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Questions and Answers

What is the purpose of asking about the duration of abdominal pain during history taking?

  • To find the exact cause of abdominal pain.
  • To determine if the pain is chronic or acute. (correct)
  • To evaluate response to previous treatments.
  • To identify the patient's level of concern.

Which factor is least likely to be considered when evaluating changes in bowel habits?

  • Consistency of stools.
  • Family history of gastrointestinal diseases.
  • Frequency of bowel movements.
  • The patient's employment status. (correct)

Which symptom could indicate a serious underlying condition according to the history taking guidelines?

  • Short-term nausea.
  • Intermittent abdominal discomfort.
  • Persistent weight loss. (correct)
  • Occasional heartburn.

Why is it important to know a patient’s nutritional history during gastrointestinal assessments?

<p>To see if the patient has food allergies. (A)</p> Signup and view all the answers

What does the nature of pain refer to in the context of gastrointestinal history taking?

<p>The quality and characteristics of pain. (A)</p> Signup and view all the answers

Which aspect of a patient's social history is most relevant in the gastrointestinal context?

<p>Smoking and alcohol consumption. (B)</p> Signup and view all the answers

Inquiring about the patient's menstrual history could be important for which of the following reasons?

<p>To assess potential hormonal influences on gastrointestinal symptoms. (A)</p> Signup and view all the answers

Which question regarding the patient's past drug use is critical due to its possible impact on liver health?

<p>Have you ever used herbal remedies? (A)</p> Signup and view all the answers

What is the initial position recommended for a patient during abdominal palpation?

<p>45 degrees with a pillow (A)</p> Signup and view all the answers

Which of the following signs indicates potential splenomegaly during examination?

<p>Palpation in the left hypochondrium (D)</p> Signup and view all the answers

What signifies a positive Murphy's sign during gallbladder examination?

<p>Inhibition of inspiration with pain (D)</p> Signup and view all the answers

When conducting an abdominal examination, what should be noted during the general inspection?

<p>Evidence of dehydration and jaundice (A)</p> Signup and view all the answers

What is the expected hand positioning when palpating the liver?

<p>Hand flat with fingers pointing upwards (A)</p> Signup and view all the answers

What technique is employed for palpating the kidneys during examination?

<p>Balloting with two hands (A)</p> Signup and view all the answers

Which abdominal sign is specifically looked for during the inspection phase?

<p>Signs of purpura (A), Kidney tenderness (B), Weight gain (C), Bowel sounds (D)</p> Signup and view all the answers

What position is required for deeper palpation after gaining the patient's confidence?

<p>Supine position (B)</p> Signup and view all the answers

Flashcards

Chief Complaint

The primary reason the patient is seeking medical attention, stated in the patient's own words.

Nature of Pain

Describing the character of the pain (e.g., sharp, dull, burning).

Site of Pain

The location of pain in the body.

Dysphagia

Difficulty swallowing.

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Bowel Habits

Frequency, consistency, and character of bowel movements.

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Nutritional History

Detailed account of the patient's eating habits, including diet, food preferences, allergies, fiber, and fluid intake.

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Medications

List of all prescription, over-the-counter, and herbal remedies, and recreational drugs, including dosages and frequency.

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Family History

Medical conditions in the patient's family, including diseases like liver, gallbladder, hepatitis, IBD, and colon cancer.

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Abdominal Examination

Systematic assessment of the abdomen, including inspection, palpation, and specific organ exams (liver, gallbladder, spleen, kidneys).

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Abdominal Inspection

Visual assessment of the abdomen for abnormalities like distension, bruising, scars, hernias, and peristalsis.

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Abdominal Palpation

Touching the abdomen to feel for organs, masses, and tenderness. Begin gently and gradually increase pressure.

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Liver Palpation

Examining the liver by placing a hand flat on the abdomen, positioned just under the liver.

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Gallbladder Palpation (Murphy's Sign)

Finding tenderness in the gallbladder region by palpating and asking the patient to breathe deep; positive if pain increases on inspiration.

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Splenomegaly Detection

Checking for an enlarged spleen by palpating below the left lower ribs.

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Kidney Palpation

Feeling for enlarged or palpable kidneys. Use two hands, pressing together over each area.

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Patient Positioning

Adjusting the patient's position for comfort and optimal examination access. Often starts at a 45-degree angle for comfort but then moves to supine for palpation.

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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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