POM M9 PEPSINOGEN • HCl + Intrinsic Factors •

• Anatomical • Ex: Gastric Outlet Obstruction SYSTEMIC DISEASE • Infection • Diabetes (diabetic gastroparesis) • Due to weakening of nerves that affects the autonomic nerves

LIPASES & PROTEASES • Activated upon secretion of HCl

DUODENUM • CHOLECYSTOKININ o o Stimulates the gall bladder to contract SPHINCTER OF ODDI  • Guards the Ampulla of Vater 3. •

Know the systemic diseases suffered by the patients

DIARRHEA • OSMOTIC • High sugar, fat • Watery stool • INFLAMMATORY • Mucus • INFECTIOUS • Pus • Blood – if invasive • DYSMOTILITY • Semi-solid • Scattered • 3 hours gastric emptying

Ileum ends at Right Lower Quadrant where Cecum strats

HISTORY COMMON CHIEF COMPLAINTS: 1. ABDOMINAL PAIN a. VISCERAL PAIN • Autonomic (feels stretch) • Generalized • Patient is restless and keeps on moving b. PARIETAL PAIN • Somatic (feels pain) • Localized • “peritonitis” • Contact with the purulent area • Patient doesn’t move c. REFERRED PAIN • Structures of the same dermatome • Level (innervation) • CELIAC PLEXUS • Starts at L1 • ACUTE APPENDICITIS • Parietal pain 2. VOMITING • OBSTRUCTION • 4.

CONSTIPATION • • OBSTRUCTION DIET • Hydration • Amount of fiber SYSTEMIC DISEASE • DIABETES – neuropathy • DRUG EFFECTS

PHYSICAL EXAMINATION • INSPECTION o o Symmetry Color

Icteric/jaundice • Obstruction of bile

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Change from a stable state   Size/shape Striae – previous pregnancies -Rosette Go 090510 

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Scars  Previous surgical procedures

PALPATION o o Tenderness Rigidity  o Muscle guarding

Organomegally  Liver, spleen

PERCUSSION o o Tympani – GAS Dullness – SOLID

AUSCULTATION o BOWEL SOUNDS    5 – 35/minutes intervals Squishy Borborygmi – long squishing peristaltic sound Bruit • • • Squishy Vascular in nature Coincide with systolic part of cardiac cycle Related to atherosclerosis (narrowing of abdominal aorta)

o

Auscultate first

Most common cause of Epigastric Problem • Peptic Ulcer Disease (stomach)

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