXAMINATION OF THE ABDOMEN:
Management of LOOK AND PALPATE
ABDOMINAL
PAIN • LOOK for unusual bulge that may suggest mass.
• LOOK for abdominal distention that may
suggest intestinal obstruction, mass or fluid.
• PALPATE for possible presence of mass.
• PALPATE for presence of tenderness (pain on
pressure) – if present, evaluate further.
 • Clinical diagnosis of abdominal pain?
Fundamentals
and Generalities TIPS:
in Medical BASIC EXAMINATION OF THE ABDOMEN:
Management of LOOK AND PALPATE
ABDOMINAL
PAIN • LOOK for unusual bulge that may suggest mass.
• LOOK for abdominal distention that may
suggest intestinal obstruction, mass or fluid.
• PALPATE for possible presence of mass.
• PALPATE for presence of tenderness (pain on
pressure) – if present, evaluate further.
 • Clinical diagnosis of abdominal pain? Clinical Diagnosis
Fundamentals
General Statements:
and Generalities TIPS:
in Medical In looking for the SPECIFIC CAUSE of ABDOMINAL
Abdominal pain
Management of PAIN,
secondary to:
ABDOMINAL use PATTERN RECOGNITION of a particular
PAIN medical condition or disease and PREVALENCE
• Non-specific
process in those with similar presentation of
cause
symptoms and signs.
• Specific cause
(specify the
disease)
• Primary clinical diagnosis: Most probable
• Secondary clinical diagnosis: Second most
probable
 • Clinical diagnosis of abdominal pain?
Fundamentals
and Generalities CUES for: If there are cues for
in Medical • ABDOMINAL MASS – palpable mass a specific disorder,
Management of • GASTROINTESTINAL OBSTRUCTION – vomiting, then specify the
ABDOMINAL abdominal distention, and no bowel disorder and then
PAIN movement look for the specific
• GASTROINTESTINAL BLEEDING - vomiting of cause.
frank blood; passage of frank blood per anus;
black stools per anus
• JAUNDICE – yellowing of the white part of the
eyes
 • Clinical diagnosis of abdominal pain? Clinical Diagnosis
Fundamentals
General Statements:
and Generalities In patients with ABDOMINAL PAIN but without
Abdominal pain
in Medical clear-cut CUES for
secondary to:
Management of • Abdominal mass
• Non-specific
ABDOMINAL • Abdominal obstruction
cause
PAIN • Abdominal bleeding
• Specific cause
• Jaundice
(specify the
and ABDOMINAL PAIN is mild and with no clear-
disease)
cut characteristics and with NO CUES for a specific
disease whatsoever, If there are cues for
DIAGNOSIS is usually “Non-specific abdominal a specific disease,
pain”. [This has to be monitored afterwards.] then specify the
disease.
 • Clinical diagnosis of abdominal pain? If no mass, no
Fundamentals
Case Illustration: bleeding, no signs of
and Generalities
A patient presenting with epigastric pain. obstruction, and no
in Medical
Based on location, possible common organs of jaundice,
Management of
involvement: stomach, pancreas, liver, and consider STOMACH
ABDOMINAL
intestines (small and large). first as it is the most
PAIN
common organ
affected in the area.

If there is jaundice,
think of LIVER.
 • Clinical diagnosis of abdominal pain? If no mass, no
Fundamentals
Case Illustration: bleeding, no signs of
and Generalities
A patient presenting with epigastric pain. obstruction, and no
in Medical
Based on location, possible common organs of jaundice,
Management of
involvement: stomach, pancreas, liver, and consider STOMACH
ABDOMINAL
intestines (small and large). first as it is the most
PAIN
common organ
affected in the area.

Then, determine
characteristic of pain
to zero into the
specific STOMACH
condition or disease.
 • Clinical diagnosis of abdominal pain? If no mass, no
Fundamentals
Case Illustration: bleeding, no signs of
and Generalities
A patient presenting with epigastric pain. obstruction, and no
in Medical
Based on location, possible common organs of jaundice,
Management of
involvement: stomach, pancreas, liver, and consider STOMACH
ABDOMINAL
intestines (small and large). first as it is the most
PAIN
common organ
affected in the area.

Examples:
• Food indigestion
• Gastritis
• Gastric ulcer
 • Clinical diagnosis of abdominal pain? If no mass, no
Fundamentals
Case Illustration: bleeding, no signs of
and Generalities
A patient presenting with epigastric pain. obstruction, and no
in Medical
Based on location, possible common organs of jaundice,
Management of
involvement: stomach, pancreas, liver, and consider STOMACH
ABDOMINAL
intestines (small and large). first as it is the most
PAIN
common organ
affected in the area.

