...
Is there associated dyspnea? If there is associated dyspnea, one should look for congestive heart failure, pulmonary emphysema, and other cardiopulmonary conditions.
... DIAGNOSTIC WORKUP
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Is there associated fever? The presence of fever along with chest pain should make one think of a perinephric abscess or pyelonephritis. Occasionally, however, hypernephroma can ... DIAGNOSTIC WORKUP
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Is there a family history of migraine or epilepsy? Migraine and epilepsy both present with abdominal pain.
Is the pain colicky or persistent? Chronic colicky abdominal pain ... DIAGNOSTIC WORKUP
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Where is the pain located? If it is diffuse, one should consider pancreatitis, mesenteric artery occlusion, or ruptured peptic ulcer. In addition, another viscus may be perforated, such as a ruptured ... DIAGNOSTIC WORKUP
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Is there tenderness and rebound tenderness? If this is absent, consider voluntary rigidity. If this is present, the finding must be considered serious.
Is there a history of trauma ... DIAGNOSTIC WORKUP
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Is it in the right upper quadrant? A mass in the right upper quadrant is most often an enlarged liver. However, the liver may be pushed down by a subphrenic abscess, and there may be an enlarged ... DIAGNOSTIC WORKUP
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Is there hepatomegaly? If there is hepatomegaly, one should suspect congestive heart failure, emphysema, constrictive pericarditis, hepatic vein thrombosis, and cirrhosis ... DIAGNOSTIC WORKUP
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Is there a history of alcohol or drug ingestion? Alcohol and many drugs such as digitalis, aspirin, nonsteroidal anti-inflammatory agents, ... DIAGNOSTIC WORKUP
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Lower abdominal pain is a common complaint that must be evaluated carefully and systematically to reach the appropriate diagnosis in timely manner. All diagnoses must be considered, with the most emergent etiologies rapidly ruled out,... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Upper abdominal pain is a common presenting symptom. A complete differential diagnosis should be developed based on the organs in the upper abdomen in addition to the associated history and... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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In evaluating an acute abdomen, rebound tenderness is one of the most important signs of peritonitis. It is elicited by pressing deeply on the abdomen and then suddenly releasing pressure, which... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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An abdominal bruit is a murmur that corresponds to the cardiac cycle. It is heard best with the diaphragm of the stethoscope, usually over the abdominal aorta, renal arteries, or spleen. It can be a sign of... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Abdominal distension is a common complaint that must be evaluated carefully and systematically to expediently rule out serious and life-threatening diagnoses and evaluate for... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Abdominal guarding refers to muscular rigidity of the abdomen upon palpation. It may be involuntary or voluntary. The examiner may try to limit the voluntary guarding during the physical examination by having the... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Many disease processes, including malignancies, infections, and bowel obstruction, present with abdominal masses. The most serious and dramatic etiology is an abdominal aortic... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Pain and/or tenderness on the side of the trunk from the ribs to the ileum is often associated with renal disease; however, nonrenal etiologies are very common. Of course, renal disease should be strongly suspected in... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Vomiting is an involuntary forceful extrusion of stomach contents. It is a mediated by a complex reflex that is located in the vomiting center of the medulla oblongata. Reflex... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Abdominal pain is a frequent complaint and associated with an enormous number of causes. Many causes of acute abdominal pain require surgical intervention, so a prompt diagnosis is needed. Diagnostic... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Ascites, the accumulation of serous fluid within the peritoneal cavity, may be caused by a combination of factors, including hypoalbuminemia, portal hypertension, increased aldosterone and antidiuretic hormone secretion,... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Vomiting is the forceful expulsion of gastric contents through the mouth that involves an integrated and largely somatic motor response. It represents a protective reflex in the body's defense system.... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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A prominent “potbelly” contour is normal in infants and young children. Pathologic enlargement of the abdomen is a fairly common problem that can result from reduced tone of... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Abdominal masses are common presenting signs of malignant solid tumors in children and should be presumed to be such. They require urgent evaluation to rule out compression of internal organs, hemorrhage, and/or... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Projectile vomiting is the forceful expulsion of stomach contents classically associated with pyloric stenosis. Although pyloric stenosis is one cause, there are many other causes inside and outside the GI tract.
