GI & Musculoskeletal

Sample Solution

 

Gastrointestinal (GI) Assessment

Relevant Information to Gather

When assessing a patient with abdominal pain, it is crucial to gather a comprehensive history and perform a thorough physical examination. The following information is essential:

History

• Onset and duration of pain: Determine when the pain started, its character (sharp, dull, crampy), and any aggravating or relieving factors.

• Location and radiation of pain: Identify the precise location of the pain and whether it radiates to other areas of the abdomen or chest.

Full Answer Section

   

• Associated symptoms: Inquire about any accompanying symptoms, such as nausea, vomiting, diarrhea, constipation, bloating, jaundice, fever, or hematochezia (blood in the stool).
• Past medical history: Review the patient's past medical history, including any previous abdominal surgeries, gastrointestinal disorders, or chronic conditions like diabetes or kidney disease.
• Medications and allergies: Ask about the patient's current medications, including over-the-counter drugs and herbal supplements. Also, inquire about any allergies to medications or food.
• Diet and lifestyle: Assess the patient's dietary habits, including food intake, alcohol consumption, and smoking habits. Investigate any recent changes in diet or lifestyle.
• Social history: Explore the patient's social history, including psychosocial stressors, family history of gastrointestinal disorders, or travel to areas with endemic diseases.

Physical Examination

• Inspection: Observe the abdomen for any visible abnormalities, such as distention, asymmetry, or pulsations.
• Auscultation: Listen for bowel sounds using a stethoscope. Hypoactive or absent bowel sounds may indicate an ileus or obstruction.
• Percussion: Percuss the abdomen to assess for tympany (air in the bowel) or dullness (fluid or mass).
• Palpation: Palpate the abdomen gently to detect any tenderness, masses, or organomegaly (enlarged organs).

Assessing for Abdominal Masses Palpation is the primary method for assessing abdominal masses. Start by palpating in the superficial quadrants and gradually move deeper. Use a light touch and follow a systematic approach to avoid missing any abnormalities. Documentation of Mass Findings When documenting a palpable abdominal mass, include the following details:

• Location: Describe the precise location of the mass in relation to anatomical landmarks.
• Size: Estimate the size of the mass in centimeters.
• Shape: Describe the shape of the mass, such as round, oval, or irregular.
• Consistency: Characterize the consistency of the mass, such as firm, soft, or cystic.
• Tenderness: Note whether the mass is tender or non-tender.
• Mobility: Assess the mobility of the mass, whether it is fixed or movable.
• Pulsation: Determine if the mass pulsates.
• Associated symptoms: Document any associated symptoms, such as pain, nausea, or vomiting.

Case Example A 55-year-old woman presented with a chief complaint of right upper quadrant abdominal pain for several weeks. The pain was dull and aching, aggravated by fatty foods, and occasionally radiated to the back. She also reported nausea and occasional vomiting. Her past medical history included hypertension and hyperlipidemia. She denied any history of abdominal surgeries or other significant medical conditions. On physical examination, her abdomen was soft, non-distended, and normothermic. Bowel sounds were active. Palpation revealed a firm, non-tender mass in the right upper quadrant, approximately 5 cm in diameter. The mass was mobile and did not pulsate. Based on the history and physical examination, a diagnosis of gallbladder cholelithiasis (gallstones) was suspected. An ultrasound confirmed the presence of gallstones, and the patient underwent a cholecystectomy (gallbladder removal). Musculoskeletal Conditions Osteoarthritis Osteoarthritis (OA) is the most common type of arthritis, affecting millions of people worldwide. It is a chronic degenerative joint disease that causes the breakdown of cartilage, the protective tissue that cushions the ends of bones. This breakdown leads to pain, stiffness, and swelling in the affected joints. Rheumatoid Arthritis Rheumatoid arthritis (RA) is an autoimmune disease that attacks the lining of the joints, causing inflammation, swelling, and damage to the cartilage and bone. RA can affect multiple joints throughout the body, including the hands, wrists, knees, and ankles. It can also lead to systemic symptoms, such as fatigue, weight loss, and fever.