EXAMINATION OF CHRONIC ABDOMEN

**EXAMINATION OF CHRONIC ABDOMEN **

Definition of Chronic Abdominal Conditions

• Chronic abdominal conditions refer to persistent or recurring abdominal symptoms that last for more than three months.
• Examples include chronic constipation, irritable bowel syndrome (IBS), and chronic abdominal pain.

Types of Chronic Abdominal Conditions

• Chronic Abdominal Pain: Persistent pain in the abdominal region that lasts for more than three months.

  • Types:
    • Visceral pain: Pain originating from internal organs.
    • Musculoskeletal pain: Pain from muscles and bones in the abdominal region.
    • Neuropathic pain: Pain resulting from nerve damage.
  • Causes:
    • Gastrointestinal disorders (e.g., IBS, inflammatory bowel disease).
    • Musculoskeletal disorders (e.g., abdominal muscles strain).
    • Nerve damage (e.g., herniated disc, nerve compression).
  • Clinical Features:
    • Persistent or recurring abdominal pain.
    • Pain that worsens with movement or pressure.
    • Pain that radiates to other areas (e.g., back, legs).
  • Investigations:
    • Imaging studies (e.g., X-ray, CT scan, MRI).
    • Endoscopy and colonoscopy.
    • Blood tests and stool tests.
  • Complications:
    • Chronic pain syndrome.
    • Depression and anxiety.
    • Sleep disturbances.
  • Management:
    • Medications (e.g., analgesics, antidepressants).
    • Lifestyle modifications (e.g., diet, exercise, stress management).
    • Alternative therapies (e.g., acupuncture, massage).

• Chronic Constipation

  • Types:
    • Primary constipation: No underlying medical condition.
    • Secondary constipation: Underlying medical condition (e.g., diabetes, hypothyroidism).
  • Causes:
    • Poor diet and hydration.
    • Sedentary lifestyle.
    • Certain medications.
  • Clinical Features:
    • Infrequent bowel movements (less than 3 times a week).
    • Hard or lumpy stools.
    • Straining during bowel movements.
  • Investigations:
    • Stool tests.
    • Imaging studies (e.g., X-ray, CT scan).
  • Complications:
    • Hemorrhoids.
    • Fecal impaction.
    • Rectal prolapse.
  • Management:
    • Dietary changes (e.g., increase fiber intake).
    • Exercise and physical activity.
    • Medications (e.g., laxatives, stool softeners).

• Irritable Bowel Syndrome (IBS)

  • Types:
    • IBS-D (diarrhea-predominant).
    • IBS-C (constipation-predominant).
    • IBS-M (mixed-type).
  • Causes:
    • Unknown, but may be related to gut motility, hypersensitivity, and stress.
  • Clinical Features:
    • Recurring abdominal pain or discomfort.
    • Changes in bowel habits (diarrhea, constipation, or both).
    • Bloating and gas.
  • Investigations:
    • Stool tests.
    • Imaging studies (e.g., X-ray, CT scan).
  • Complications:
    • Anxiety and depression.
    • Sleep disturbances.
    • Social and work-related difficulties.
  • Management:
    • Dietary changes (e.g., low FODMAP diet).
    • Exercise and stress management.
    • Medications (e.g., antispasmodics, antidepressants).

Comprehensive History

• Medical History:
  • Previous abdominal surgeries.
  • Gastrointestinal disorders (e.g., IBS, inflammatory bowel disease).
  • Musculoskeletal disorders (e.g., abdominal muscles strain).
  • Nerve damage (e.g., herniated disc, nerve compression).
• Family History:
  • Gastrointestinal disorders.
  • Musculoskeletal disorders.
  • Nerve damage.
• Social History:
  • Lifestyle habits (e.g., diet, exercise, stress management).
  • Use of medications or supplements.
  • Travel history.

Detailed Examination

• General Examination:
  • Abdominal palpation (to assess tenderness, masses, or guarding).
  • Auscultation (to assess bowel sounds).
  • Percussion (to assess organ size and boundary).
• Specific Examination:
  • Rectal examination (to assess rectal tone, tenderness, or masses).
  • Proctoscopy or sigmoidoscopy (to visualize the rectum and sigmoid colon).

Identify Specific Signs

• Abdominal Tenderness:
  • Pain or discomfort in the abdominal region.
• Abdominal Mass:
  • A palpable lump or mass in the abdominal region.
• Guards:
  • Stiffening of the abdominal muscles to protect the underlying organs.
• Rebound Tenderness:
  • Pain or discomfort upon release of abdominal pressure.

Formulate Differential Diagnosis

• Chronic Abdominal Pain:
  • Gastrointestinal disorders.
  • Musculoskeletal disorders.
  • Nerve damage.
• Chronic Constipation:
  • Poor diet and hydration.
  • Sedentary lifestyle.
  • Certain medications.
• Irritable Bowel Syndrome (IBS):
  • Unknown, but may be related to gut motility, hypersensitivity, and stress.

Discuss Laboratory Investigations

• Stool Tests:
  • To diagnose gastrointestinal infections.
  • To detect blood or mucus in the stool.
• Blood Tests:
  • To diagnose underlying medical conditions (e.g., anemia, diabetes).
• Imaging Studies:
  • To visualize internal organs and structures.
  • To diagnose underlying medical conditions (e.g., hernias, gallstones).

Explain Imaging and Endoscopy

• X-ray:
  • To visualize internal organs and structures.
  • To diagnose underlying medical conditions (e.g., hernias, gallstones).
• CT Scan:
  • To visualize internal organs and structures.
  • To diagnose underlying medical conditions (e.g., tumors, abscesses).
• MRI:
  • To visualize internal organs and structures.
  • To diagnose underlying medical conditions (e.g., nerve damage, herniated discs).
• Endoscopy:
  • To visualize the inside of the gastrointestinal tract.
  • To diagnose underlying medical conditions (e.g., ulcers, polyps).
• Colonoscopy:
  • To visualize the inside of the colon and rectum.
  • To diagnose underlying medical conditions (e.g., colon cancer, polyps).

Homoeopathic Therapeutic Medicines

• Arnica Montana:
  • For abdominal pain and discomfort.
  • For inflammation and swelling.
• Calendula Officinalis:
  • For wound healing and tissue repair.
• Belladonna:
  • For abdominal pain and discomfort.
  • For inflammation and swelling.
• Lycopodium Clavatum:
  • For abdominal pain and discomfort.
  • For digestive issues (e.g., bloating, gas).
• Nux Vomica:
  • For abdominal pain and discomfort.
  • For digestive issues (e.g., constipation, diarrhea).