HISTORY-Associated SymptomsNausea,Associatedsymptomscanbeimportantdiagnosticclues.vomitingconstipation,diarrhea,pruritis,melena,hematochezia,and/or hematuria canall behelpfulsymptomsifpresentandrecognizedVomitingis more likelytoprecedetheonsetof significantabdominal painin manymedicaconditions,whereasitissecondarytotheabdomenpainofanacutesurgicalabdomenConstipationObstructionDiarrhea
HISTORY-Associated Symptoms • Associated symptoms can be important diagnostic clues. Nausea, vomiting, constipation, diarrhea, pruritis, melena, hematochezia, and/or hematuria can all be helpful symptoms if present and recognized • Vomiting is more likely to precede the onset of significant abdominal pain in many medical conditions, whereas it is secondary to the abdomen pain of an acute surgical abdomen • Constipation • Obstruction • Diarrhea
HISTORY -The Past Medical HistoryThe past medical history could be more helpful than any other single part of thepatient's evaluationPrevious illnesses or diagnoses can greatlyincrease ordecrease thelikelihood of certairconditions that would otherwisenot be stronglyconsidered.During the abdominaexamination, all scars on the abdomen should beaccounted for bythe medical historyobtained
HISTORY-The Past Medical History • The past medical history could be more helpful than any other single part of the patient’s evaluation • Previous illnesses or diagnoses can greatly increase or decrease the likelihood of certain conditions that would otherwise not be strongly considered. During the abdominal examination, all scars on the abdomen should be accounted for by the medical history obtained
HISTORY -MedicationsMedications can both create acute abdominal conditions or alternatively mask theirsymptomsNarcoticInterferewithbowelactivityandleadtoobstipation andobstructionSpasmofthesphincterofoddiandexacerbatebiliaryorpancreaticpainSuppresspainsensationandaltermentalstatusImpair theabilityto diagnosethecondition accuratelyNSAIDsIncreased risk ofuppergastrointestinal inflammation and perforationBlock protectivegastricmucousImmunosuppressiveagentsIncreaseapatient'sriskofacquiringvariousbacterial orviral illnessesBlunttheinflammatoryresponseDiminishing the pain that is present and the overall physiologic response
HISTORY-Medications • Medications can both create acute abdominal conditions or alternatively mask their symptoms • Narcotic • Interfere with bowel activity and lead to obstipation and obstruction • Spasm of the sphincter of oddi and exacerbate biliary or pancreatic pain • Suppress pain sensation and alter mental status • Impair the ability to diagnose the condition accurately • NSAIDs • Increased risk of upper gastrointestinal inflammation and perforation • Block protective gastric mucous • Immunosuppressive agents • Increase a patient’s risk of acquiring various bacterial or viral illnesses • Blunt the inflammatory response • Diminishing the pain that is present and the overall physiologic response