EXAMINATION OF

CHRONIC ABDOMINAL
CONDITIONS
 SYMPTOMOLOGY

 Haematemesis and Malena

 Pain
 Loss of weight and appetite
 Dyspepsia
 Fever
 Nausea and vomiting
 Lump
 Jaundice

 Bowel Habit
 SYMPTOMOLOGY

 Haematemesis and Malena

 Pain
 Loss of weight and appetite
 Dyspepsia
 Fever
 Nausea and vomiting
 Lump
 Jaundice

 Bowel Habit
 Types of Vomiting

 Acute – Less than 10 days

 Chronic - More than 10 days
 Types of Vomiting

 Acute – Less than 10 days

 Chronic - More than 10 days
Causes of Vomiting
 Causes of Gastric Outlet Obstruction

 Benign Chronic Duodenal Ulcer,

Extraluminal obstruction
Adult hypertrophic
pyloric stenosis
 Malignant Adenocarcinoma
Lymphoma
GIST
CA Head of
pancreas
General Scheme Of History Taking

 Particulars
 Complaints
 History of presenting illness
 Past History
 Drug History
 Family History
 Personal History
 Allergy and Immunization
 PARTICULARS

 Name  Young – Benign

 Age  Old - Malignant
 Gender
 Religion
 SES
 Residence
 Occupation
 DOA and E
 PARTICULARS

 Name  Both are common in male

 Age
 Gender
 Religion
 SES
 Residence
 Occupation
 DOA and E
 PARTICULARS

 Name  High socio economic

 Age
 Gender
 Religion
 SES
 Residence
 Occupation
 DOA and E
General Scheme Of History Taking


Complaints
Particulars
 Complaints
 Vomiting
 History of presenting illness
 Abdominal Pain
 Past History
 Related to other causes
 Drug History
 Family History
 Personal History
 Allergy and Immunization
 HOPI

 Duration
 Frequency
 Relationship with food intake
 Character of act
 Color
 Taste
 Smell
 Blood in vomiting
 Asso. Symptoms
 HOPI
 Duration
 Frequency
 Relationship with food intake
 Character of act
 Color
 Acute or Chronic
 Taste
 Smell
 Blood in vomiting
 Asso. Symptoms
 HOPI
 Duration
 Frequency
 Relationship with food intake
 Character of act
 Color
 Severity
 Taste
 Smell
 Blood in vomiting
 Asso. Symptoms
 HOPI
 Duration
 Frequency
 Relationship with food intake
 Character of act
 Immediate – Acute
 Color
 After few hours - Chronic
 Taste
 Smell
 Blood in vomiting
 Asso. Symptoms
 HOPI
 Duration
 Frequency
 Relationship with food intake
 Character of act
 Projectile – GOO , CNS
 Color
 Taste
 Smell
 Blood in vomiting
 Asso. Symptoms
 HOPI
 Duration
 Frequency
 Relationship with food intake
 Character of act
 Bilious or non bilious
 Color
 Taste
 Smell
 Blood in vomiting
 Asso. Symptoms
 HOPI
 Duration
 Frequency
 Relationship with food intake
 Character of act
 Sour – GOO
 Color
 Smell – Foul smelling - GOO
 Taste
 Smell
 Blood in vomiting
 Asso. Symptoms
 HOPI
 Duration
 Frequency
 Relationship with food intake  Rolling mass – GOO
 Character of act
 APD Symptoms
 Color
 Pain – Benign
 Taste
  Symptoms of other diseases
Smell
 Blood in vomiting
 Asso. Symptoms
 Past History

 Similar complaints in the past is S/O Benign disease

 Familial History

 Gastric malignancy
 Carneys Triad
 Functioning extra adrenal paragangliomas
 Pulmonary chondromas
 Gastric GIST
 Personal History

 Appetite – Normal in Benign

 Addiction
 Stool - Malena
Drug History
General Physical Examination

 Mental Status
 Built
 Facies
 Gait
 Decubitus
 Hydration
 Nutrition
 PICCLE
 P,BP,T,R
General Physical Examination

 Mental Status
 Built
 Facies
 Gait
 Decubitus
 Hydration
 Nutrition
 PICCLE
 P,BP,T,R
 Electrolyte Abnormality

 VOMITING - HYPOCHLORAEMIC ALKALOSIS

 DEHYDRATION - Kidney has to conserve Na2+ but excrete bicarbonate
 HYPOKAELEMIA - Intracellular Shift
Vomiting
Initially K excreated but later
Hydrogen, so paradoxical aciduria
 Per Abdominal

 Inspection
 Palpation
 Percussion
 Auscultation
 Per Abdominal

 Inspection  Shape and Contour

 Palpation  Umblicus
 Skin – Scar, Pigmentation,
 Percussion
Striae, vein
 Auscultation  Movements – Respiration,
Pulsatile, Peristalsis
 Swelling
 Hernia
 Externa Genitalia
 Per Abdominal

 Inspection  Temp and Tenderness

 Palpation  Feel of the abdomen
 Percussion  Lump
 Auscultation  Deep tender points
 Organ palpation
 Per Abdominal

 Inspection  Ascites
 Palpation  Succusion splash
 Percussion
 Auscultation