POM M9 PEPSINOGEN HCl + Intrinsic Factors

Anatomical Ex: Gastric Outlet Obstruction SYSTEMIC DISEASE Infection Diabetes (diabetic gastroparesis) Due to weakening of nerves that affects the autonomic nerves

LIPASES & PROTEASES Activated upon secretion of HCl

DUODENUM CHOLECYSTOKININ o o Stimulates the gall bladder to contract SPHINCTER OF ODDI Guards the Ampulla of Vater 3.

Know the systemic diseases suffered by the patients

DIARRHEA OSMOTIC High sugar, fat Watery stool INFLAMMATORY Mucus INFECTIOUS Pus Blood if invasive DYSMOTILITY Semi-solid Scattered 3 hours gastric emptying

Ileum ends at Right Lower Quadrant where Cecum strats

HISTORY COMMON CHIEF COMPLAINTS: 1. ABDOMINAL PAIN a. VISCERAL PAIN Autonomic (feels stretch) Generalized Patient is restless and keeps on moving b. PARIETAL PAIN Somatic (feels pain) Localized peritonitis Contact with the purulent area Patient doesnt move c. REFERRED PAIN Structures of the same dermatome Level (innervation) CELIAC PLEXUS Starts at L1 ACUTE APPENDICITIS Parietal pain 2. VOMITING OBSTRUCTION 4.

CONSTIPATION OBSTRUCTION DIET Hydration Amount of fiber SYSTEMIC DISEASE DIABETES neuropathy DRUG EFFECTS

PHYSICAL EXAMINATION INSPECTION o o Symmetry Color

Icteric/jaundice Obstruction of bile

Change from a stable state Size/shape Striae previous pregnancies -Rosette Go 090510

Scars Previous surgical procedures

PALPATION o o Tenderness Rigidity o Muscle guarding

Organomegally Liver, spleen

PERCUSSION o o Tympani GAS Dullness SOLID

AUSCULTATION o BOWEL SOUNDS 5 35/minutes intervals Squishy Borborygmi long squishing peristaltic sound Bruit Squishy Vascular in nature Coincide with systolic part of cardiac cycle Related to atherosclerosis (narrowing of abdominal aorta)

Auscultate first

Most common cause of Epigastric Problem Peptic Ulcer Disease (stomach)