Post on 02-Jun-2018
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History taking in abdominaldiseases
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History taking
Family history Colon cancer Gallstones
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History taking
Factors, habits and previousdiseases
Diet Drugs Alcohol Smoking Transfusion Iv. drug abuse Lifestyle
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History taking - summary Abdominal pain Dysphagia Nausea and vomiting Anorexia and unexpected weight loss Abdominal gas Abdominal distension Diarrhea Constipation Gastrointestinal bleeding Jaundice
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History taking
Abdominal pain Localisation Type
Severity Chronology Aggravating or relieving factors Associated symptoms Radiation of pain
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Diffuse abdominal pain
Peritonitis Intestinal obstruction
Irritable bowel syndrome Tense ascites
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Acute abdomen Peritonitis Appendicitis Bowel or gastric perforation Gallbladder perforation Intestinal obstruction (ileus) Mesenterial ischaemia Extrauterine pregnancy (ectopic pregnancy)
Acute necrotising pancreatitis Biliary colic Renal colic
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History taking
Other causes abdominal pain
Diabetic ketoacidosis Hyperthyroidism Acute intermittent porphyria Hypercalcemia, hyperkalemia Vasculitis Pneumonia Sickle cell crisis Herpes zoster
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Radiation of pain
Ulcer disease: to the back Biliary pain: to the back, right scapula,
right shoulder Pancreatic: band-like, to the back Kidney, ureter: to the genitalia, groin Splenic: left shoulder
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History taking
Substernal pain Cardiac painRadiation: leftType: pressing,
constrictingAggravating factors:
physical activity,stress
Relieving factors:nitrates
Associated symptoms:
dyspnoea, sweating
Esophageal painRadiation : backType:burning,
spasmodicAggravating factors:
body position, eating
Relieving factors:antacid
Associated symptoms:
dysphagia,regurgitation
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History taking
Dysphagia-difficulty in swallowing Where is the food hanging up?
oropharyngeal or esophageal Difficulty to swallow liquids?
Odynophagia- painful swallowing
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History taking
Weight loss Is it associated with anorexia? Chronology Severity (significant:> 5%
of body weight) Underlying diseases Causes:
general disorders: diabetes, hyperthyroidism,chr.infections,malignancy, medicationsbehavioral disorders: anorexia nervosa, depressionGI disorders: malignancy, malabsorption,
hepatic, biliary, pancreatic diseases
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History taking
Nausea and vomiting Organic, functional or psychogenic? connection with meals accompanied by weight loss
Content of the vomit Factors: taste, smell, color, pH Subtypes: acid : reflux disease, duodenal ulcer bile: bilio-pancreatic diseases
undigested food: obstruction of theupper GI
faeces (miserere): bowel obstruction(ileus)
blood: ie. ulcer, tumor, oes.varix
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History taking
Abdominal gas Belching, bloating (meteorism),
flatulence Causes
Aerophagia (habitual, poor dentition, inadequatechewing, rapid eating)
GI motor dysfunction or obstruction Malabsorption, maldigestion Bacterial overgrowth
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History taking
Bowel movement Factors: frequency, volume, fluidity, color,
associated sensations, change in bowel habits,stool calibre
Diarrhea> 300 g of stool/daymore than 3 loose or watery
stools/day Constipation two or less stools/week
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History taking
Bowel movement Stool alterations
Color - hypocholic, acholic- pleiochromic
- bloody Content - mucus
- blood
- fat - steatorrhea- undigested proteins -
creatorrhea
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History taking
Bowel movement Constipation
Chronic or recent onset Causes
Decreased fluid and/or food intake Functional (irritable bowel syndrome) Medications Hypothyroidism Fecal impaction Rectal or colon cancer Chronic debilitating disease
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History taking
GI bleeding Classification
Hematemesis - fresh blood- coffee ground
Melena Hematochezia - blood on the stool
- blood mixed with thestool
Occult bleeding
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History taking
Jaundice
Observe it in bright, natural light
First time you can observe on the sclerae
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History taking
Jaundice Important anamnestic factors Color of the skin: overproduction: lemon
obstructive: dark-yellow,
greenish Color of the stool: overproduction: dark, greenish
(pleiochromic)obstructive: hypocholic, acholic
Color of the urine: overproduction: cherry-redobstructive: dark, brown
Associated symptoms: anemia, pain, fever,hepatomegaly, splenomegaly, ascites
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Physical examination of theabdomen
1.Inspection2.Auscultation3.Percussion4. Palpation
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Position of the patient
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Physical examination Inspection
Configurations of the abdomenin the level or above or below the chest
apple-type : visceral obesity - cardiovascularrisk
pear-type : gluteal obesity Abdominal skin striae : white, livid (pink)
hernias veins : caput Medusae visible peristalsis visible pulsations scars
Physical examination
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Physical examination
Abdominal distension
Generalised Obesity
Pregnancy Ascites Bowel obstruction -
ileus Big ovarian cyst Peritonitis
Localised Hepatomegaly Splenomegaly Polycystic kidney Gastric distension Inflammatory mass Tumor Obstructed bladder Hernia
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Physical examination Auscultation
Bowel sounds above the umbilicus or in the RUQ normal: 5-35/min, clicks and gurgles altered: absent: paralytic ileus
hyperperistalsis: diarrhea,
mechanical bowel obstruction Bruits
arterial aortic, renal, iliac arteries
Friction rubs spleen, liver, peritonitis Succussion splash normal: above the
stomachpathologic: gastric or bowel obstruction
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Physical examination
Percussion
Meteorism Liver span midclavicular line: 6-12 cm
midsternal line: 4-8 cm Splenic dullness norm: in the midaxillary
line
pathological:dullness in the ant. axillary lineduring inspiration Liver or/and splenic dullness absent:
perforation
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Ascites shifting dullness
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Physical examination
Palpation Position Warm hands, short fingernails
Approach slowly, avoid quickmovements Exemine tender areas at last
Watch the patients face
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Physical examination
Palpation
1. Light palpationa. muscular resistance - guarding -
defense musculaireb. alterations in the abdominal wall
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Physical examination
Palpation
2. Deep palpationa. assessing abdominal massesb. assessing abdominal tenderness
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Physical examination
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y
Palpation of the liver andspleen
Characteristics:1. size
2. surface3. edge4. consistency
5. tenderness(6. liver pulsation)
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Physical examination
Palpation of the gallbladder Hydrops vesicae felleaeCurvoisiers sign - painless enlargement of
the gallbladder due to cancer of the head ofthe pancreas
Murphys sign - RUQ pain aggravated byinspiration - acute cholecystitis
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Physical examination
Palpation of the aorta to the left of the midline normal: < 3-4 cm >6 cm: aortic aneurysm transmitted pulsations: pancreatic or
gastric tumor, pseudocyst of thepancreas
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Physical examination
Rectal digital examination Perianal diseases fistulas, masses Anal alterations hemorrhoids, fisssuras, masses Rectal alterations polyp, neoplasm, ulcer Prostate gland Douglass space
Stool on the glove