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Possible Diagnoses
Mesenteric ischemia
Mesenteric ischemia
Over age 60 years
Early frequent passage of mucosal
Nonspecific abdominal pain
Severe periumbilical pain
Bloody diarrhea
Abdominal distension
Continuous pain
Diffused
Diffused abdominal pain
Early severe abdominal pain
Moderate tenderness
No bowel sounds
Severe pain
Abdominal bruits
Peritoneal signs
Hematochezia
Severe abdominal pain
Weight loss
Diarrhea
Massive fluid protein and electrolytes start to leak
Peptic ulcer
Peptic ulcer
Centered in epigastrium
Epigastric pain
Awakes the patient from sleep
Relief with anti secretory agents
Recurs when stomach is empty
Burning pain
Upper abdomen discomfort
At night
Relieved by eating
Relief with antiacid
Gnawing pain
Worsens with eating
Dyspepsia
Patient show site of pain with one finger
Vomiting after eating
Radiate to back
Meal related
Recurrent abdominal pain
Weight loss
Anorexia
Dyspepsia
Dyspepsia
Burning
Early satiety
Epigastric pain
No evidence of structural disease to explain the symptoms
Postprandial fullness
Symptom onset at least six months
Discomfort or pain in upper belly
Ribs area pain
Upper belly disomfort
Upper belly pain
Upset stomach
Fullness
Last three months
Meal related
Bloating
Abdominal discomfort
Centered in the upper abdomen
Epigastric pain syndrome
Persistent abdominal pain
Postprandial distress syndrome
Pancreatitis
Gallstone pancreatitis
Discomfort
Left upper quadrant pain
Alleviated in fetal position
Worsens with movement
Acute upper abdominal pain
Boring pain
Periumbilical pain
Relief on bending forward
Relieved by sitting up
Epigastric pain
Vomiting
Pain radiate to back
Nausea
Clinical signs of hypocalcemia
Gradual pain
Worse when supine
Sudden onset
Fever
Guarding
Increased pain several weeks after onset
Acute pancreatitis
Nausea
Vomiting
Mild discomfort
Left upper quadrant pain
Alleviated in fetal position
Worsens with movement
Acute upper abdominal pain
Boring pain
Periumbilical pain
Relief on bending forward
Relieved by sitting up
Epigastric pain
Pain radiate to back
Signs of hypovolemia
Anorexia
Hypotension
Abdominal distention
Blue-red-purple of flanks
Clinical signs of hypocalcemia
Gradual pain
Biliary sod
Biliary sod
Presence of both elevated liver enzymes and a dilated cbd
Recurrent pain
Recurrent right upper quadrant pain
Epigastric pain
Last at least 30 minutes
Right upper quadrant pain
Exclusion of other structural disease explain symptoms
Moderate pain
Pain builds up to a steady level
Pain interrupt patients daily activities
Pain lead to an emergency department visit
Pain not relieved by antiacids
Pain not relieved by bowel movements
Pain not relieved by postural change
Recurrent symptoms occurring at different intervals not daily
Severe pain
Biliary type pain
Nausea
Pain awakening patient from sleep in middle of night
Pain radiating to back
Cholecystitis
Acute cholecystitis
Sudden onset
Pain persisting beyond 5 hours
Prolonged biliary pain
Prolonged right upper quadrant pain
Epigastric pain
Acute onset of upper abdominal pain
Upper abdominal pain
Abdominal pain
Steady pain
More severe than biliary colic
Severe pain
Positive murphy sign
Right upper quadrant pain
Unremitting right upper quadrant pain
Fever
Nausea
Murphy's sign
Vomiting
Previous episode of biliary pain
Low grade fever
Emphysematous cholecystitis
Sudden onset
Pain persisting beyond 5 hours
Prolonged biliary pain
