COMMON COMPLAINTS

OF DISEASES OF THE
ABDOMEN
 ABDOMINAL PAIN
 determine whether:

a. Psychogenic

- inappropriate behavior and attitude

- inconsistent, bizarre sxs
- persistent despite potent
b. Organic
- constant and consistent

c. REFERRED
- perceived in areas remote from where it originates.

Ex. Pneumonia- right hypochondrium

Ureteral stone- inner thigh scrotum, penis.
Attributes of Abdominal Pain

1. Mode or manner of onset

A. Acute
sudden, abrupt
- determine whether there are
major threats like comas or
shock, cardio-respiratory arrest,
confusion, restlessness.
- consider severity, urgency- medical or surgical?
B.CHRONIC
gradual- progressive
- inflammatory- PID
- neoplastic- Ca
- vascular-aortic aneurysm
- others– IBS, fecal impaction
2. Character-
descriptive ability and intelligence.
- hollow viscus– dull, gnawing, crampy.
- distention– sharp, discrete, steady, aching.
- tearing- dissecting aneurysm.
3. Duration
A. Short- an hour-several hrs.- renal, biliary stones.
B. Days- several days- acute pancreatitis.
4. Location/ radiation
Points to source:
- Esophagus- substerna, epig.
- Gall bladder- epig- right shoulder -back
- Appendix- peri umbilical -rt. iliac
5. Time of appearance
- Nocturnal- reflux esophagitis
- after vomiting- non surgical
before vomiting= surgical- obstruction?
6. Precipitating, aggravating, relieving factors.
 Acute pancreatitis- precipitated by alcohol, aggravated lying down
supine, relieved by sitting upright with knees flexed towards the chest.
 Acute cholecystitis- pptd by fatty food, aggravated jarring, relieved by
doubling up.
 PUD- pptd by hunger, alcohol, relieved by food or antacids or PPI.
7. Associated symptoms– diagnostic clue.
- Pain with hematuria- UTI
-with jaundice– liver, biliary tract, pancreas.
- with diarrhea- gastroenteritis
8. Relation to physiologic functions
- awakened at night- PUD
- loss of appetite/ weight loss.- CA
CAUSES OF ABDOMINAL PAIN

1. Intra abdominal
A. Somatic/ parietal
> from parietal peritoneum
- steady, aching, sharp, located directly above
inflamed area.
- aggravated by movement/ pressure/ change
in tension of peritoneum (coughing, sneezing)
B. Visceral
from hollow viscus obstruction.
- intermittent, colicky, poorly localized.
- from distention, stretching -steady, aching.

2. Extra Abdominal
a. Vascular– severe, diffuse
Ex: - impending rupture of aortic
aneurysm.
b. Abdominal wall- constant, aching aggravated by
movement or pressure.
c. Referred pain– pneumonia- splinting, pleuritic pain
d. Metabolic- when cause is obscure
e. Neurogenic- limited to the distribution of
peripheral nerve.
Ex: herpes zoster
Neuro SY
Examples:

PUD
- epig- gnauing or burning or hunger like
- intermittent, awakened at night
- pptd- hunger, alcohol, NSAIDS, aspirin,
steroids, stress relief- food, antacids,
H2 reception antagonist, PPI.
- ass. With nausea, vomitting, belching
bloating and heartburn.
2. ACUTE MECHANICAL INTESTINAL
OBSTRUCTION

