med 2.1c history notes of the abdomen
DESCRIPTION
MedTRANSCRIPT
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TRANSCRIBED BY: WENG, DAWNN, JAZZY, RUSTY, FERY
chorva chorva Paulo Coelho
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Dr. Bates. Sanity is a cozy lie Susan Sontag Pasa
History Taking of the Abdomen and Supplemental
2.1c 4 Aug
2014
ANATOMY OF ABDOMEN BY QUADRANTS
Right Upper Quadrant Upper Midline Left Upper Quadrant
Liver o soft consistency o lower edge is palpabale at the
costal margin
Gallbladder and duodenum are not palpable
Kidney o Lower pole is usually felt especially
in thin people with relaxed abdominal muscles
Xiphoid Process
Abdominal Aorta usually has visible pulsations
Spleen o Above the left kidney at the
midaxillary line o Tip of the spleen may be
palpable below the left costal margin
Pancreas not palpable
Right Lower Quadrant Lower Midline Left Lower Quadrant
Appendix and Cecum not palpable
Ileocecal junction not palpable
Bladder o Distended may be
palpated o 300 ml of urine normal o 400-500 full capacity of the
bladder
Sacral Promontory S1
Uterus and ovaries - women
Portions of Transverse, Descending Colon may be palpable
Sigmoid Colon
ABDOMINAL PAIN
VISCERAL PAIN o Distention of hollow abdominal organs biliary tree and
intestines o Solid organs such as liver painful when capsules are
stretched o May be difficult to localize o May be due to ischemia o Described as burning, gnawing, cramping, or aching
Examples:
o RUQ pain Liver distention due to capsule irritation (alcoholic hepatitis), biliary tree
o Periumbilical pain - early acute appendicitis (changes to parietal pain in the right lower quadrant peritoneal inflammation)
o Small intestine and proximal colon o Epigastric pain stomach, duodenum, pancreas o Suprapubic Pain rectum o Hypogastric colon, bladder, uterus
PARIETAL PAIN
o Inflammation of the PARIETAL PERITONEUM o Steady, aching, and more severe pain o Localized o Aggravated by movement and coughing patients prefer
to lie still
REFERRED PAIN o Distant sites innervated at the same spinal level o Develops as more pain becomes intense o Usually localized but can be superficial or deep
Examples: o Duodenal/ Pancreatic Back o Biliary Tree Right shoulder or Right Posterior Chest o Pleuritic Pain or MI Epigastric Area
UPPER ABDOMINAL PAIN
ACUTE PAIN
Doubling Over with Cramping Colicky Pain
Renal Stone
Sudden knifelike Epigastric Pain
Gallstone Pancreatitis
Epigastric Pain GERD, Gastritis
RUQ Pain Cholecystitis
CHRONIC PAIN
Pain precipitated by exertion and relieved by rest
Angina from inferior wall CAD
Dyspepsia Chronic or recurrent discomfort or pain
Discomfort Subjective negative feeling that is NONPAINFUL
Bloating Inflammatory Bowel Disease
Belching Aerophagia
Functional or nonulcer dyspepsia
3 month hx iof nonspecific upper abdominal discomfort not attributable to structural abnormalities May be caused by H. pylori
CHRONIC: Gastroesophageal Reflux Disease (GERD)
Mucosal damage on endoscopy
Associated with: o Heartburn rising retrosternal burning pain or
discomfort occurring weekly or more often o Acid Reflux o Regurgitation o Atypical Respiratory Symptoms cough, wheeze,
aspiration pneumonia o Pharyngeal Symptoms chronic sore throat,
hoarseness, laryngitis o Alarm symptoms dysphagia, odynophagia, GI
bleeding, weight loss, recurrent vomiting, anemia, palpable mass, jaundice
Warrants endoscopy to check for Barretts esophagus Squamocolumnar Junction is displaced proximally and there is intestinal metaplasia
LOWER ABDOMINAL PAIN
ACUTE PAIN
RLQ Pain periumbilical + rigidity upon palpation
Appendicitis In women, PELVIC INFLAMMATORY DISEASE, RUPTURED OVARIAN FOLLICLE, ECTOPIC PREGNANCY
Cramping Pain radiating to right or left
Renal Stone
LLQ Pain Diverticulitis
Diffuse abdominal pain with absent bowel sounds and firmness , guarding, and reboud tenderness
Small or Large Bowel obstruction
CHRONIC PAIN
Change in bowel habits with mass lesion
Colon CA
Intermittent pain for 12 weeks of preceding 12 months with relief of defecation, change in bowel habits, stool consistency
Irritable bowel SYNDROME
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TRANSCRIBED BY: WENG, DAWNN, JAZZY, RUSTY, FERY
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Abdomen
GI SYMPTOMS Associated with PAIN
NAUSEA feeling sick to the stomach
RETCHING involuntary spasm of the stomach, diaphragm, and esophagus, precedes and culminates in vomiting
REGURGIATION raising esophageal or gastric contents without nausea or retching
o FECAL ODOR - suggests small bowel obstruction or gastrocolic fistula
HEMATEMESIS coffee ground emesis or red blood emesis or vomitus. May suggest esophageal varices or peptic ulcer disease
ANOREXIA loss of appetite
DYSPHAGIA difficulty swallowing from impaired passage of solid foods or liquids from mouth to stomach. May suggest motility or swallowing disorders
o Lump in the throat is NOT true dysphagia
ODYNOPHAGIA pain upon swallowing
FLATUS excessive passage of gas (600ml/day)
DIARRHEA
increased water content of stool or stool volume or > 200g in 24 hours
o ACUTE 2 weeks. Caused by infection
o CHRONIC 4 weeks or more Crohns Disease or Ulcerative Colitis
TENESMUS constant urge to defecate, accompanied by pain, cramping, and involuntary straining
HIGH VOLUME, frequent and watery small intestine
SMALL VOLUME with tenesmus rectal inflammation
CONSTIPATION
present for 12 weeks of the prior 6 months with at least 2 of the following:
o < 3 bowel movements per week o Iumpy or hard stools o Manual facilitation o More defecations with straining
Thin-pencil like stool Apple-Core lesion of sigmoid colon (Colon CA)
OBSTIPATION no passage of either feces or gas. Suggests intestinal obstruction
MELENA black tarry stools, and can be as little as 100 ml or bleed. UPPER GI
HEMATOCHEZIA bright, maroon red, and can be >1000 ml or blood from LOWER GI
Blood on tissue paper - hemorrhoids
JAUNDICE
yellowish discoloration of skin
Intrahepatic o Hepatocellular liver damage o Cholestatic impaired excretion due to damaged
hepatocytes or intrahepatic bile ducts (viral hepatitis, cirrhosis, biliary cirrhosis, etc)
Extrahepatic obstruction of cystic and common bile ducts(gallstones or pancreatic CA)
o ACHOLIC STOOLS gray light-colored stools
Conjugated Bilirubin o Can be excreted in the urine o Yellowish brown or tea-colored o Unconjugated bilirubin is not soluble