Curriculum Vitae

Nama Lahir Alamat Istri Anak/Mantu/Cucu Pendidikan : : : : : : I Gede Arinton Singaraja, 1 Januari 1950 Jl. Pramuka 249 Purwokerto 1 5/3/3 1. dr. umum FK. UNUD 1977 2. dr. SpPD FK. UNDIP 1987 3. MKom STIBBi Jkt 1999 4. MMR UNSUD 2005 5. KGEH FK. UI 2007 6. Doktor Ilmu Kedokteran UNDIP 2008 : Bag. Penyakit. Dalam RSUD. Margono Soekarjo/FKIK Unsud Purwokerto Pelatihan Endoscopy di RSU dr. : 1. Hasan Sadikin Bandung. 2. International Endoscopy Workshop 2007, Jakarta 5 7 April 2007. 3. Training Endoscopy Showa University Yokohama 2009

Pekerjaan Pendidikan Tambahan

Anamnesis Abdominal Pain

Dr.dr. I Gede Arinton,SpPD-KGEH The Internal Medicine of FKIK Unoed Purwokerto 2012

Remember
1. CHIEF COMPLAINT :
a pain a symptom of discomfort a loss of usual function troublesome bodily change a psychiatric symptom Yes - ressucitation No --- :
HISTORY OF PRESENT ILLNESS PAST MEDICAL HISTORY FAMILY HISTORY

2. Emergency :

Abdominal pain
Acute abdominal pain

Chronic abdominal pain

Etiology and pathogenesis

Acute abdominal pain
Parietal peritoneal inflammation:
Bacterial contamination

Chemical irritation

Acute inflammation of abd.

Organs :
Gastritis Enteritis

Etiology and pathogenesis

Acute abdominal pain
Mechanical obstruction of hollow viscera
Vascular disturbances Referred pain
pneumonia, coronary occlusion
obstruction of the small or large intestine obstruction of the biliary tree Embolism, vascular rupture, torsion of the organs

Etiology and pathogenesis

Acute abdominal pain
Abdominal wall
trauma or infection of muscles, distortion or traction of mesentery

Metabolic and toxic causes

allergic factors etc.

Etiology and pathogenesis

Chronic abdominal pain Chronic inflammation of abd.organs
reflux esophagitis chronic ulcerative colitis Peptic ulcer

Distention of visceral surfaces

hepatic or renal capsules, hepatitis, hepatic cancer

Etiology and pathogenesis

Obstruction or torsion Infiltration or metastasis of tumor Metabolic and toxic causes
Uremia

Neurogenic
Irritable colon neurosis

Mechanisms of abdominal pain

Visceral pain
Somatic pain Referred pain

Visceral pain
Results from stimulation of autonomic nerves in the visceral peritoneum which

surrounds internal organs

The message may be transferred into the spinal cord via sympathic route Clinically :
Pain poorly localized

Intermittent, cramp or colicky pain

Accompanied by nausea, vomitting and diaphoresis

Somatic pain
Stimuli occurs with irritation of parietal peritoneum Sensations conducted along peripheral nerves which can localize pain better Clinically :
Precisely localized pain Pain described as intense, constant With local guarding or rigidity Getting worse after coughing or position changes May be caused by infection, chemical irritation, or other inflammatory process

Referred pain
Pain felt at a distance from its source

Clinically:
Obstruction of small intestine: periumbilical, supraumbilical Obstruction of large intestine: infraumbilial area Acute distention of gallbladder: right upper quadrant with radiation to the right posterior region of the thorax or the tip of the right scapula

HISTORY OF PRESENT ILLNESS

7 Core Dimensions:

1. Location- punctum max(surface anatomy):

Epigastric Pain
PUD GERD MI AAA- abdominal aortic aneurysm Pancreatic pain Gallbladder and common bile duct obstruction

Right Upper Quadrant Pain

Acute Cholecystitis and Biliary Colic

Acute Hepatitis or Abscess

Hepatomegaly due to CHF

Perforated Duodenal Ulcer

Herpes Zoster

Myocardial Ischemia
Right Lower Lobe Pneumonia

Left Upper Quadrant Pain

Acute Pancreatitis

Gastric ulcer
Gastritis

Splenic enlargement, rupture or

infarction

Myocardial ischemia
Left lower lobe pneumonia

Right lower Quadrant Pain

Appendicitis Regional Enteritis Small bowel obstruction Leaking Aneurysm Ruptured Ectopic Pregnancy PID Twisted Ovarian Cyst Ureteral Calculi Hernia

Left Lower Quadrant Pain

Diverticulitis Leaking Aneurysm Ruptured Ectopic pregnancy PID Twisted Ovarian Cyst Ureteral Calculi Hernia Regional Enteritis

Periumbilical Pain
Disease of transverse colon
Gastroenteritis

Small bowel pain

Appendicitis

Early bowel obstruction

Diffuse Pain
Generalized peritonitis Acute Pancreatitis Sickle Cell Crisis Mesenteric Thrombosis Gastroenteritis Metabolic disturbances Dissecting or Rupturing Aneurysm Intestinal Obstruction Psychogenic illness

HISTORY OF PRESENT ILLNESS

2. Quality

What is it like?

Penetrating or tissue destructive

process : stabbing - burning twisting tearing
squeezing.

Bodily or emotional reaction : terrifying

nauseating - sickening

HISTORY OF PRESENT ILLNESS

3. Quantity/Severity:/Characteristic :

spastic pain : intermittent Inflammatory : persisting

4. Chronology/Timing:
When did each symptom or problem begin?

5. Setting/Context:
What environmental factors, activities,
emotional reactions or other circumstances may have contributed to or led up to the problem?

HISTORY OF PRESENT ILLNESS

6. Modifying Factors:
What makes it better? What makes it

worse?

ulcer pain:

relieved by ingestion of food

7. Associated Symptoms/ Manifestations:

What other symptoms occur preceding, coincidentally, or following the primary symptom?

PAST MEDICAL HISTORY

is a record of the patient's past experiences with illnesses and medical treatments -- information :
adds to the physician' s understanding of the presenting problem or that leads to diagnostic possibilities to explain the current illness PMH often has a great impact on eventual patient management.

FAMILY HISTORY
a systematic exploration of the

presence or absence of illness

in the patient's family-

information may be helpful in

diagnosing the patient's present illness or suggest possible risks for future disease.

PAST MEDICAL HISTORY

Core Elements of the PMH :
7. Medications:
hormone replacement and birth control pils (include dosage and dosing regimen)

8. Allergies/Drug intolerance:
medication, environmental and food allergies. medication side effects

FAMILY HISTORY
Core Element of the FH :
1. Parents, siblings, and children:
health status, major illnesses, age at and causes of death

2. Other family members:

genetic factors : diabetes, CAD, hypertension, cancers, lipid disorders, psychiatric illnesses including alcoholism Illnesses similar to the patient's