ABoowen name/age/sexfoceupation/address presenting complaints, H/o presenting complaints + abdominal pain: w © Duration o Site fo Nature(continuous/intermittent) ° Character(constant/colicky) o Severity 0 Radiation co Aggravating / relleving factors S Associated features(fever/nauses/ voritine/ defecation) name distension: . ,o Duration © ‘Onget(Insidlous/atute).., Site(iocallsed/unitorm) Progress © AVF features WY Leg swelling © Breathlessness Chest pain fo Livor features! y Loss of appetite. y Hematemesis/ Malena a © Constipation/ Obstipation oo Renal: J oligurla “+, Puffiness of face UX Faathvutine(Nephrotiesyndroms) : ‘© Vomiting/ Blood in vomit + Nootepisodas Duration Projectile ~ Assoslated with naysea/ iusincta urring af vision Quantity Character(cqlays/émeli/blood strsoks) Associated withfpar intake: * Associated features(pain/malena/hematemesis/ = Hodrug ia NSAIDS, sao Ise ofeonaeedeiny) +9 Jaundice +e Duration itching » Nature(Sti + associated.paln Blood streaks © Massin abdomen 5 Site 2. Duration © Progression = Associated paln + Negative History: o Fever a . ” “« Duration/ Time of occurrence «| Grade (high/ow) a *_ Nature(continuous / remitterit) «Associated with rleots/ sweating ©» Upper GIT: oe © Dysphagia(solids/liquids/both) = Heartburn * | Vomiting © Urinary Tract = °° a> pysurla 1 *). Pain/Burning micturition *. Ollguria "2 Hematurla +. Frequency a "> Fever with rigor © H/o bleeding diathesis r Eplstaxis * Bleéding gums "© Menotrhagia < . Prolonged bleeding after trauma + H/o loss of appetite/ weight loss-T8 & malignancy + H/o swelling of legs + H/o pulfiness of face = renal + H/o prufttides, bleedlne ber rectum + H/Saleredsieep pattern. Past History: + «H/o previous similar eplsode«/ saundice # H/o tattooing o H/o drug intake o filo blood trarstusion ali a exposure to sto’s *y Hy © H/ovaccination Ascites © Previous abdomen surgerles(Sear- iritation) © H/o TB,.0M, IHD, H’ ~ H/o renal colic Family History: Coe Any similar History(clethosts/illson’s‘zease/At Hep ALES Personal history: Smoking Alcohol Dietlappetite) a MA ln perme Sexuat history | Menstrual history, Obstetic history Treatment history: Summary: features bey ees ae Age/sex/name? Personal: ‘Ho? Fainlly H/o? presenting coniplaints? Other relevant positive Examination of Abdomen pet eae 5 fe : Gervetal examination: Aldswinn Y patler > Conscious (Wupahe Cro ae Co-operative 2 haem atemes Bult Sea : Moline Afebrile 5 Congr 2 a Cyanosts ips es oem oe a at r ao a Aneinia i Res i > Prine iaundice (Herr*) 2p d Clubbing(cerhos Zip matiBsorption syndrome) 4 Significant lymphadenopathy Ci praca Uptime ak Ay re Pedal oedema ( ny Wiens Wales or vet faild ermine? Des © Head: "Alopecia° tye + alot spot(it ssatiesniss) + Subconjunctvalheemortagetvity) (Mt & Wyte + Colour(Anemia- pale/ Jaundice - yellow) + Metaboli rng/wilson's/xanthalagma- fat) + Medial sypracilary madarosis * Sunken eyes, cheeks Loss of facial hair feats Parotid enlargement fs Mole © Mouth % + bleeding gum 5 : * Petorhhepaticys Sappmnbse pads © chest Srtesalhee: Spider naev! saapel iE a : Le cymaecomastin ._\ve we Coes tine <8 Atrophy of east, S Sopot 4 oss of pectoral halr, axiliaty hall + “Pectoral myscle'atrophy * llated veins ‘ oo Chantel’ © Hands Grech (Gi 45 + Anemia ny Sot Bounding pulse pears Pred tbenks = clubbing '* Duputiyen’s contracture £ = gneve teens, Wing raring Axeeoer- WILE +. eeyvthems palmar = Leuconychla, e 9 Abdomen © distension yer * Dilated velns{caput medusa] ~ "6 Tests Reka Cen aban wh Proltict aged + Arophy Pubic halcloss + Tumour ee © Lower limbs: eee GrPedaloedema Savy wanker dey * Chronic leg ulcers © General “ Pruits/splderiman appearance ; ee Mathers OFS ae thyte Vtilin “Lt Markers of HIV rene te,‘Vital sign ae)? Puke sRateyRhythin Voluime/ (Choracter/RF delay/telt in an Peripheral vessel wall S/ condition of vesce hooray BP constant FBh HB, don limb, . ‘posture pow f esohotoly rte Rate/Rtythm / ype (rca ABA) : Temperature -Apstst ee Ne ‘¥stemic examination of Abdomen: Beet vcry % Unspection: © Shape: x ° Sezehelel ev etended -untorm oclciived x© Flanks (free / full) °. Umbiticus isin oo he © Shape(snvitier everted) Se ae nS ‘Movement of abdorren wall -of 2. Deep palpation oliver: © Atender/non tender swelling Is palpable. «ly uts-.uem below/above right costal margin in MCL Extending from snmnnnnnne medial £0 « (lateral), With sovonnnesie(SMmooth/ (soft/firm/hard) ia ble, not able to nodular) surface and éamanwon(sharp/rounded) margins, : ‘consistency. It moves/not) with respiration, not bimanually palpa insinuate fingers under the costal margin. © Spleen: We Z G30 A e Surface : © Tender -Glesnieabsced onli) oy Extent * ‘@ Notchon the medial harder p. Consistency — « . © itmoves with redfiration; not bimanially palpable not ballatable, upper i : border, cannot be’ felt, Golonie band of resonarcenor tery © Kidney: a ‘0 - Normally lower rt, Pole in thin individuals © ir moves with respiration, bimanuelly palpable; ballatable, colonic band of : cesonance felt co Others: © Diréction of blood flown, 4 Fluid thrill (v0? Sega at 9% Abdominal girth movement a 1 Inguinal/fareAortic/supraclavcular nodes Percussion: f : we = Fuld ot a » - ood . =. © Shifting dullness ” . © Puddle sin ¢ yw“) 5 yy + Liver Z ve eo © Dullness and span : Spleen a ©. Dullness oak "g) “Traube's space : : a + Kidney ‘2 Colonic band of resonance a ‘Auscultation: = Gowelsounds: 10 t025/ipin'small bowel 0 3 to5/miniarge bowel © eerAad on oe id ne - face vy Bruit: Wo © Renal(Mid abdomen, around midline) © Liver(haenangioma, HCC, Acute alcoholic hepatitis) {ep © Aortic brutt s Venous hum: thre © Midway between ut ndrt. costal niargin tx * "POV est * Collaterals In Portal HT tobe «> Cruvilhier = Baumgartner syndrome : i + frp: Wd. tro brn 3 x © Perispleenitis hiss aw wis “9 Perihepatitis - wth hans flrngack _ * Succusston splash: Pent 4 po y oe (ees ether systems: te JP gg omelet oo a (% roe eee = ws: OF, Uh tre Urol rm, Untuk vee : : © | S1,SZheard {to rule corny: 3 Seon wad © RS: * o NVBS, bn bition ee = = CNS: : ° Norma lepatic encephalopathy, Peripheral neurons om es ac a Diagnosis: # Chronic decompensated fiver disedse with portal hypertension and ascites