History taking in abdominal

diseases
 History taking

Family history
Colon cancer
Gallstones
 History taking

Factors, habits and previous

diseases
Diet
Drugs
Alcohol
Smoking
Transfusion
Iv. drug abuse
Lifestyle
 History taking - summary
Abdominal pain
Dysphagia
Nausea and vomiting
Anorexia and unexpected weight loss
Abdominal gas
Abdominal distension
Diarrhea
Constipation
Gastrointestinal bleeding
Jaundice
 History taking

Abdominal pain
Localisation
Type
Severity
Chronology
Aggravating or relieving factors
Associated symptoms
Radiation of pain
 Diffuse abdominal pain
Peritonitis
Intestinal obstruction
Irritable bowel syndrome
Tense ascites
 Acute abdomen
Peritonitis
Appendicitis
Bowel or gastric perforation
Gallbladder perforation
Intestinal obstruction (ileus)
Mesenterial ischaemia
Extrauterine pregnancy (ectopic pregnancy)
Acute necrotising pancreatitis
Biliary colic
Renal colic
 History taking

Other causes abdominal pain

Diabetic ketoacidosis
Hyperthyroidism
Acute intermittent porphyria
Hypercalcemia, hyperkalemia
Vasculitis
Pneumonia
Sickle cell crisis
Herpes zoster
 Radiation of pain

Ulcer disease: to the back

Biliary pain: to the back, right scapula,
right shoulder
Pancreatic: band-like, to the back
Kidney, ureter: to the genitalia, groin
Splenic: left shoulder
 History taking

Substernal pain
Cardiac pain Esophageal pain
Radiation: left Radiation : back
Type: pressing, Type:burning, spasmodic
constricting Aggravating factors:
Aggravating factors: body position, eating
physical activity, stress
Relieving factors: Relieving factors:
nitrates antacid
Associated symptoms: Associated symptoms:
dyspnoea, sweating dysphagia,regurgitation
History taking

Dysphagia-
difficulty in swallowing
Where is the food hanging up?
oropharyngeal or esophageal
Difficulty to swallow liquids?

Odynophagia- painful swallowing

 History taking

Weight loss
Is it associated with anorexia?
Chronology
Severity (significant:> 5%
of body weight)
Underlying diseases
Causes:
general disorders: diabetes, hyperthyroidism,
chr.infections,malignancy, medications
behavioral disorders: anorexia nervosa, depression
GI disorders: malignancy, malabsorption,
hepatic, biliary, pancreatic diseases
 History taking

Nausea and vomiting

Organic, functional or psychogenic?
connection with meals
accompanied by weight loss
Content of the vomit
Factors: taste, smell, color, pH
Subtypes: acid : reflux disease, duodenal ulcer
bile: bilio-pancreatic diseases
undigested food: obstruction of the
upper GI
faeces (miserere): bowel obstruction
(ileus)
blood: ie. ulcer, tumor, oes.varix
 History taking

Abdominal gas
Belching, bloating (meteorism),
flatulence
Causes
Aerophagia (habitual, poor dentition, inadequate
chewing, rapid eating)
GI motor dysfunction or obstruction
Malabsorption, maldigestion
Bacterial overgrowth
 History taking

Bowel movement
Factors: frequency, volume, fluidity, color,
associated sensations, change in bowel habits,
stool calibre
Diarrhea
> 300 g of stool/day
more than 3 loose or watery
stools/day
Constipation two or less stools/week
 History taking

Bowel movement
Stool alterations
Color - hypocholic, acholic
- pleiochromic
- bloody
Content - mucus
- blood
- fat - steatorrhea
- undigested proteins -
creatorrhea
 History taking

Bowel movement
Constipation
Chronic or recent onset
Causes
Decreased fluid and/or food intake
Functional (irritable bowel syndrome)
Medications
Hypothyroidism
Fecal impaction
Rectal or colon cancer
Chronic debilitating disease
 History taking

GI bleeding
Classification
Hematemesis - fresh blood
- coffee ground
Melena
Hematochezia - blood on the stool
- blood mixed with the
stool
Occult bleeding
 History taking

Jaundice

Observe it in bright, natural light

First time you can observe on the sclerae

 History taking

Jaundice
Important anamnestic factors
Color of the skin: overproduction: lemon
obstructive: dark-yellow,
greenish
Color of the stool: overproduction: dark, greenish
(pleiochromic)
obstructive: hypocholic, acholic
Color of the urine: overproduction: cherry-red
obstructive: dark, brown
Associated symptoms: anemia, pain, fever, hepatomegaly,
splenomegaly, ascites
Physical examination of the

abdomen

1.Inspection

2.Auscultation
3.Percussion
4. Palpation
Position of the patient
 Physical examination

Inspection
Configurations of the abdomen
in the level or above or below the chest
apple-type : visceral obesity - cardiovascular
risk
pear-type : gluteal obesity
Abdominal skin
striae : white, livid (pink)
hernias
veins : caput Medusae
visible peristalsis
visible pulsations
scars
 Physical examination

Abdominal distension

Generalised Localised
Obesity Hepatomegaly
Pregnancy Splenomegaly
Ascites Polycystic kidney
Bowel obstruction - Gastric distension
ileus Inflammatory mass
Big ovarian cyst Tumor
Peritonitis Obstructed bladder
Hernia
 Physical examination

Auscultation
Bowel sounds
above the umbilicus or in the RUQ
normal: 5-35/min, clicks and gurgles
altered: absent: paralytic ileus
hyperperistalsis: diarrhea,
mechanical bowel obstruction
Bruits
arterial aortic, renal, iliac arteries
Friction rubs spleen, liver, peritonitis
Succussion splash normal: above the
stomach
pathologic: gastric or bowel obstruction
 Physical examination

Percussion
Meteorism
Liver span midclavicular line: 6-12 cm
midsternal line: 4-8 cm
Splenic dullness norm: in the midaxillary line
pathological:dullness in the ant. axillary line
during inspiration
Liver or/and splenic dullness absent: perforation
Ascites shifting dullness
 Physical examination

Palpation
Position
Warm hands, short fingernails
Approach slowly, avoid quick
movements
Exemine tender areas at last
Watch the patients face
 Physical examination

Palpation
1. Light palpation
a. muscular resistance - guarding -
defense musculaire
b. alterations in the abdominal wall
 Physical examination

Palpation
2. Deep palpation
a. assessing abdominal masses
b. assessing abdominal tenderness
 Physical examination

Palpation
Characteristics of an abdominal mass
1. location
2. size
3. shape
4. consistency
5. surface
6. tenderness
7. movable or fixed
8. shifting by respiration
 Physical examination

Palpation of the liver and

spleen
Characteristics:
1. size
2. surface
3. edge
4. consistency
5. tenderness
(6. liver pulsation)
 Physical examination

Palpation of the gallbladder

Hydrops vesicae felleae
Curvoisiers sign - painless enlargement of
the gallbladder due to cancer of the head of
the pancreas

Murphys sign - RUQ pain aggravated by

inspiration - acute cholecystitis
 Physical examination

Palpation of the aorta

to the left of the midline
normal: < 3-4 cm
>6 cm: aortic aneurysm
transmitted pulsations: pancreatic or
gastric tumor, pseudocyst of the
pancreas
 Physical examination

Rectal digital examination

Perianal diseases fistulas, masses
Anal alterations hemorrhoids, fisssuras, masses
Rectal alterations polyp, neoplasm, ulcer
Prostate gland
Douglass space
Stool on the glove