If cannot specify
based on symptoms
and signs, diagnosis
is NON-SPECIFIC
EPIGASTRIC PAIN.
 • Clinical diagnosis of abdominal pain? If no mass, no bleeding,
Fundamentals no signs of obstruction,
and Generalities Case Illustration: no jaundice, and no liver
in Medical A patient presenting with right upper quadrant enlargement
Management of pain. consider GALLBLADDER
Based on location, possible common organs of first as it is the most
ABDOMINAL
common organ affected
PAIN involvement: liver, gallbladder, and intestines
in the area.

If with jaundice,
evaluate LIVER,
GALLBLADDER and
PANCREAS.
 If no mass, no bleeding,
• Clinical diagnosis of abdominal pain? no signs of obstruction,
Fundamentals
Case Illustration: no jaundice, and no liver
and Generalities
enlargement
in Medical A patient presenting with right upper quadrant consider GALLBLADDER
Management of pain. first as it is the most
ABDOMINAL Based on location, possible common organs of common organ affected
PAIN involvement: liver, gallbladder, and intestines in the area.

If there is
tenderness where
the GALLBLADDER is
located, diagnosis is
CHOLECYSTITIS –
inflammation of
Gallbladder.
 • Clinical diagnosis of abdominal pain? If no mass, no bleeding,
Fundamentals no signs of obstruction,
and Generalities Case Illustration: no jaundice, and no liver
in Medical A patient presenting with right upper quadrant enlargement
Management of pain. consider GALLBLADDER
Based on location, possible common organs of first as it is the most
ABDOMINAL
common organ affected
PAIN involvement: liver, gallbladder, and intestines
in the area.

If cannot specify
based on symptoms
and signs, diagnosis
is NON-SPECIFIC
RUQ ABDOMINAL
PAIN.
 • Clinical diagnosis of abdominal pain? If no mass, no bleeding,
Fundamentals no signs of obstruction,
and Generalities Case Illustration: and no jaundice,
in Medical A patient presenting with right lower quadrant consider APPENDIX first
Management of pain. as it is the most common
Based on location, possible common organs of organ affected in the
ABDOMINAL
area.
PAIN involvement: appendix, intestines, ovary (female)
If there is definite,
persistent,
increasing RLQ
tenderness, consider
ACUTE
APPENDICITIS.
 • Clinical diagnosis of abdominal pain? If no mass, no bleeding,
Fundamentals no signs of obstruction,
and Generalities Case Illustration: and no jaundice,
in Medical A patient presenting with right lower quadrant consider APPENDIX first
Management of pain. as it is the most common
Based on location, possible common organs of organ affected in the
ABDOMINAL
area.
PAIN involvement: appendix, intestines, ovary (female)

If cannot specify
based on symptoms
and signs, diagnosis
is NON-SPECIFIC RLQ
ABDOMINAL PAIN.
 • Clinical diagnosis of abdominal pain? If no mass, no bleeding,
Fundamentals no signs of obstruction,
and Generalities Case Illustration: and no jaundice,
in Medical A patient presenting with left lower quadrant consider COLON first as
Management of pain. it is the most common
Based on location, possible common organs of organ affected in the
ABDOMINAL
area.
PAIN involvement: intestines, ovary (female)

If there is bowel
disturbance,
consider colon and
evaluate further for
specific condition
and disease.
 • Clinical diagnosis of abdominal pain? If no mass, no bleeding,
Fundamentals no signs of obstruction,
and Generalities Case Illustration: and no jaundice,
in Medical A patient presenting with left lower quadrant consider COLON first as
Management of pain. it is the most common
Based on location, possible common organs of organ affected in the
ABDOMINAL
area.
PAIN involvement: intestines, ovary (female)

If cannot specify
based on symptoms
and signs, diagnosis
is NON-SPECIFIC LLQ
ABDOMINAL PAIN.
 • Clinical diagnosis of abdominal pain? BASIC PROCESSES
Fundamentals
and Generalities Processes used in clinical diagnosis of
in Medical abdominal pain:
Management of • Pattern recognition process means realization
ABDOMINAL that the patient’s presentation conforms to a
PAIN
previously learned picture or pattern of
disease.
• Prevalence process means choice of a diagnosis
is based on the frequency of occurrence of the
disease in a certain locality, in a certain age and
sex group, and in the affected organ and
system.
 • Clinical diagnosis of abdominal pain?
Fundamentals
and Generalities Aids in clinical diagnosis:
in Medical • Location of pain
Management of • Character of pain
ABDOMINAL
PAIN • Specific (as much as possible)
• Non-specific clinical diagnosis (allowed)

• Onset and course of pain

• Severity of pain
• Acute abdomen (acute surgical abdomen vs
acute non-surgical abdomen)
 Some abdominal
• Clinical diagnosis of abdominal pain? conditions and
Fundamentals diseases have typical
and Generalities Onset and course of pain – aids in clinical courses.
in Medical diagnosis Some have chronic
Management of and recurrent track
ABDOMINAL • Acute or recent - about a week or two records – such as
PAIN • Chronic – lasting for about 3 months duodenal ulcer and
• Recurrent – 3 episodes within 3 months colonic diverticulitis.
• Progressive – increasing in intensity
Others just one bout
or rarely recur.

