4. SITE AND RADIATION
ORGAN SITE OF PAIN RADIATION
STOMACH EPIGASTRIUM Rt HYPO,
LUMBAR,Rt
ILIAC,Lt
CHEST,VERTEBR
AL COLUMN
LIVER-Rt LOBE Rt SHOULDER,SUP
HYPOCHONDR RACLAVICULAR
& SCAPULAR
IUM
REGION ON Rt
5. LIVER-Lt LOBE EPIGASTRIUM PRECORDIUM,
Lt SCAPULAR, Lt
CLAVICLE
GALL BLADDER EPIGASTRIUM or CHEST,Rt
Rt SCAPULA,Rt
HYPOCHONDRI CLAVICLE,SHOU
UM LDER,BACK
May resemble
ANGINAL pain
SPLEEN Dragging Local inflamn of
(pain unusual) sensation peritoneum-
&fullness-Lt Catching pain
HYPO & respiration
LUMBAR
6. PANCREAS EPIGASTRIUM Acute-symps of
OR BACK shock
Chronic-vague in
nature & location
KIDNEYS LOINS or Obstructive
LUMBAR lesions-Penis or
REGION Labia + urgency
for urination
URINARY HYPOGASTRIUM PERINEUM &
BLADDER URETHRA
7. SMALL UMBILICUS
INTESTINE
LARGE ILIAC or LUMBAR
INTESTINE
APPENDIX Rt ILIAC FOSSA Rt LUMBAR,
CAECUM UMBILICAL
RECTUM Lt ILIAC FOSSA Assoc. with
or tenesmus
HYPOGASTRIUM
8. UTERUS HYPOGASTRIU LOW BACK &
M & UMBILICUS FLANKS
DYSMENORRHOEA LOWER
ABDOMEN
OVARY ILIAC FOSSA EXTERNAL
GENITALIA
9. PERITONITIS
LOCALISED GENERALISED
Eg. Rt iliac fossa in DIFFUSE affecting
appendicitis the whole abdomen
GUARDING AND RIGIDITY ON PALPATION
10. REFERRED PAIN
Pain arising from lesions outside
abdomen
REFERRED to abdomen
Eg. MI radiate to epigastrium
Girdle pain B/L dorsal nerve root
compression
12. NATURE OF PAIN
SOLID ORGANS:DULL & CONSTANT
aggravated by pressure.Organ
enlarged,palpable,tender.
HOLLOW VISCERA:COLICKY PAIN
reach max. in secs or mins & passes off.
Exception biliary tract & pancreas
13. DURATION OF PAIN
ACUTE CHRONIC
Intense pain with Periods of remissions
dramatic onset & exacerbations with
Reach maximum in intervals of relief in
hrs or days btwn
Months or years
14. Relation to normal physiological events
Pain related to ingestion of Gastric ulcer
food
Pain relieved by food intake Duodenal ulcer
Relief of pain by vomiting Gastric outlet obstruction
Pain on recumbency & GERD
relief on erect posture
15. Pain on ingestion of fat Malabsorption
Pain on defaecation Colonic disease
Blood and mucus in faeces Colonic ulcer
Pain as food pass down to Intestinal angina
be digested & absorbed
17. Personal History
Appetite & Loss of weight
Bowel habits- Malena-Upper GIT ds
Hematochezia-Lower GIT ds
Difficulty in micturition
Menstrual history
18. General Examination
PALLOR Malabsorption,Acute or
chronic blood loss
ICTERUS Hepatobiliary disease
CYANOSIS Cirrhosis liver with portal
hypertension
CLUBBING Cirrhosis,ulcerative
colitis,Crohn`s disease
LYMPHADENOPATHY Generalised or localised