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Questions and Answers
What is the purpose of asking about the duration of abdominal pain during history taking?
What is the purpose of asking about the duration of abdominal pain during history taking?
Which factor is least likely to be considered when evaluating changes in bowel habits?
Which factor is least likely to be considered when evaluating changes in bowel habits?
Which symptom could indicate a serious underlying condition according to the history taking guidelines?
Which symptom could indicate a serious underlying condition according to the history taking guidelines?
Why is it important to know a patient’s nutritional history during gastrointestinal assessments?
Why is it important to know a patient’s nutritional history during gastrointestinal assessments?
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What does the nature of pain refer to in the context of gastrointestinal history taking?
What does the nature of pain refer to in the context of gastrointestinal history taking?
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Which aspect of a patient's social history is most relevant in the gastrointestinal context?
Which aspect of a patient's social history is most relevant in the gastrointestinal context?
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Inquiring about the patient's menstrual history could be important for which of the following reasons?
Inquiring about the patient's menstrual history could be important for which of the following reasons?
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Which question regarding the patient's past drug use is critical due to its possible impact on liver health?
Which question regarding the patient's past drug use is critical due to its possible impact on liver health?
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What is the initial position recommended for a patient during abdominal palpation?
What is the initial position recommended for a patient during abdominal palpation?
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Which of the following signs indicates potential splenomegaly during examination?
Which of the following signs indicates potential splenomegaly during examination?
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What signifies a positive Murphy's sign during gallbladder examination?
What signifies a positive Murphy's sign during gallbladder examination?
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When conducting an abdominal examination, what should be noted during the general inspection?
When conducting an abdominal examination, what should be noted during the general inspection?
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What is the expected hand positioning when palpating the liver?
What is the expected hand positioning when palpating the liver?
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What technique is employed for palpating the kidneys during examination?
What technique is employed for palpating the kidneys during examination?
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Which abdominal sign is specifically looked for during the inspection phase?
Which abdominal sign is specifically looked for during the inspection phase?
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What position is required for deeper palpation after gaining the patient's confidence?
What position is required for deeper palpation after gaining the patient's confidence?
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Study Notes
Al-Zahraa University for Women, College of Health and Medical Techniques, Anesthesia Department
- Practical/Gastrointestinal diseases (1) lecture (3)
- Second Stage
- Dr. Ghada Ali
History Taking
- Chief complaint
- Nature of the complaint
- Location (site) of the pain
- Radiation (spread) of the pain
- Time of onset of the pain
- Duration of the pain
- Relieving factors
- Precipitating factors
- Associated symptoms
Dysphagia
- Food regurgitation?
- Time elapsed after swallowing
- Burning pain after eating?
- Obstruction complaint: ask patient to indicate the level
- Abdominal pain complaint?
- Nature of the abdominal pain
- Location of the pain (ask patient to indicate)
- Aggravating or relieving factors (e.g., fatty foods, sitting forward, medication)
- Duration of the pain
- Radiation of the pain
Abdominal Pain
- Foregut pain: localized to the epigastric region
- Midgut pain: localized to the periumbilical region
- Hindgut pain: localized to the suprapubic region
Bowel Function
- Normal bowel habits and duration of changes
- Consistency of stool
- Fecal incontinence?
- Painful defecation?
- Blood or mucus in stool?
- Stool color
- Appetite (good or changed)?
- Weight change (up or down)?
- Duration and amount of weight change
- Malnutrition possible with significant weight loss
Menstrual and Social History
- Smoking, alcohol consumption, and exact quantities
- Medication history (including NSAIDs)
- Herbal remedies (potential for hepatitis)
- Opiate abuse (potential for nausea, anorexia, constipation)
- Intravenous drug use (risk of hepatitis C, B, and HIV)
- Cocaine derivatives (appetite suppression)
- Foreign travel history (possible traveler's diarrhea)
- Family history of liver, gallbladder, hepatitis, inflammatory bowel disease, or colon cancer
Nutritional History
- Diet history and food preferences
- 24-hour dietary recall
- Caffeine use
- Fluid intake and fiber intake
- Appetite and weight changes
- Food allergies or intolerances (e.g., lactose, gluten)
- Anorexia and weight loss may indicate cancer or inflammation
Examination: Preparation
- Adequate patient undressing and comfortable positioning
- Head slightly elevated with support (one pillow)
- Arms placed alongside the body (relaxes abdominal muscles)
- Explanation of procedure and permission to proceed
- Obesity can make examination more difficult
General Inspection
- Patient appearance (unwell?)
- Pain visibility
- Jaundice presence
- Dehydration signs
- Weight loss signs
- Purpura (skin discoloration)
- Abdominal inspection (distension, respiration, bruising, scars, herniae, visible peristalsis, masses)
Palpation of the Abdomen
- Inquiry about pain
- Patient positioning (initially at 45 degrees, then supine)
- Pillow support for head or knees as needed
- Ideal exposure from nipples to lower abdomen
- Patient to indicate pain location
- Gentle palpation to build trust and relaxation, progressing to deeper palpation
Examination of the Liver
- Beginning in the right iliac fossa, moving gently upward toward the right hypochondrium
- Examining hand flat on abdomen, fingers pointing upward parallel to the expected liver edge
- Gentle but deep palpation if no pain
- Instruct patient to take a deep breath while pressing inward and upward.
Examination of the Gallbladder
- Place examining fingers over gallbladder area
- Patient takes a deep breath
- Presence of sudden pain accentuation during inspiration may indicate a positive Murphy's sign.
Examination of the Spleen
- Place examining hand flat on abdomen, below the left costal margin
- Press inward and upward; request patient to breathe in
- If not palpable, have patient lie on right side, facing examiner
- Palpate up into left hypochondrium, asking for deep breaths.
- Other hand behind ribcage for support.
Palpation of the Kidneys
- Use two hands; one on the patient's right loin, the other on right upper quadrant
- Patient should breathe in and out
- Attempt to palpate enlarged kidneys (balloting).
- Repeat process for the left kidney.
- Percussion is used to determine if distention is due to solid or cystic tumors, ascites, or gas. A resonant abdomen may signal excessive flatus. Solid or liquid masses beneath the fingers are dull.
Auscultation of the Abdomen
- Bowel sounds are irregular, typically occurring every 5-10 seconds.
- Absence of bowel sounds could indicate paralytic ileus or peritonitis.
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