Differential ... Workup and Diagnosis ... Treatment
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... Most cases of flank pain are associated with inflammation of the kidney. As is shown in Table 29 , however, jumping to that conclusion in any given case may be
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... As the physician examines the abdomen, how can he or she recall all of the causes of a mass or swelling? The physician should consider the possibilities for the mass’s composition. It may be
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... The GI tract is the only “organ” that really covers the abdomen from one end to the other. Anything that causes an irritation of all or a large portion of this &
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... These two should be considered together, because nausea is just a forme fruste of vomiting. This symptom lends itself well to anatomic analysis,
... READ MEDICAL BOOK EXCERPTS ONLINE » (free access, no registration)
... Abdominal distention refers to increased abdominal girth — the result of increased intra-abdominal pressure forcing the abdominal wall outward. Distention may be mild or severe, depending on... Emergency interventions ... History and physical examination ... Medical causes ... Special considerations
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... Commonly detected on routine physical examination, an abdominal mass is a localized swelling in one abdominal quadrant. Typically, this sign develops insidiously and may represent an... Emergency interventions ... History and physical examination ... Medical causes ... Special considerations ... Pictures
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... Abdominal pain usually results from a GI disorder, but it can be caused by a reproductive, genitourinary (GU), musculoskeletal, or vascular disorder; drug use; or ingestion of... Emergency interventions
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... Pain in the flank, the area extending from the ribs to the ilium, is a leading indicator of renal and upper urinary tract disease or trauma. Depending on the cause, this symptom may vary from a dull ache to severe... Emergency interventions ... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers ... Pictures
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... Vomiting is the forceful expulsion of gastric contents through the mouth. Characteristically preceded by nausea, vomiting results from a coordinated sequence of abdominal muscle contractions... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Pictures
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... Detected by palpation, abdominal rigidity refers to abnormal muscle tension or inflexibility of the abdomen. Rigidity may be voluntary or involuntary. Voluntary rigidity reflects the... Emergency interventions ... History and physical examination ... Medical causes ... Special considerations ... Pictures
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... Absent bowel sounds refers to an inability to hear any bowel sounds with a stethoscope in any quadrant after listening for at least 5 minutes. Bowel sounds cease when mechanical or vascular... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pictures
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... Mechanical Bowel Obstruction
Extraluminal compression
Congenital abnormalities
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... Without Peritoneal Disease
Portal hypertension
Cirrhosis
Alcoholic hepatitis
Hepatic
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... Diffuse
Gastroenteritis
Peritonitis
Pancreatitis
Leukemia
Sickle cell crisis
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... Abdominal Disorders
Inflammatory disorders
Peritoneum
Peritonitis (chemical or bacterial)
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... Central Nervous System Disorders
Increased intracranial pressure
Head trauma
Central nervous system
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... Signs and Symptoms Pulsating mass in periumbilical area, systolic bruit over aorta, tenderness with deep palpation, flank and groin pain, weakness, sweating, tachycardia, hypotension ... Treatment (Tx)
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... Abdominal aneurysm, an abnormal dilation in the arterial wall, generally occurs in the aorta between the renal arteries and iliac branches. Rupture — in which the aneurysm breaks open, resulting... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations ... Pictures
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... Blunt and penetrating abdominal injuries may damage major blood vessels and internal organs. Their most immediate life-threatening consequences are hemorrhage and hypovolemic shock; later threats include infection. The prognosis... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations ... Pictures
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... Signs and Symptoms Pallor, cyanosis, pain, tachycardia, dyspnea, hypotension, bruising, abdominal distention and rigidity
Treatment (Tx) I.V. fluid replacement,
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... Abdominal distention refers to increased abdominal girth—the result of increased intra-abdominal pressure forcing the abdominal wall outward. Distention may be mild or severe, depending on the amount of... Emergency interventions ... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... Commonly detected on routine physical examination, an abdominal mass is a localized swelling in one abdominal quadrant. Typically, this sign develops insidiously and may represent an enlarged organ, a neoplasm, an abscess, a vascular... Emergency interventions ... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... Abdominal pain usually results from a GI disorder, but it can also be caused by a reproductive, genitourinary (GU), musculoskeletal, or vascular disorder; drug use; or ingestion of toxins. At times, such pain signals life... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Pictures
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Flank pain
(Professional Guide to Signs & Symptoms (Fifth Edition))
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... Pain in the flank, the area extending from the ribs to the ilium, is a leading indicator of renal and upper urinary tract disease or trauma. Depending on the cause, this symptom may... Emergency interventions ... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers ... Pictures
