diseases
History taking
Family history
Colon cancer
Gallstones
History taking
Diet
Drugs
Alcohol
Smoking
Transfusion
Iv. drug abuse
Lifestyle
Abdominal pain
Dysphagia
Nausea and vomiting
Anorexia and unexpected weight loss
Abdominal gas
Abdominal distension
Diarrhea
Constipation
Gastrointestinal bleeding
Jaundice
History taking
Abdominal pain
Localisation
Type
Severity
Chronology
Aggravating or relieving factors
Associated symptoms
Radiation of pain
Peritonitis
Intestinal obstruction
Irritable bowel syndrome
Tense ascites
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
History taking
Diabetic ketoacidosis
Hyperthyroidism
Acute intermittent porphyria
Hypercalcemia, hyperkalemia
Vasculitis
Pneumonia
Sickle cell crisis
Herpes zoster
Radiation of pain
History taking
Substernal pain
Cardiac pain
Esophageal pain
Radiation: left
Type: pressing,
constricting
Aggravating factors:
physical activity,
stress
Relieving factors:
nitrates
Associated symptoms:
dyspnoea, sweating
Radiation : back
Type:burning,
spasmodic
Aggravating factors:
body position, eating
Relieving factors:
antacid
Associated symptoms:
dysphagia,regurgitation
History taking
Dysphagiadifficulty in swallowing
Where is the food hanging up?
oropharyngeal or esophageal
Difficulty to swallow liquids?
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, medications
behavioral disorders: anorexia nervosa, depression
GI disorders: malignancy, malabsorption,
hepatic, biliary, pancreatic diseases
History taking
History taking
Abdominal gas
Belching, bloating (meteorism),
flatulence
Causes
Aerophagia (habitual, poor dentition, inadequate
chewing, rapid eating)
History taking
Bowel movement
Factors: frequency, volume, fluidity, color,
associated sensations, change in bowel habits,
stool calibre
Diarrhea
> 300 g of stool/day
more than 3 loose or watery
stools/day
Constipation two or less stools/week
History taking
Bowel movement
Stool alterations
Color
Content
- hypocholic, acholic
- pleiochromic
- bloody
- mucus
- blood
- fat - steatorrhea
- undigested proteins creatorrhea
History taking
Bowel movement
Constipation
Chronic or recent onset
Causes
History taking
GI bleeding
Classification
Hematemesis
Melena
Hematochezia
Occult bleeding
- fresh blood
- coffee ground
- blood on the stool
- blood mixed with the
stool
History taking
Jaundice
Observe it in bright, natural light
First time you can observe on the sclerae
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-red
obstructive: dark, brown
Associated symptoms: anemia, pain, fever,
hepatomegaly, splenomegaly, ascites
Physical examination
Inspection
Abdominal skin
Physical examination
Abdominal distension
Generalised
Localised
Obesity
Pregnancy
Ascites
Bowel obstruction ileus
Big ovarian cyst
Peritonitis
Hepatomegaly
Splenomegaly
Polycystic kidney
Gastric distension
Inflammatory mass
Tumor
Obstructed bladder
Hernia
Physical examination
Auscultation
Bowel sounds
Bruits
arterial
Physical examination
Percussion
Meteorism
Liver span midclavicular line: 6-12 cm
midsternal line: 4-8 cm
Splenic dullness
line
pathological:dullness in the ant. axillary line
during inspiration
Liver or/and splenic dullness absent:
perforation
Ascites
shifting dullness
Physical examination
Palpation
Position
Warm hands, short fingernails
Approach slowly, avoid quick
movements
Exemine tender areas at last
Watch the patients face
Physical examination
Palpation
1. Light palpation
a.
b.
Physical examination
Palpation
2. Deep palpation
a. assessing abdominal masses
b. assessing abdominal tenderness
Physical examination
Palpation
Characteristics of an abdominal mass
1.
2.
3.
4.
5.
6.
7.
8.
location
size
shape
consistency
surface
tenderness
movable or fixed
shifting by respiration
Physical examination
Physical examination
Physical examination
Physical examination