Gastrointestinal Diseases Notes PDF

AL-Zahraa University for Women College of Health and Medical Techniques Anesthesia Department practical/Gastrointetinal diseases(1)/lec(3) Second stage Dr.Ghada Ali History taking: Chief complaint: Nature Site Radiation Time Duration...

AL-Zahraa University for Women College of Health and Medical Techniques Anesthesia Department practical/Gastrointetinal diseases(1)/lec(3) Second stage Dr.Ghada Ali History taking: Chief complaint: Nature Site Radiation Time Duration Relieving factor Precipitating factor Associating symptoms  Dysphagia Is food regurgitated? If so, how long after swallowing? Is it a burning pain just after eating? If there is complaint of obstruction, ask the patient to point to the level. Abdominal pain If there is complaint of abdominal pain? What is the nature of the pain? ask the patient to point to the location of the pain. Are there any aggravating or relieving factors? may include fatty food, sitting forward or taking medication. How long does it last? Is there radiation? Abdominal pain  Bowel function asking if bowels are normal or any change in bowel habit and its duration. What is the consistency? Is there any faecal incontinence? Is defecation painful? Is there blood or mucus in the stool? What is the colour of the motion? Is appetite good or changed? Is there any change of weight up or down? How much and over what period of time? Not everyone watches their weight.? Loss of weight means malnutrition.  Menstrual Hx: Social Hx Ask about smoking and alcohol consumption & exact amounts. Drug Hx: Ask about medication. (NSAID) Herbal remedies can cause hepatitis. Opiate abuse will cause nausea, anorexia and constipation. Intravenous drug abuse carries a risk of hepatitis C, hepatitis B and HIV infection. Cocaine derivatives cause appetite suppression. Travel history: Ask about foreign travel. Traveller's diarrhoea is just one possibility. Family history Identify any history in the family of liver or gallbladder disease, hepatitis, inflammatory bowel disease, and cancer of the colon. Nutritional history Take a diet history and inquire about food preferences. - Ask the patient for 24-hour dietary recall. - Ask the patient about the use of caffeine. - Document the amount and type of fluid and fiber intake. - Note any changes in appetite, and weight. Anorexia and weight loss may indicate cancer or inflammation. - Ask about food allergies or food intolerances, including lactose and gluten Examination: Preparation The patient should be adequately undressed and lying comfortably with the head a little elevated and well supported (one pillow). The arms should be placed alongside the body. This relaxes the abdominal muscles. Explain what about to do and ask permission to start Obesity may make the examination more difficult. Inspection General inspection Does the patient look unwell? Is pain apparent? Is there jaundice? Is there evidence of dehydration? Are there signs of weight loss. Look for purpura. Inspection of the abdomen Note any distension, abdominal respiration, bruising, scars, herniae and any visible peristalsis. A mass may be apparent. Palpation of the abdomen Inquire if the patient has any pain. Position the patient. The patient is initially positioned at 45 degrees for comfort but a supine position is necessary for palpation of the abdomen. Keeping a pillow under the patient’s head or knees can be considered. The ideal exposure is from the nipples to the lower abdomen. Ask the patient to point to the site of any pain. Start with light palpation to gain the patient's confidence and relax them and then perform deeper palpation. Examination of the liver Start in the right iliac fossa and move gently up towards the right hypochondrium. The examining hand should be flat on the abdomen and the fingers should be pointing upwards so that the fingertips are on a line parallel to the expected liver edge. Palpation should be gentle but deep if there is no pain. Press inwards and upwards and hold this position while asking the patient to take a deep breath.  Examination of the gallbladder By placing examining fingers over the gallbladder area and then asking the patient to take a deep breath, If there will be sudden accentuation of the pain on inspiration and inspiration will be inhibited, Murphy's sign is positive. Examination of the spleen To detect splenomegaly, place the examining hand flat on the abdomen as before, well below the left costal margin. Press inwards and upwards and ask the patient to breathe in again. If an enlarged spleen is not palpable, ask the patient to lie on right side, facing towards you and palpate up into the left hypochondrium as before, asking for deep breaths on the way & other hand can be placed behind the rib cage on the patient's left side for support. Palpation of the kidneys This technique uses two hands, one hand round to the patient's right loin with other hand over the right upper quadrant. Push hands together, asking the patient to breathe in and out. Try to palpate any enlarged kidney between two hands (called 'balloting'). Repeat for the left kidney. This can either be done by examining the patient from the left side with right hand under their left loin or by examining them from the right side with left hand reaching round under their left loin area. Percussion of the abdomen Percussion of the abdomen. It is really to allow determine if abdominal distension is because of solid or cystic tumours, ascites or gas. A generally resonant abdomen suggests much flatus, solid or liquid under the fingers will be dull. Auscultation of the abdomen Bowel sounds can be irregular. On average, you can hear them every 5-10 seconds through a stethoscope. If bowel sounds are absent, this may indicate paralytic ileus or peritonitis.