Internal Diagnosis II(
Infernal Die, Too
)Larry WyattGet notes from bookstore -look carefully at the points marked with (TQ)
– problems in the organs or body
– test all the organs and don’t know what’s wrong with the patient.
Treat your patients in a bio-psycho-social manner…
Hx and Physical
History: AMPLE, HISTORY, OPPQRST:
Allergy, Medication, Past medical hx, Last menses/meal, Event of complaint (illness)
Hospitalizations, Immunizations, Sugar diabetes/Social Hx, Tumors/Trauma, Operations, Review of systems, YouthIllnesses.
Onset, Palliative, Provocative, Quality, Radiation/Region, Setting/Site/Severity, Timing
Physical exam: Inspection, Auscultation, Percussion, Palpation
Auscultation done 2
to keep from altering sounds (bowel sounds, etc.)
Pain in gut is primarily from distension.
Most tumors are painless, until they grow enough to distend the organ (as they are encapsuled, in the serosa).
The peritoneum is also pain producing, primarily due to inflammation.
2 primary reasons for pain in the gut:
Irritation/inflammation of the peritoneum.
Both shown in
At onset, pain in appendicitis is diffuse (caused bydistension)
In 18-36 hours, the pain will migrate to the region of theappendix. Abdominal guarding begins.
If appendix ruptures – pain reduces substantially initially because the distension reduces.
However, within a few hours pain severely increases andgeneralized, and the abdomen becomes very rigid (muscle tension) as the pusand bacteria spread throughout the abdominal cavity (and abdominal sepsis begins).
Death CAN occur in this case.
Pitting Edema (of the leg)
Blood pooling on heel of the foot
Cardiovascular (most common)
Most likely CHF
Renal failure probably caused death (more common)
Hepatic (Maybe, but no jaundice present)