Progressive connotes
serious diagnosis.
 Some abdominal
• Clinical diagnosis of abdominal pain? conditions and
Fundamentals diseases have typical
and Generalities Severity of pain – aids in clinical diagnosis severity score.
in Medical
Management of • Mild Some are usually
ABDOMINAL • Moderate mild. Some usually
PAIN • Severe (of greatest urgency) moderate in pain.
Some usually severe.
SEVERE PAIN – aside from
implying greatest urgency in Example: pain caused
medical treatment, it also has a by gallbladder stones
Food
connotation in diagnosis and
indigestion is causing acute
subsequent treatment. Example:
usually mild obstruction will have
ACUTE ABDOMEN
to moderate. severe pain.
 Sometimes the
• Clinical diagnosis of abdominal pain? specific cause of the
Fundamentals acute abdomen
and Generalities ACUTE ABDOMEN is a condition, usually with cannot be definitely
in Medical severe abdominal pain, that demands urgent established.
Management of attention and treatment. It is enough for the
ABDOMINAL physician to decide
PAIN ACUTE SURGICAL ABDOMEN is a condition, whether it is a
usually with severe abdominal pain, that SURGICAL or NON-
demands urgent attention and operative SURGICAL abdomen.
treatment.
This is a special
ACUTE NON-SURGICAL ABDOMEN is a condition category of clinical
that demands urgent attention and non-operative diagnosis of
treatment. abdominal pain.
 • Clinical
Paraclinical
diagnosis
diagnostic
of abdominal
procedures
pain?
for
Fundamentals
abdominal pain?
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
 • Clinical
Paraclinical
diagnosis
diagnostic
of abdominal
procedures
pain?
for
Fundamentals
abdominal pain?
and Generalities
in Medical Common instrumental and laboratory diagnostic
Management of procedures for ABDOMINAL PAIN:
ABDOMINAL
PAIN • Imaging procedures (x-rays – plain / with
barium dye; ultrasound; CT scan; MRI; PET
scan; etc.)
• Endoscopy (upper - esophagogastroscopy /
lower – colonoscopy, sigmoidoscopy,
proctoscopy)
• Blood tests (CBC; liver function tests; tumor
markers; etc.)
 • Clinical
Paraclinical
diagnosis
diagnostic
of abdominal
procedures
pain?
for
Fundamentals
abdominal pain?
and Generalities
in Medical
Management of The foremost indication for a paraclinical
ABDOMINAL diagnostic procedure can be stated this
PAIN way:

if you are not certain on the primary

clinical diagnosis and you need to be
certain or be more certain before
treatment, then go for a paraclinical
diagnostic procedure.
 • Clinical
Paraclinical
diagnosis
diagnostic
of abdominal
procedures
pain?
for
Fundamentals As a rule, there is no need
abdominal pain?
and Generalities for a paraclinical
in Medical diagnostic procedure if:
Management of
To decide on indication of the paraclinical
• you are quite
ABDOMINAL diagnostic procedure,
certain of your
PAIN the physician uses two processes – primary clinical
- degree of certainty on the primary diagnosis.
clinical diagnosis and • treatment plans for
primary and
- comparison of the treatment plans for secondary
the primary and secondary clinical diagnoses are the
diagnoses. same.
 • Clinical
Paraclinical
diagnosis
diagnostic
of abdominal
procedures
pain?
for
Fundamentals
abdominal pain?
and Generalities
in Medical
Competencies required of physicians managing
Management of
abdominal pain:
ABDOMINAL
PAIN • Know the uses and indications of all known
instrumental and laboratory diagnostic
procedures for abdominal pain.
• Use as needed and indicated.
• Select the most cost-effective one using the
BRCA process.
• Know how to interpret the results.
 • Clinical
Paraclinical
diagnosis
diagnostic
of abdominal
procedures
pain?
for
Fundamentals
abdominal pain?
and Generalities
in Medical
BRCA Process in selecting diagnostic procedures
Management of
ABDOMINAL Procedures Benefit Risk Cost Availability
PAIN (goal – to
be more
definite on
the
diagnosis)