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Vomiting
(Professional Guide to Signs & Symptoms (Fifth Edition))
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... Vomiting is the forceful expulsion of gastric contents through the mouth. Characteristically preceded by nausea, vomiting results from a coordinated sequence of abdominal muscle contractions and reverse... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... Detected by palpation, abdominal rigidity refers to abnormal muscle tension or inflexibility of the abdomen. Rigidity may be voluntary or involuntary. Voluntary rigidity reflects the patient’s fear or... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Pictures
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... Absent bowel sounds refers to an inability to hear any bowel sounds through a stethoscope after listening for at least 5 minutes in each abdominal quadrant. Bowel sounds cease when mechanical or... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Pictures
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Abdominal Pain
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
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... Richard W. Emerine
Abdominal pain of varying causes, ranging from the functional to the organic, is one of the top ten outpatient complaints; it is the chief complaint for 5% to 10% of patients presenting to... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment
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Ascites
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
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... C. Randall Clinch
Ascites, the accumulation of fluid within the abdominal cavity, is the most common major complication of cirrhosis; it is present in 50% of... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment
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Nausea and Vomiting
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
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... Eric M. Walsh
Approach Nausea and vomiting are common presenting complaints in office practice. An effective diagnostic approach will consider causes both within the ... History. ... Physical examination. ... Testing. ... Diagnostic assessment
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... Differential Overview
❑ Ureteral calculus
❑ Acute pyelonephritis
❑ Latissimus strain ... Diagnostic Approach ... Clinical Findings
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... Differential Overview
❑ Irritable bowel syndrome
❑ Peptic ulcer disease
❑ Cholecystitis ... Diagnostic Approach ... Clinical Findings
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... Differential Overview
Abdominal Mass
❑ Liver enlargement
❑ Spleen enlargement
❑ Fecal mass ... Diagnostic Approach ... Clinical Findings
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... Differential Overview
Ascites
❑ Right-sided heart failure
❑ Cirrhosis
❑ Hypoalbuminemia ... Diagnostic Approach ... Clinical Findings ... Pictures
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... Differential Overview
Generalized/Periumbilical
❑ Gastroenteritis
❑ Obstipation
❑ Small bowel obstruction ... Diagnostic Approach ... Clinical Findings ... Pictures
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... Differential Overview
Presenting Symptom
❑ Gastroesophageal reflux
❑ Pregnancy
❑... Diagnostic Approach ... Clinical Findings
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... With abdominal aneurysm, an abnormal dilation in the arterial wall generally occurs in the aorta between the renal arteries and iliac branches. Such aneurysms are four times... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations ... Pictures
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... Blunt and penetrating abdominal injuries may damage major blood vessels as well as internal organs. Their most immediate life-threatening consequences are hemorrhage and hypovolemic shock; later threats include infection. The... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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Abdominal pain
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
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... Abdominal pain usually results from a GI disorder, but can also be caused by drug use, ingestion of toxins, or disorders of the reproductive, genitourinary (GU), musculoskeletal,... Assessment ... History ... Physical examination ... Pediatric pointers ... Geriatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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Flank pain
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
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... Pain in the flank, the area extending from the ribs to the ilium, is a leading indicator of renal and upper urinary tract disease or trauma. Depending on the cause, this symptom may vary from a dull ache to severe stabbing... Assessment ... History ... Physical examination ... Pediatric pointers ... Medical causes ... Nursing considerations ... Patient teaching ... Pictures
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Vomiting
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
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... Vomiting is the forceful expulsion of gastric contents through the mouth. Characteristically preceded by nausea, vomiting results from a coordinated sequence of abdominal muscle contractions and reverse esophageal peristalsis. ... Assessment ... History ... Physical examination ... Pediatric pointers ... Geriatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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Abdominal rigidity
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
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... Abdominal rigidity has been described as abnormal muscle tension or inflexibility of the abdomen, and as an abdominal muscle spasm with involuntary guarding. Rigidity is detected by palpation and may be voluntary or involuntary.... Assessment ... History ... Physical examination ... Pediatric pointers ... Geriatric pointers ... Medical causes ... Nursing considerations ... Patient teaching ... Pictures
