Doctor, I get pain in the upper abdomen after my meals.
1. Do you get pain immediately after meals
(Gastric ulcer), or you feel better for 2-3 hrs, and then get the pain (Duodenal ulcer)? “After 2-3 hrs.”
1. Is there retrosternal burning? “No”. (So unlikely to be Esophagitis) 2. Do you get pain early morning around 3-4 AM? “Yes” 3. Do you get sour eructations, regurgitation or vomiting? “Yes” 4. Did you have a similar episode in the past? Few weeks or months ago? “Yes doctor. I had similar pain last year.” (Periodicity typical of DU) 5. Did you take any medicines before the pain started? NSAIDs or steroids? “Yes, I had taken Voveron tablets for backache.” (Precipitating factor)
Ask the patient to lie down with the legs flexed, and abdomen relaxed.
1. Palpate the abdomen gently, for tenderness in epigastrium & right hypochondrium. 2. Press under the right hypochondrium and ask him to take a deep breath – for Gall bladder tenderness. (Murphy’s sign)
Palpate for colonic tenderness on both the sides. If tender, ask, Do you get dysentery off & on?
Is there mucus or blood in the stools?
(Is it Amoebiasis? – a common condition in our country) Action:
