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

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