 
Class of 2023
 Go Back | | Session Title: | | SURG: Undifferentiated Abdominal Pain | | | | Description: | | | | Keywords: |
| Blueprint ID | Learning Objectives | | 1280 | Gather a complete or problem-focused history with emphasis on the following: (a) characterization of pain (location, severity, character, pattern) (b) temporal sequence (onset, frequency, duration, progression) (c) alleviating/exacerbating factors (position, food, activity, medications) (d) associated signs/symptoms (nausea, vomiting, fever, chills, anorexia, weight loss, cough, dysphagia, dysuria/frequency) altered bowel function (diarrhea, constipation, obstipation, hematochezia, melena, etc.) (e) pertinent medical history: prior surgery or illness, associated conditions (pregnancy, menstrual cycle, diabetes, atrial fibrillation or cardiovascular disease, immunosuppression) (f) medications: anticoagulation, steroids, etc. | | 1281 | Demonstrate the components of a complete abdominal examination including rectal, genital, and pelvic examinations. (a) Relate the significance of the various component examinations: observation, auscultation, percussion, and palpation as they apply to common abdominal pathologic processes. Examples: distention, visible peristalsis, high- pitched or absent bowel sounds, tympany, mass, localized vs. generalized guarding, and/or rebound tenderness. | | 1282 | Demonstrate and relate the significance of various maneuvers utilized in evaluating acute abdominal pain. Examples: iliopsoas sign, Rovsing’s sign, obturator sign, Murphy’s sign, cough tenderness, heel tap, cervical motion, tenderness. | | 1283 | Describe the keys to successful examination of infants and children with abdominal pain. Characterize examination skills that may be utilized in pregnancy or in patients with altered neurologic status. | | 1284 | Develop a differential diagnosis for various patients presenting with acute abdominal pain. Differentiate based on the following: (a) location: RUQ, epigastric, LUQ, RLQ, LLQ (b) symptom complex, e.g., periumbilical pain localizing to RLQ, acute onset left flank pain with radiation to the testicle, etc. (c) age: pediatric, adult, geriatric (d) associated conditions: pregnancy, immunosuppression (AIDS, transplant, chemotherapy/radiation therapy) | | 1285 | Explain the rationale for utilizing various diagnostic modalities in the evaluation of abdominal pain. (a) laboratory: CBC, amylase, electrolytes, BUN, creatinine, glucose, urinalysis, beta-HCG, liver profile (b) diagnostic imaging: flat and upright abdominal radiographs, upright chest X-ray, abdominal ultrasonography, CT scan of abdomen and pelvis, GI contrast radiography, angiography, IVP (c) special diagnostic/interventional techniques: upper endoscopy, procto-sigmoidoscopy, colonoscopy, laparoscopy | | 1286 | Discuss the presentation, diagnostic strategy, and initial treatment of patients presenting with common or catastrophic painful abdominal conditions. (a) acute appendicitis (b) cholecystitis/biliary (c) colic/choledocholithiasis/cholangitis (d) pancreatitis (e) peptic ulcer disease with and without perforation (f) gastroesophageal reflux (g) gastritis/duodenitis (h) diverticulitis (i) inflammatory bowel disease (j) enterocolitis (k) small bowel obstruction: incarcerated hernia, adhesions, tumour (l) colon obstruction: volvulus, tumour, stricture (m) splenomegaly/splenic rupture (n) mesenteric ischemia (o) leaking abdominal aortic aneurysm (p) gynecologic etiologies: ectopic pregnancy, ovarian cysts (torsion, hemorrhage, rupture), tubo-ovarian abscess, salpingitis, endometriosis (q) genitourinary etiologies: UTI, pyelonephritis, ureterolithiasis, testicular torsion | | 1287 | Discuss the common non-surgical conditions that can present with abdominal