History taking 33

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Author:
prem77
ID:
280361
Filename:
History taking 33
Updated:
2014-08-07 13:31:31
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Examination an acute abdomen
Folders:
History taking
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  1. History

    1. Age
    • - Newborn - intestinal obstruction due to intestinal atresia and stenosis, meconium ileus, meconium peritonitis, imperforate anus, annular pancreas
    • - Infants - midgut vulvolus, intussusecption, meckel's diverticulitis
    • - Children - appendicitis, non specific mesenteric lymhadenitis, primary pneumococcal or streptococcal peritonitis, round worm intestinal obstruction,
    • - Young adults - appendicitis, meckel's diverticulitis
    • - Adults - perforation of of peptic ulcer, acute cholecystitis, acute pancreatitis,
    • - Elderly - sigmoid vulvolus, intestinal obstruction due to malignant growth, diverticulitis, mesenteric occlusive disease
  2. Sex
    • More common in females - acute cholecystitis, acute appendicitis, primary peritonitis
    • More common in males - Peptic ulcer, pancreatitis, volvulous, intussecption
  3. Occupation
    Recurrent abdominal colic due to lead poisoning, arsenic industries
  4. Social status
    • High income group - appendicitis,
    • Low income group - peptic ulcer
  5. Chief complains

    1. Pain
    • a. Time of onset
    • - Early morning - acute appendicitis
    • - Afternoon - perforation of peptic ulcer after lunch break but the patient is often brought to the hospital in night


    • b. Mode of onset -
    • - Sudden - perforation, colic, torsion, vulvulous
    • - Gradual - acute intestinal obstruction
    • - Dull in beginning and suddenly become acute - acute appendicitis

    • c. Similar history of pain in past
    • - appendicitis, cholecystitis, peptic ulcer


    • d. Site of pain
    • - Flanks - renal origin
    • - Right coastal margin - Liver, gall bladder
    • - Epigastric region - pancreatitis,  peptic ulcer perforation

    • e. Shifting of pain
    • - from umbilicus to RIF - acute appendicitis

    • f. Radiation of pain
    • - from right hypochondrium to right iliac fossa - peptic perforation
    • - from RIF to LIF - spreading peritonitis in acute appendicitis


    • g. Referred pain
    • - Stomach, duodenum and jejunum (T5-8) - Epigastrium
    • - Illeum and appendix (T9,10) - Periumbilicus
    • - Colon (T11-L2) - Hypogastrium
    • - Diaphragm (C3-5) - shoulder and upper part of the front of chest
    • - Renal colic  (L1,2- Genitofemoral nerve)- loin to groin, testis and inner side of thigh
    • - Biliary colic (T7-9) - inferior angle of right scapula

    • h. Character of pain
    • - Colicky pain - obstruction of hollow organ either bowel, common bile duct or renal pelvis/ureter
    • - Constant burning pain - peritonitis, perforated peptic ulcer
    • - Severe agonizing pain - acute pancreatitis, torsion
    • - Throbbing pain - inflammation as in hepatitis or cholecystits

    • i. Change in nature of pain
    • - Colicky pain of acute intestinal obstruction  change to constant burning pain - strangulation
    • - Dimunition of pain - second stage of peptic perforation

    • j. Effect of pressure
    • - relief - colicky pain
    • - increase - inflammatory conditions





    • k.  Aggravating factors
    • - Purgatives - acute appendicitis
    • - Straining - perforation
    • - walking and Jolting - Ureteric colic, amoebic hepatitis, cholecystitis, appendicitis
    • - Deep inspiration - diaphragmatic pleursity,
    • - Micturation (strangury) - ureteric colic, pelvic appendicitis, pelvic abscess
    • - Moving or rolling about - peritonitis,
    • - Fatty foods - cholecystitis
    • - Alcohol, acidic foods - peptic ulcer
    • - Stooping - reflux oesophagitis, hiatus hernia

    • l. Relieving factors
    • - Vomiting - peptic ulcer
    • - Stooping forewards - acute pancreatitis
    • - Local pressure - colicky pain
  6. Vomiting

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