Knowledge - Students should be able to be define and describe the:

1. Pathophysiologic mechanisms of abdominal pain that mediate obstruction, peritoneal irritation, referred pain, vascular insufficiency, motility dysfunction, mucosal irritation and psychopathology; and that these varied mechanisms of abdominal pain explain the differences in clinical presentations.
2. Signs and symptoms of the common causes of abdominal pain, such as peptic ulcer disease, dyspepsia, cholecystitis and biliary tract disease, pancreatitis, appendicitis, diverticular disease, irritable bowel syndrome, intestinal obstruction, ileus and ischemic bowel.
3. Signs and symptoms of the acute abdomen and differentiate this from chronic abdominal pain situations.

Skills - Students should be able to:

1. Obtain, document and present an appropriate and accurate medical history that differentiates between the etiologies of abdominal pain. Understand that the broad differential diagnosis in patients with abdominal pain can be narrowed significantly by a careful medical history.
2. Perform an accurate physical examination that recognizes peritoneal irritation, guarding, abdominal tenderness, masses in the abdomen/pelvis/rectum, ascites, organomegaly, vascular bruits.
3. Generate a specific differential diagnosis after careful medical history and physical examination.
4. Recommend appropriate laboratory studies and be able to interpret results obtained. Know when to order appropriate endoscopic procedure, ultrasound examination, CT scans, nuclear medicine studies.
5. Communicate with the patient and explain the results of the evaluation.
6. Develop an appropriate treatment plan for the patient based on the diagnosis that includes drug therapy (if indicated), consultation with subspecialists (GI medicine and surgery), pain management, psychotherapy, patient education.

Attitudes and Professional Behaviors:

• Students should recognize the impact of chronic abdominal pain on patient's lifestyle and its impact on the utilization of medical resources.

Recommended Readings:

1. Harrison's Principle of Internal Medicine B 14th Edition