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... Abdominal distention refers to increased abdominal girth — the result of increased intra-abdominal pressure forcing the abdominal wall outward. Distention may be mild or severe, depending on the amount of pressure. It may be... Emergency Actions ... History ... Physical assessment ... Medical causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... Commonly detected on routine physical examination, an abdominal mass is a localized swelling in one abdominal quadrant. Typically, this sign develops insidiously and may represent an enlarged organ,... Emergency Actions ... History ... Physical assessment ... Medical causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... Abdominal pain usually results from a GI disorder, but it can be caused by a reproductive, genitourinary (GU), musculoskeletal, or vascular disorder; drug use; or ingestion of toxins. At times, such pain signals... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... Pain in the flank, the area extending from the ribs to the ilium, is a leading indicator of renal and upper urinary tract disease or trauma. Depending on the cause, this symptom may... Emergency Actions ... History ... Physical assessment ... Medical causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
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... Vomiting is the forceful expulsion of gastric contents through the mouth. Characteristically preceded by nausea, vomiting results from a coordinated sequence of abdominal muscle contractions and reverse esophageal peristalsis. ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... Detected by palpation, abdominal rigidity refers to abnormal muscle tension or inflexibility of the abdomen. Also known as abdominal muscle spasm or involuntary guarding, rigidity may be voluntary or... Emergency Actions ... History ... Physical assessment ... Medical causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... Many diseasescause abdominal pain, and clinical dilemma is to distinguish life-threateningones from those that are mild and self-limited. Best way to approach diagnosis is toconsider age of child and... Principal Causes of Acute Abdominal Pain ... Clinical Features and Diagnosis: Acute Abdominal Pain ... Diagnostic Approach: Acute Abdominal Pain ... Principal Causes of Chronic or Recurrent Abdominal Pain ... Diagnostic Approach: Chronic or Recurrent Abdominal Pain ... References
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...Although vomiting, abdominal pain, GI bleeding,hematuria, and fever accompany some types of abdominal mass lesions,other types occur without any associated signs and symptoms. Thus,it is... Principal Causes of Abdominal Masses ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
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...Regurgitation is the nonforceful expulsionof contents from esophagus or stomach, whereas vomiting is the forcefulexpulsion of gastric contents through the mouth. The first partof this chapter is... Principal Causes of Regurgitation ... Clinical Features and Diagnosis: Regurgitation ... Diagnostic Approach: Regurgitation ... Principal Causes of Vomiting ... Clinical Features and Diagnosis: Vomiting ... Diagnostic Approach: Vomiting ... References
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... Abdominal distention refers to increased abdominal girth—the result of increased intra-abdominal pressure forcing the abdominal wall outward. Distention may be mild or severe,... History and physical examination ... Medical causes ... Nursing considerations ... Patient teaching ... Pictures
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... Commonly detected on routine physical examination, an abdominal mass is a localized swelling in one abdominal quadrant. Typically, this sign develops insidiously and may... History and physical examination ... Medical causes ... Nursing considerations ... Patient teaching ... Pictures
... READ MEDICAL BOOK EXCERPTS ONLINE » (free access, no registration)
... Abdominal pain usually results from a GI disorder, but it can be caused by a reproductive, genitourinary (GU), musculoskeletal, or vascular disorder; drug use; or ingestion of... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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... Pain in the flank, the area extending from the ribs to the ilium, is a leading indicator of renal and upper urinary tract disease or trauma. Depending on the cause, this symptom may vary from a dull ache to severe stabbing or... History and physical examination ... Medical causes ... Nursing considerations ... Patient teaching
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... Vomiting is the forceful expulsion of gastric contents through the mouth. Characteristically preceded by nausea, vomiting results from a coordinated sequence of abdominal muscle contractions and reverse... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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... Detected by palpation, abdominal rigidity refers to abnormal muscle tension or inflexibility of the abdomen. Rigidity may be voluntary or involuntary. Voluntary rigidity reflects... History and physical examination ... Medical causes ... Nursing considerations ... Patient teaching ... Pictures
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... Absent bowel sounds refers to an inability to hear any bowel sounds with a stethoscope in any quadrant after listening for at least 5 minutes in each quadrant. Bowel sounds cease when mechanical or vascular... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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...
Most cases of flank pain are associated with inflammation of the
kidney. As is shown in Table 29, however, jumping to that
conclusion in any given case may be hazardous.
...
Pictures
...
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...
As the physician examines the abdomen, how can he or she recall all of
the causes of a mass or swelling? The physician should consider the
possibilities for the mass’s... Pictures
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...
The GI tract is the only “organ” that really covers the abdomen
from one end to the other. Anything that causes an irritation of all or a
large portion of this “tube” may cause... Pictures
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...
These two should be considered together, because nausea is just a
forme fruste of vomiting. This symptom lends itself well to anatomic analysis,
particularly by the target... Pictures
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... Author: Craig DeWolfe, MD
What to Do - Take Action
Appropriate nutrition is vital to maintaining health and recovering from
disease and injury.... Suggested Readings
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