52 Differential Diagnosis for PT: Hematological, Cardiovascular, Immune, and Digestive System Disorders: Summary
GI Screening Indications • History of serious GI disorder ○ Abdominal (epigastric), thorax, shoulder girdle pain ○ Abdominal (umbilical/hypogastric), lumbar, pelvic pain ○ Long-term use of NSAIDs, corticosteroids, or narcotics ○ Likelihood of abdominal symptoms being musculoskeletal in nature ■ If yes – Does coughing, sneezing, or taking a deep breath make the pain feel worse? – Do activities such as sitting, lifting, twisting, or turning over in bed make the pain feel worse? ■ If no : – Has there been any change in bowel
Guidelines for Immediate Medical Attention • Anytime appendicitis or iliopsoas/obturator abscess is suspected • Positive Kehr's sign: Acute pain in shoulder due to the presence of blood or other irritants in peritoneal cavity when lying down and legs are elevated Guidelines for Physician Referral • Clients who chronically rely on laxatives should be encouraged to discuss bowel management with their physician • Joint involvement accompanied by skin or eye lesions may be reflective of IBD and should be reported to the physician if they are unaware of these manifestations • Anyone with history of NSAID use presenting with back or shoulder pain, especially when accompanied by any associated signs and symptoms listed for peptic ulcer • Back pain associated with meals or relieved by a bowel movement (especially if accompanied by rectal bleeding) • Back pain of unknown cause that does not fit a musculoskeletal pattern
habits since the start of symptoms? – Does eating certain foods make the pain feel worse? – Has weight changed since symptoms started? o Sensitivity = 0.67; Specificity = 0.86
GI Signs and Symptoms • Abdominal pain
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• Indigestion; heartburn • Difficulty swallowing • Nausea/vomiting; loss of appetite • Diarrhea or constipation • Fecal incontinence • Skin rash followed by joint pain (Crohn's disease)
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