HISTORY TAKING IN ABDOMEN CASE Name/Age/Sex/Occupation/Place PRESENTING COMPLAINTS H/o PRESENTING COMPLAINTS: Abdominal pain Duration Site Nature

ure (Continuous/ intermittent) Character (constant/colicky) Severity Radiation Aggravating/ Relieving factors Associated features (fever/ nausea/ vomiting/ defecation) Abdominal distension Duration Onset (insidious/ acute) Site (localized/ uniform) Progress RVF features Leg swelling Breathlessness Chest pain Liver features Loss of appetite Hematemesis/ Melena Constipation/ Obstipation Renal Oliguria Puffiness of face Frothy urine ( Nephrotic syndrome)

Vomitting/ Blood in vomit No. of episodes Duration Projectile Associated with nausea/ headache/ blurring of vision Quantity Character (colour/ smell/ blood stricken) Associated with food intake Associated features (pain/ melena/ hematemesis/ loss of consciousness) H/o drug intake(NSAIDs, steroids) Jaundice Duration Itching

Colour of urine/ stools Any fever with rigor Treatment taken Frequency Colour (dark/ tarry black/ pale) Consistency (solid/ liquid) Nature (sticky/ mucoid) Associated pain Blood streaks

Stools

Mass in abdomen Site Duration Progression Associated pain

NEGATIVE HISTORY

Fever

Duration and time of occurrence Grade (high/ low) Nature (continuous/remittent) Associated with rigors/ sweating

Upper GIT Dysphagia( solids/ liquids/ both) Heat burn Vomitting Urinary Tract Dysuria Pain/ burning micturition Oliguria Hematuria Frequency Fever with rigor H/o bleeding diathesis Epistaxis Bleeding gums Menorrhagia Prolonged bleeding after trauma H/o loss of appetite/ weight loss TB and malignancy H/o swelling of legs CVS

H/o puffiness of face renal H/o pruritides, bleeding per rectum liver H/o altered sleep pattern

PAST HISTORY H/o previous similar episodes H/o surgery/ drug intake Jaundice H/o tattooing H/o drug intake H/o blood transfusion H/o exposure to STDs H/o vaccination

Ascites

Previous abdomen surgeries(scar irritation) H/o TB, DM, IHD, HT H/o renal colic

FAMILY HISTORY Any similar history (Cirrhosis/ Wilsons disease/ a-1-AT/ HepA /HepB/ HepE) PERSONAL HISTORY Smoking Alcohol Diet (appetite) Sexual history Menstrual history/ obstetric history TREATMENT HISTORY SUMMARY : Age/ Sex/ Name? Personal h/o? Family h/o? Presenting complaints? Other relevant positive features. EXAMINATION OF ABDOMEN CASE GENERAL EXAMINATION

Conscious Cooperative Built Afebrile Cyanosis Anemia Jaundice Clubbing (Cirrhosis/ IBD/ Malabsorption syndrome) Significant lymphadenopathy Pedal edema

Markers of LIVER CELL FAILURE Head Alopecia Eye Bitot Spots (Vit A) Sub conjunctival hemorrhage (Vit K) Colour (anemia pale/ Jaundice yellow) Metabolism (KF Ring Wilsons/ Xanthelasma Fat)

Face

Medial surpaciliary madarosis Sunken eyes, cheeks Loss of facial hair Parotid enlargement Bleeding gums Fetor hepaticus Spider nevi Gynaecomastia Atrophy of breast Loss of pectoral hair, axillary hair, Pectoral muscle atrophy Dilated veins

Mouth

Chest

Hands Anemia Bounding pulse Clubbing Duputryens contracture Flapping tremor/ asterexis Erythema palmar Leuconychia Abdomen Distension Dilated veins ( Caput medusa) Testis Atrophy Pubic hairloss Tumor Lower limbs Pedal edema Chromic leg ulcers General Pruritis/ Spiderman appearance

Markers of TB Markers of HIV

PALPATION Superficial Palpation Warmth Tenderness Thrills Deep Palpation Liver A tender/ non tender swelling is palpable ______ cm below right costal margin in MCL extending from ________ (medial) to _____ (lateral) , with ______ (smooth/ nodular) surface and _____ (sharp/ rounded) margins, _____ (soft/ firm/ hard) in consistency. It _____ (moves, not) with respiration, not bimanually palpable, not able to insinuate fingers under the costal margin. Spleen Site Surface Tender Splenic abscess, IMV Extent Notch on medial border Consistency It moves with respiration, not bimanually palpable, not ballotable, upper border, cannot be felt, colonic band of resonance not felt. Kidney (Normally lower rt pole in thin individuals) It moves with respiration, bimanually palpable, ballotable, colonic band of resonance felt. Others Direction of blood flow Fluid thrill Abdominal girth measurement Inguinal/ Para Aortic/ Supraclavicular nodes

PERCUSSION Fluid Shifting dullness Puddle sign