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  • Topic: Stomach, Abdominal pain, Peptic ulcer
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  • Published : May 16, 2011
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Visceral pain; dull poorly localized pain
Somatic pain; sharp pain, well localized
Referred pain; pain experience at a distance from disease process Fetor hepaticus; sweet fecal odor caused by hepatic failure
Feculent breath; foul fecal odor caused by severe bowel obstruction Severe halitosis; foul breath odor can be caused by poor dental hygience or neoplasms or esophagus and stomach Jaundice; yellowish discoloration of skin caused by high bilirubin level associated with liver disease, biliary obstruction, excessive hemolysis Grey turner’s sign; ecchymosis to flanks indicative of retroperitoneal bleeding Ascitis; intraperitoneal fluid infrequently associated with Anasarca; entire body edema seen in end stage renal disease

Diastasis recti abdominis; abnormal separation of two abdominal muscles by raising his or her head from bed Ballottment; technique of examining a fluid filled part of body to detect floating object. Cullen’s sig; ecchymosis around umbilicus indicative in intraparanteal bleeding Mcburney's sign: is a sign of acute appendicitis

Salivary glands
1000-1500 ml/day
Enzymes pityalin (amylase) and lysozyme
Initiates carb metabolism, destroy bacterial protects muscus membrane, and tooth decay Stomach 2500 ml/day
Enzyme pesin
Converts proteins into proteoses and peptones
Liver bile 500-100 ml/day
No enzymes
Emulsifies fat
Pancrease 1000-1500 ml/day
Enzymes trypsin , amylase, mylase
Digest major components of chime
Differntation of abd pain
Gastritis; epigastric or slightly left midline, maybe described as indigestion, nausea vomiting, hematamesis, abd tenderness Peptic ulcer, epigastric or RUQ, gnawing or burning, abd tenderness, hematemesis or melena Pancreatitis; epigastric or LUQ may radiate to back, flanks or left shoulder, boring worsen by lying down, nausea or vomiting, jaundice maybe present if common bile duct is obstructed. Cholecystitis; epigastric PR RUQ area, cramping, maybe referred to below right scapula, murphy’s sign; nausea vomiting, abd tenderness in RUQ Appendicitis; epigastric or periumbilical pain, later localizes in RLQ, mcburneys sign, rovsing sing, dull to sharp pain, anorexia, fever, diarrhea, leukocytosis, rebound tenderness, indicates peritoneal irriation Intestinal obstruction, epigastric or umbilical, spastic to dull, change in bowel habits, melena or hematochezia, hyperactive to hypoactive bowel sounds Steps

General survey
Contour of abd
Abd girth
Weakness of abd wall
Movement of abd
Put pillow under knees to relax abd muscle
Bowel sounds
Succussion splash
Vascular sounds; use bell
Peritoneal friction rub; presence of peritoneal fluid
Percussion tones normally heard are
Dull liver, full sigmoid colon, full bladder, flute tone, tympani gastric bulle (drum like sound) When testing for ascitis (fluid like, shifting dullness, midline dullness) Organ borders (spleen, liver, stomach, bladder, intestine)

Light palpation 1-2 cm
Deep palpation 4-5 cm only physician

Laboratory and Diagnostic exams
Upper GI study
series of radiography’s of lower esophagus, stomach, duodenum, using barium sulfate as contrast medium Detects any abnormal conditions of GI tract
Other ulcerative lesions
NPO post midnight
No smoking night before study
Explain importance of expelling barium solution
Stools will be whitish or light in color until all solution expelled out (72) hrs Eventual absorption of fecal water may cause hardened barium impaction Advice increase fluid intake
Administer MOM after exam to promote expulsion of solution unless contraindicated Tube Gastric analysis
Stomach contents aspirated to determine amount of acid produced by parietal cells in stomach Analysis helps determine completeness of vagotomy, confirm hypersecretions of achlohydria, estimate acid secretory capacity or test for intrinsic...
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