pain. Examples: MI, pneumonia, pleuritis, hepatitis, gastroenteritis, mesenteric adenitis, sickle cell crisis, DKA, herpes zoster, nerve root compression. | | 1288 | Compare and contrast acute appendicitis in young adults, the very young, very old, and pregnant women. Discuss issues relevant to presentation, diagnosis, treatment, complications, etc. Example: perforation risk. | | 1289 | Discuss the diagnosis and treatment of abdominal problems with particular relevance to the pediatric population. Include neonates, infants, children, and adolescents. List the abdominal problems characteristic of each group, and outline diagnostic and intervention strategies for the following: (a) congenital: hernias, malrotation, midgut volvulus (b) Hitschspring’s disease (c) pyloric stenosis (d) intussuception (e) Meckel’s diverticulitis (f) child abuse | | 1290 | Describe the normal bacterial flora of the GI, GU and GYN systems, and compare to pathological infections. (a) Discuss appropriate antibiotic therapy where indicated in various conditions manifesting with abdominal pain. | | 1291 | Discuss the approach to patients with post-operative abdominal pain. Contrast findings in non-operated patients with regard to the following: (a) presentation (b) examination (c) differential diagnosis (d) intervention strategies | | 1292 | Gather a focused history and physical examination including rectal/ genital and pelvic examinations with emphasis on characterization of findings, differentiation of signs/symptoms of peritonitis and adjunctive maneuvers to enhance diagnostic abilities. | | 1293 | Interpret laboratory findings and various imaging modalities that contribute to the diagnosis of common abdominal problems. Consider plain films of the abdomen, CT scans, ultrasound, etc. | | 1294 | Demonstrate correct place of the following: (a) nasogastric tubes (b) peripheral intravenous catheters (c) venipuncture and insertion of Foley catheters | | 1295 | Compose appropriate admission orders as part of the initial assessment and care of patients with acute abdominal pain. | | |
| Blueprint ID | Course Goals | | 11632 | EPA 1 (AFMC): Obtain a history and perform a physical examination adapted to the patient''s clinical situation.
Linked Program Competencies
To This Course Goal: me-1 me-2 cm-1 cm-2 ld-3 ha-1 sc-1 sc-2 pr-1 | | 11633 | EPA 2 (AFMC): Formulate and justify a prioritized differential diagnosis.
Linked Program Competencies
To This Course Goal: me-4 me-6 cm-1 cm-2 cm-3 co-3 ld-3 ha-1 ha-2 sc-2 pr-1 | | 11634 | EPA 3 (AFMC): Formulate an initial plan of investigation based on the diagnostic hypotheses.
Linked Program Competencies
To This Course Goal: me-4 me-5 me-6 cm-1 cm-2 cm-3 cm-4 cm-5 ld-2 ld-3 ha-1 ha-2 sc-1 sc-2 pr-1 | | 11635 | EPA 4 (AFMC): Interpret and communicate results of common diagnostic and screening tests.
Linked Program Competencies
To This Course Goal: me-4 me-5 me-6 cm-1 cm-3 cm-5 co-1 co-3 ld-3 ha-1 ha-2 sc-1 sc-2 sc-3 pr-1 | | 11636 | EPA 5 (AFMC): Formulate, communicate and implement management plans.
Linked Program Competencies
To This Course Goal: me-4 me-5 me-6 cm-1 cm-2 cm-3 cm-4 cm-5 co-1 co-2 co-3 ld-2 ld-3 ha-1 ha-2 sc-1 sc-2 sc-3 pr-1 | | 11637 | EPA 6 (AFMC): Present oral and written reports that document a clinical encounter.
Linked Program Competencies
To This Course Goal: me-4 me-5 me-6 cm-1 cm-3 cm-5 co-1 co-3 ld-2 ld-3 ha-1 ha-2 ha-3 sc-1 sc-2 sc-3 pr-1 | | 11638 | EPA 7 (AFMC): Provide and receive the handover in transitions of care.
Linked Program Competencies
To This Course Goal: me-4 me-5 me-6 cm-1 cm-2 cm-3 cm-4 cm-5 co-1 co-2 co-3 ld-2 ld-3 ha-1 ha-2 ha-3 sc-1 sc-2 pr-1 | | 11639 | EPA 8 (AFMC): Recognize a patient requiring urgent or emergent care, provide initial management and seek help.