Small intestine- periumbatical pain upper abdomen

Large intestine- lower abdomen or generalized

Characteristic
crampy, simultaneous with jyperperistalsis
Ass: nausea, vomiting, constipion, abdominal distention
< ACUTE PANCREATATIS
location- epig. – back (poorly localized)
characteristic- steady, severe, persistent
last for days.
precipitated by - alcohol, trauma
aggravated by- supine
relieve by- leaning forward with trunk flexed.
associated symptoms- nausea, vomiting abdominal
distention
ACUTE APPENDICITIS
location- poorly localized at first at the periumblical- right lower
quadrant
character- mild with increasing severity, last for 4-6 hrs.
aggravated by- coughing or sneezing
associated symptoms- nausea, anorexia, low grade fever
 DIARRHEA
Definition- increase h2o content of the stool, stool volume greater than
200 gems in 24 hrs.
1. Acute- usually infectious, last for 2 wks. or less.
Questions to ask?
a. Duration
b. Volume, frequency, consistency
Examples:
High volume, frequent, watery- SI
Small volume, with tenesmus mucus, pus or blood-
- LI inflammation.
B. Accompanied by- crampy pain and involuntary straining
gastroenteritis.
C. Character-Greasy, oily, frothy,floating,foul smelling,
steatorrhea, malabsorption syndrome
D. Medications previously taken penicillin, macrolides,
Mg based antacids, metformin
E. Recent travel- giardiasis
 CONSTIPATION
definition- when present for at least 12 wks(3mos)0f the prior
6mons with 2 of following conditions
->less than 3 BM in 1 week:
-> 25 % or more defecation with either straining or
tenesmus, feeling of incomplete evacuation
- lumpy or hard stools or its manual extraction.
 Questions to ask
1. Frequency of bowel
2. Passage of hard or painful stools- manual extraction
3. Presence of straining
4.Sense of incomplete evacuation
5. Character of the stool
Ex: Pencil like sigmoid obstruction
6. Previous medications taken
Ex: Anti cholinergic,Ca channel blocker, Fe supplements,
opiates
7. Past illnesses
Ex: diabetes,hypothyroidism,Parkinson's disease,
hypercalcemia
8. Passage of gas or flatus-- obstipation, intestinal
obstruction
9. Presence of blood
Ex: Melena- UGIB
hematochezia- LGIB on tissue paper or surface of the stool-
hemorrhoids.
Blood on tissue paper with anal pain- anal fissure reddish, but non
bloody- ingestion of beets.
 DYSPHAGIA
OROPHARYNGEAL- affects pharyngeal muscles due to
motor disorders.
1. Diffuse esophageal spasm-- intermittent difficulty of
swallowing of solids or liquids.
> chest pain, r/o angina, MI
2. Scleroderma– intermittent, progress slowly, to solids/ liquids
3. Achalasia-- intermittent, may progress, solids- liquids
> Nocturnal regurgitation, nocturnal cough.
>Chest pain precipitated by eating.
SYMPTOMS:
1. Drooling
2. Nasopharyngeal regurgitation
3. Cough from aspiration with the muscular/ neurologic disease
4. Gurgling/ regurgitation of undigested food.
ESOPHAGEAL DYSPHAGIA
- due to mechanical obstruction
1. esophageal stricture-- intermittent dysphagia due to
solids regurgitation.
2. Esophageal Ca- intermittent progressive from solids liquids.
< Regurgitation
< Chest pain, with loss
QUESTIONS TO ASK:
1. Location:
> below sternoclavicular joint ---esophageal
> Neck- oropharyngeal
2. type of food that provokes it
Solids- obstruction due to stricture, neoplasm.
Solids to liquid- motility disorder
3. With odynophagia?
- esophageal ulceration
- caustic ingestion of lye
- infection by fungus megalo
 JAUNDICE
definition- yellowish discoloration of the skin & mucus membrane
Mechanism:
> production of hgb (u conjugated)
< uptake (u conjugated)
< ability of liver to conjugate bilirubin (u conjugated)
< excretion of bilirubin into the bile (conjugated)
 QUESTIONS TO ASK?
1. Setting in wc illness occurred
a. Travel to endemic areas
b. Meals with poor sanitation
c. Drug addiction
d. Contact with hepatitis patients
e. Blood transfusion, tattoo
2. Associated symptoms
a. Highly colored urine
b. Acholic stools
c. Pruritus
d. Pain
3. Risk factors
a. Poor sanitation
b. Alcoholics
c. Industrial solvents
d. Previous GB surgery
e. Genetic
f. Medications taken
 CAUSES OF JAUNDICE
1. Intrahepatic- hepatocellular
> hepatitis A B C D E F
> hepatocellular Ca
2. Cholestatic- impaired excretion
3. Extra hepatic- obstruction of extra hepatic bile ducts ( CBD,
cystic)
> GB stones
> pancreatic ca
 URINARY TRACT
Common complaints:
1. Frequency
A. Irritative- Inflammatory
- calculi
- tumor
- foreign body in the bladder
1. Frequency- how often amount
< Burning sensation on urination
<Dysuria
<Urinary urgency
<Gross hematuria
B. OBSTRUCTIVE
1. Hesitancy in starting stream
2. Straining to void
3. Reduced size and force of stream
4. Dribbling during or at end of mic tuition.
II. Nocturia- urinary frequency at night more than once. Always ask
amount of fluid intake.
A. High volume- large volume
< chronic renal insuff
< CHF
< Nephrotic syndrome
< Cirrhosis with as cite
B. Low volume
< voiding at night without urge- pseudo frequency insomnia.
C. Polyuria > 24 hour volume> than 3L
> diabetes insipidus
> kidney disease
> hypercalcemia
> hypokalemic nephropathy
> drug toxicity
> May have frequency without polyrethane
IV. HEMATURIA
< gross
< microscopic
a. Initial- urethra
b. Midstream- bladder, urether
c. Terminal- kidney
In women ask menstruation
V. RENAL OR FLANK PAIN
- Pain due to distantion of renal capsule- steady, aching
- Acute pyelonephritis
Urethral pain- severe, colicky, starts at CVA- trunk- lower
quadrant O.R upper inner thigh labium or testicle.
VI. URINARY INCONTINENCE
A. Stress- weakness of pelvic floor with less support to the bladder.
Multi paras upon coughing, laughing, sneezing.
B. Urge- frequent voluntary voiding at low bladder volume. Strokes,
brain tumor, dementia
C. Overflow
- Incontinence- Obstruction of bladder outlet. BPH
- diabetic
-Nephropathy
-Peripheral n disease
 <Continuous dribbling or dripping
< force of urinary stream
D. Functional incontinence functional inability to get to the toilet in time
coz of impaired health or environmental conditions- arthritis, poor vision,
weakness
E. Secondary to Medications
- diuretics, sedatives, anti cholinergics, tranquilizers.