Option1        
Option2        
Option3        
 Sometimes the
• Clinical diagnosis of abdominal pain? specific cause of the
Fundamentals acute abdomen
and Generalities ACUTE ABDOMEN is a condition, usually with cannot be definitely
in Medical severe abdominal pain, that demands urgent established.
Management of attention and treatment. It is enough for the
ABDOMINAL In patients with ACUTE SURGICAL physician to decide
PAIN ACUTE SURGICAL
ABDOMEN, NO ABDOMEN
TIME shouldis a condition,
be wasted on whether it is a
usually with severe abdominal pain, that SURGICAL or NON-
paraclinical diagnostic procedures just to
demands urgent attention and operative SURGICAL abdomen.
establish
treatment.the definite cause. A surgeon
should operate without establishing the This is a special
specific cause. The operation
ACUTE NON-SURGICAL ABDOMEN is can serve as
a condition category of clinical
that paraclinical
the demands urgent attentionprocedure
diagnostic and non-operative
as it diagnosis of
treatment.
will establish the cause. abdominal pain.
 • Clinical
Basic treatment
diagnosismodalities
of abdominal
for abdominal
pain?
Fundamentals
pain?
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
 • Clinical
Basic treatment
diagnosismodalities
of abdominal
for abdominal
pain?
Fundamentals
pain?
and Generalities
in Medical SPECIFIC DISEASE SURGICAL / POTENTIALLY SURGICAL / NON-SURGICAL
Management of
ABDOMINAL W
PAIN X
Y
Z

• Surgical – outright surgical

• Non-surgical – non-surgical at all times (no operation)
• Potentially surgical – surgical only when needed
 • Clinical
Basic treatment
diagnosismodalities
of abdominal
for abdominal
pain? Surgical Treatment:
Fundamentals
pain? • Drainage of
and Generalities
infections
in Medical Examples of OUTRIGHT SURGICAL ABDOMEN (abscesses)
Management of • Acute surgical abdomen • Removal (-ectomy
ABDOMINAL • Complete intestinal obstruction such as
PAIN • Peritonitis secondary to ruptured intestines cholecystectomy)
• Resectable tumors • Repair (-rrhapy
such as
gastrorrhaphy)
• Surgical – outright surgical
• Non-surgical – non-surgical at all times (no operation)
• Potentially surgical – surgical only when needed
 • Clinical
Basic treatment
diagnosismodalities
of abdominal
for abdominal
pain?
Fundamentals
pain?
and Generalities
in Medical Examples of POTENTIALLY SURGICAL ABDOMEN
Management of • Asymptomatic gallstones
ABDOMINAL • Asymptomatic diverticulitis
PAIN • Incomplete intestinal obstruction
• Asymptomatic benign tumors

• Surgical – outright surgical

• Non-surgical – non-surgical at all times (no operation)
• Potentially surgical – surgical only when needed
 • Clinical
Basic treatment
diagnosismodalities
of abdominal
for abdominal
pain?
Fundamentals
pain?
and Generalities
in Medical Examples of OUTRIGHT NON-SURGICAL
Management of ABDOMEN
ABDOMINAL • Gastroenteritis
PAIN • Food ingestion Non-Surgical Treatment:
• Cirrhosis • Medicines
• Hepatitis • NO medicines (watchful waiting;
natural support management; etc.)

• Surgical – outright surgical

• Non-surgical – non-surgical at all times (no operation)
• Potentially surgical – surgical only when needed
 • Clinical
Basic treatment
diagnosismodalities
of abdominal
for abdominal
pain?
Fundamentals
pain?
and Generalities
in Medical
BRCA Process in selecting cost-effective treatment
Management of
modality.
ABDOMINAL
PAIN
 Fundamentals Contents of ABDOMINAL PAIN
and Generalities • What is an abdominal pain?
in Medical • What are the different types of abdominal
Management of pain? Summary
ABDOMINAL • What are the causes of abdominal pain?
• How common are the abdominal pain? Take Away
PAIN
• Clinical diagnosis of abdominal pain?
• Paraclinical diagnostic procedures for
abdominal pain?
• Basic treatment modalities for abdominal
pain?
 Fundamentals Be always in touch with reliable medical Take Away in
and Generalities information on fundamentals and relation to
in Medical generalities in medical management of Patient
Management of ABDOMINAL PAIN.
ABDOMINAL
Empowerment
PAIN Knowledge is power; it gives power.
Use the 4Ks of Patient Empowerment:
Kaalaman, Kakayanan, Karapatan and
Kapangyarihan
to gain greater control over decisions in
medical management of ABDOMINAL
PAIN.
 March 26, 2022
Health Disorder Empowerment 1400H - 1500H
Course– objective - for Via Zoom
Fundamentals laypeople to have an
and understanding of the
Generalities in FUNDAMENTALS
Medical and GENERALITIES in
Management the MEDICAL
of MANAGEMENT of
ABDOMINAL ABDOMINAL PAIN.
PAIN