Swelling or mass
When noticed?
- Acute (hematoma, abscess)
- chronic- neoplasm, organomegaly
How noticed?
- Incidentally noticed swelling may be present for longer duration
Painful or painless?
- Inflammatory, neoplasm
Change in size
- since first noticed? Increase- neoplasms,
- disappear or reduce in size-?hernias/ improved inflammation
Aggravating/relieving factors:
- Hernias increase in size with activity/cough
Any cause?
-
Trauma- hematoma, cough- hernia
Vomiting
-
Non- bilious: Early stage, late- pyloric obstruction
-
Bilious: bowel obstruction
-
Faeculent: late stage of bowel obstruction
-
Blood: Duodenal ulcer, oesophageal varices, tumor
-
Vomiting relieves pain- gastric ulcer
-
Vomiting food taken few days ago: pyloric stenosis
Bowel habit
Constipation:
- habitual, recent (neoplasm)
Absolute constipation (obstipation):
- Intestinal obstruction
Diarrhoea:
- duration (acute, chronic),
- number of stool,
- any blood or mucous (IBD),
Color of stool:
- Bright red (anal, rectum), maroon (colon) black- melena (upper GI)
History of discharge
Site: anal, perineum, wound
Duration
Nature:
- purulent (anal fistula), bloody (hemorrhoid), fecal from wound ( int. fistula)
Relationship to defecation/stool
- mixed with stool- IBD, independent of stool- hemorrhoids
Any pain?
- Hemorrhoids
- Anal fistula