Linked Program Competencies
To This Course Goal: me-1 me-2 me-3 me-4 me-5 me-6 cm-1 cm-2 cm-3 cm-4 cm-5 co-1 co-2 co-3 ld-1 ld-2 ld-3 ha-1 sc-1 sc-2 sc-3 pr-1 | | 11640 | EPA 9 (AFMC): Communicate in difficult situations.
Linked Program Competencies
To This Course Goal: me-4 me-5 me-6 cm-1 cm-2 cm-3 cm-4 cm-5 co-1 co-2 co-3 co-4 ld-1 ld-2 ld-3 ha-1 ha-2 ha-3 sc-1 sc-2 sc-3 pr-1 | | me-1 | Medical Expert
Perform a complete and accurate patient-centred history appropriate to the patient’s presentation. | | me-2 | Medical Expert
Perform a complete and accurate physical examination appropriate to the patient’s presentation. | | cm-1 | Communicator
Develop and maintain appropriate ethical and therapeutic relationships, rapport and trust with patients and their families. | | cm-2 | Communicator
Collect and synthesize accurate and relevant information, incorporating perspectives from patients and their families, colleagues and other health care professionals. | | ld-3 | Leader
Describe the roles and responsibilities of physicians and governing bodies in the development and support of the health care system. | | ha-1 | Health Advocate
Identify the important determinants of health, risk factors for illness, interaction between the population and their physical, biological and social environment, and personal attributes. | | sc-1 | Scholar
Develop a plan for personal continued education. | | sc-2 | Scholar
Apply the principles of research, critical appraisal and evidence-based medicine to learning and practice. | | pr-1 | Professional
Demonstrate accountability to patients by applying best practices and adhering to high ethical standards. | | me-4 | Medical Expert
Develop a differential diagnosis and key clinical problem list following assessment of a patient. | | me-6 | Medical Expert
Apply knowledge of the clinical, socio-behavioural, and fundamental biomedical sciences relevant to a clinical problem. | | cm-3 | Communicator
Discuss relevant health care information and management plans with patients and their families. | | co-3 | Collaborator
Demonstrate respect for health care team members without bias (e.g., bias related to gender, ethnicity, cultural background or health care role). | | ha-2 | Health Advocate
Identify public policies and trends that affect health locally, nationally, and globally, and barriers to access for populations, including persons with disabilities, the underserved and the marginalized. | | me-5 | Medical Expert
Develop a management plan for key clinical problems following assessment of a patient. | | cm-4 | Communicator
Develop a shared plan of care with patients, their families, and other health care professionals. | | cm-5 | Communicator
Demonstrate effective oral and written communication of information associated with a medical encounter. | | ld-2 | Leader
Apply evidence and management processes to effectively allocate health care resources. | | co-1 | Collaborator
Demonstrate effective collaboration skills within the health care system. | | sc-3 | Scholar
Demonstrate facilitation of learning for health care professionals, patients and society as part of the professional responsibility. | | co-2 | Collaborator
Demonstrate effective consultation with other health care professionals to provide care for individuals, communities, and populations. | | ha-3 | Health Advocate
Assess and respond to issues in the Canadian health care system and advocate for patients at all levels. | | me-3 | Medical Expert
Formulate an initial plan of appropriate diagnostic and therapeutic procedures relevant to the patient’s presentation. | | ld-1 | Leader
Identify strategies to effectively manage practice and career. | | co-4 | Collaborator
Demonstrate effective strategies to promote understanding, manage differences and resolve conflicts through negotiation and collaboration. |
| (016-1) ADULT CONSTIPATION | | (003-2) ACUTE ABDOMINAL PAIN | | (003-4) ANORECTAL PAIN | | (003-3) CHRONIC ABDOMINAL PAIN | | (114-1) CHILD ABUSE | | (067-1-2-1) GENERALIZED PAIN DISORDERS | | (002-4) HERNIA (ABDOMINAL WALL AND GROIN) | | (012-2) CALCIUM DISORDERS | | (002) ABDOMINAL / PELVIC MASS | | (073) PELVIC PAIN | | (001) ABDOMINAL DISTENSION |
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