• Abdominal pain, acute and chronic

• Indigestion, nausea, vomiting including blood, loss of appetite, early satiety

• Dysphagia and/or odynophagia

• Change in bowel function

• Diarrhea, constipation

• Jaundice

• Suprapubic pain

• Dysuria, urgency, or frequency

• Hesitancy, decreased stream in males

• Polyuria or nocturia

• Urinary incontinence

• Hematuria

• Kidney or flank pain

• Ureteral colic

Visceral pain

Parietal pain

Referred pain

 -difficult to localize.

-typically palpable near the midline at levels that vary according to the structure involved.

-varies in quality and may be gnawing, burning, cramping, or aching. When it becomes severe, it may be associated with sweating, pallor, nausea, vomiting, and restlessness

Visceral pain occurs when hollow abdominal organs such as the intestine or biliary tree contract unusually forcefully or are distended or stretched. Solid organs such as the liver can also become painful when their capsules are stretched.

-It is a steady, aching pain

-usually more severe than visceral pain 

 -more precisely localized over the involved structure.

-It is typically aggravated by movement or coughing. -Patients with this type of pain usually prefer to lie still

originates from inflammation in the parietal peritoneum.

Referred pain is felt in more distant sites, which are innervated at approximately the same spinal levels as the disordered structures.

Referred pain often develops as the initial pain becomes more intense and thus seems to radiate or travel from the initial site. It may be felt superficially or deeply but is usually well localized

1-Pain of duodenal or pancreatic origin may be referred to the back

2-pain from the biliary tree, to the right shoulder or the right posterior chest.

Pain may also be referred to the abdomen from

3

1-Doubling over with cramping colicky pain indicates 

2-Sudden knifelike epigastric pain occurs in

1-renal stone.

2-gallstone, pancreatitis

1-Epigastric pain occurs with (2)

 2-Right upper quadrant and upper abdominal pain signify

1-gastritis or GERD.

2-cholecystitis

Chronic Upper Abdominal Discomfort or Pain

Multifactorial causes include

-reduced salivary flow, which prolongs acid clearance by damping action of the bicarbonate buffer;

-delayed gastric emptying;

-selected medications;

-hiatal hernia.

1-GERD  atypical respiratory symptoms

1-cough, wheezing, and aspiration pneumonia. Others complain of pharyngeal symptoms, such as hoarseness and chronic sore throat

2-difficulty swallowing (dysphagia), pain with swallowing (odyophagia), recurrent vomiting, evidence of gastrointestinal bleeding, weight loss, anemia, or risk factors for gastric cancer

appendicitis.

In women other causes include pelvic inflammatory disease, ruptured ovarian follicle, and ectopic pregnancy.

1-Left lower quadrant acute pain with a palpable mass may be 

 2-Diffuse abdominal pain with absent bowel sounds and firmness, guarding, or rebound on palpation indicates

1-diverticulitis.

2-small or large bowel obstruction

1-Change in bowel habits with mass lesion indicates

2-Intermittent pain for 12 weeks of the preceding 12 months with relief from defecation, change in frequency of bowel movements, or change in form of stool (loose, watery, pellet-like), without structural or biochemical abnormalities are symptoms of

1-colon cancer

2-irritable bowel syndrome

pregnancy, diabetic ketoacidosis, adrenal insufficiency, hypercalcemia, uremia, liver disease, emotional states, adverse drug reactions, and other conditions.

Induced vomiting without nausea is more indicative of anorexia/bulimia.

1-Vomiting and pain indicate  1

2-Fecal odor occurs with 2

1-small bowel obstruction.

2-small bowel obstruction or gastrocolic fistula

loss or lack of appetite.

Find out if it arises from intolerance to certain foods or reluctance to eat because of anticipated discomfort. Check for associated symptoms of nausea and vomiting

structural esophageal conditions like esophageal stricture, web or Schatzki's ring, neoplasm;

if solids and liquids, a motility disorder is more likely.

1-infection;

2-noninfectious in origin, as in Crohn's disease and ulcerative colitis.

1-High-volume, frequent watery stools usually are from the

2-small-volume stools with tenesmus, or diarrhea with mucus, pus, or blood occur in

1-small intestine;

2-rectal inflammatory conditions

1-anticholinergic agents, calciumchannel blockers, iron supplements, and opiates.

2-diabetes, hypothyroidism, hypercalcemia, multiple sclerosis, Parkinson's disease, and systemic sclerosis.

 obstipation

1- what is it

2-Obstipation signifies what?

1-when there is no passage of either feces or gas at all

2-Obstipation signifies intestinal obstruction

1-black tarry stools

2-stools that are red or maroon-colored

1-Melena may appear w/ how much bleeding from where

2-hematochezia how much bleeding from where

1-100 ml of upper gastrointestinal bleeding

2-if more than 1000 ml of blood, usually from lower gastrointestinal bleeding

 -Increased production of bilirubin

viral hepatitis, cirrhosis, primary biliary cirrhosis,

-and drug-induced cholestasis, as from oral contraceptives, methyl testosterone, and chlorpromazine

-briefly in viral hepatitis

-they are common in obstructive jaundice

1-cholestatic or obstructive jaundice

2-a distended liver capsule, biliary cholic, or pancreatic cancer.

• Hepatitis: Travel or meals in areas of poor sanitation, ingestion of contaminated water or foodstuffs (hepatitis A); parenteral or mucous membrane exposure to infectious body fluids such as blood, serum, semen, and saliva, especially through sexual contact with an infected partner or use of shared needles for injection drug use (hepatitis B); intravenous illicit drug use; or blood transfusion (hepatitis C)
• Alcoholic hepatitis or alcoholic cirrhosis (interview the patient carefully about alcohol use)
• Toxic liver damage from medications, industrial solvents, or environmental toxins

1-ascites-fluid wave test

2- a distended bladder or pregnant uterus; hernias

vascular occlusive disease

listen with the bell

 large dull areas in percussion suggets

physiologic (pregnant uterus)

inflammatory (diverticulitis of the colon)

vascular (an abdominal aortic aneurysm), neoplastic (carcinoma of the colon)

 obstructive (a distended bladder or dilated loop of bowel)

 peritoneal inflammation.

If tenderness is felt elsewhere than where you were trying to elicit rebound, that area may be the real source of the problem

1-The span of liver dullness is increased

1-when the liver is enlarged

2-when the liver is small, or when free air is present below the diaphragm, as from a perforated hollow viscus.

3-the low diaphragm of chronic obstructive pulmonary disease. Span, however, remains normal.

urethral stricture, prostatic hyperplasia; also from medications and neurologic disorders such as stroke, multiple sclerosis.

1-an AAA.

 Pain may signal rupture.

begins near the umbilicus, then shifts to the right lower quadrant, where coughing increases it.

Older patients report this pattern less frequently than younger ones

appendicitis

Early voluntary guarding may be replaced by involuntary muscular rigidity

appendicitis (a positive Rovsing's sign).

So does right lower quadrant pain on quick withdrawal (referred rebound tenderness).

obturator sign, suggesting irritation of the obturator muscle by an inflamed appendix.

(Localized pain with this maneuver, in all or part of the right lower quadrant, may accompany appendicitis.)

ask the patient to raise both head and shoulders off the table.

hernia

(Ventral hernias are hernias in the abdominal wall exclusive of groin hernias)

1-remains palpable when the pt flexes

2-is obscured by muscular contraction.