Prolonged right upper quadrant pain
Epigastric pain
Acute onset of upper abdominal pain
Left hypochondrial pain
Left upper quadrant pain
Midline upper abdominal pain
Right hypochondrial pain
Abdominal pain
Steady pain
More severe than biliary colic
Severe pain
Positive murphy sign
Right upper quadrant pain
Unremitting right upper quadrant pain
Fever
Nausea
Murphy's sign
Hiatus hernia
Hiatus hernia
Substernal region pain
Epigastric pain
Nausea
Postprandial fullness
Retching
Substernal region fullness
Auscultation reveal gastric sounds in chest
Dysphagia
Dyspnea
Heartburn
Hematemesis
Painful swallowing
Reflux of sour liquid material
Wheezing
Chills
Confusion
Fevers
Nonbilious vomiting
Oropharyngitis
Esophageal dysphagia
Gastric volvulus
Gastric volvulus
Inability to pass a nasogastric tube
Pain in lower chest
Severe pain in upper abdomen
Severe vomiting
Abdominal pain
Chest pain
Borchardt triad
Dullness to percussion
Intermittent pain
Persistent retching
Recurrent vomiting
Severe chest pain
Severe pain
Stomach becomes dilated and fluid-filled
Sudden pain
Upper abdominal distention
Upper abdominal pain
Vague pain
Mild upper abdominal discomfort
Bloating
Pancreatic cancer
Pancreatic cancer
Asthenia
Weight loss
Anorexia
Abdominal pain
Intermittent pain
Epigastric pain
Jaundice
Intermittent abdominal pain
New onset of diabetes mellitus
Nausea
Midepigastric pain
Upper abdominal pain
Radiate to back
Radiate to sides
Hepatomegaly
Vomiting
Courvoisier sign
Trousseau syndrome
Palpable periumbilical mass
Abdominal mass
Biliary colic
Biliary colic
Plateauing within an hour
Acute
Dull discomfort
Steady fullness
Upper abdominal pain
Epigastric pain
Right upper quadrant pain
Subsides gradually over 30 minutes to several hours
Sudden onset pain
Constant pain
Intense pain
Recurrent attacks
Gnawing pain
Last at least 30 minutes
Episodes separate in months
Episodes separate in weeks
Diaphoresis
Restlessness
Deep pain
Hours to years frequency
Tinnitus
History Consider: Systemic illness Medication
PE, BP, Cerumen impaction, Perforated tympanic membrane, Otitis media, Localization
Nonlocalized tinnitus
Neurologic and psychiatric examination
Consider: Encephalitis of temporal lobe, Psychosis
Localized tinnitus
Auscultate external canal, carotids, skull
No sound noted on examination (Subjective tinnitus)
Consider: 90% otologic problem Metabolic disorders Depression/anxiety
Hearing Evaluation
Hearing loss
Peripheral tinnitus/cochlear: Symmetric hearing loss, Normal impedance, Normal speech discrimination
Consider: Presbycusis, Noise-induced hearing loss
Therapy: Hearing Aids, Masking, Biofeedback, Medications
Central tinnitus/retrocochlear: Asymmetric hearing loss, and/or Abnormal impedance, and/or Abnormal speech discrimination
MRI with Gadolinium
Cochlear
Retrocochlear
Mixed or conductive hearing loss
Consider: External/middle ear or nasopharyngeal pathologic condition
See Hearing Loss algorithm
Bruit or sound noted on examination
Objective tinnitus
Pulsatile
Consider: AV shunt, Arterial bruit, Venous hum, Valvular murmur
Otoscopy
Normal
Magnetic Resonance Angiography and Imaging
Retrotympanic mass
High-Resolution CT of Temporal Bones
Crackling
Worsens with external noise
Stapedial muscle spasm
Consider: Division of muscle
Clicking
EMG of palatal muscles
Tetanic contractions
Palatal myoclonus
Consider: Benzodiazepines
Blowing
Tympanic membrane fluctuates with respiration
Tympanometry
Patulous eustachian tube
ENT consult