Imperialism Rise in Nationalism • During the French and Industrial Revolution, nationalism continued to inspire nations to increase their political and economic power. • Nationalism became the ideal force in the political, economic, and cultural life in the world, becoming the first universal ideology-organizing all people into a nation state. Nationalism Defined • The strong belief that the interest of a particular nation-state is of primary importance. o Nation-State – a state where the vast majority shares the same culture and is conscious of it. It is an ideal in which cultural boundaries match up with political ones. • As an ideology, it is based on the idea that the individual’s loyalty and devotion to the nation-state surpass other individual/group interests. • Exalting one nation’s belief above all others and placing primary emphasis on promotion of its culture and interests, excluding the interests of others. Changing the World through a Nationalistic Vision • The French Revolution significantly changed the political world and how countries govern. • The Industrial Revolution significantly changed the economic world. • The Age of Imperialism (1870-1914) dramatically changed the political, economic, and social world. What is Imperialism? • Imperialism- The policy of extending the rule of authority of an empire or nation over foreign countries, or of acquiring and holding colonies and dependencies. Power and influence are done through diplomacy or military force. Reasons for Imperialism • There are 5 main motives for empires to seek to expand their rule over other countries or territories: 1. Exploratory • Imperial nations wanted to explore territory unknown to them. • The main purpose for this exploration of new lands was for resource acquisition, medical or scientific research. o Charles Darwin • Other reasons: o Cartography (map making) o Adventure 2. Ethnocentric • Europeans acted on the concept of ethnocentrism o Ethnocentrism- the belief that one race or nation is superior to others. • Ethnocentrism developed out of Charles Darwin’s “survival of the fittest” theory. Philosophers used the theory to explain why there were superior races and inferior races. o This became known as Social Darwinism. • Most imperial nations believed that their cultural values or beliefs were superior to other nations or groups. • Believed imperial conquest would bring successful culture to inferior people. 3. Religious • Imperial expansion promoted a religious movement of people setting out to convert new members of conquered territories. • With the belief that Christianity was superior, missionaries believed it was their duty to spread Christianity to the world. • Christian missionaries established churches, and in doing so, they spread Western culture values as well. • Typically, missionaries spread the imperial nation's language through education and religious interactions. 4. Political • Patriotism and Nationalism helped spur our imperial growth, thus creating competition against other supremacies. • It was a matter of national pride, respect, and security. • Furthermore, European rivalry spurred nations for imperial conquest. Since land equaled power, the more land a country could acquire the more prestige they could wield across the globe. • Empires wanted strategic territory to ensure access for their navies and armies around the world. • The empire believed they must expand, thus they needed to be defended. 5. Economic • With the Industrial Revolution taking place during the same time, governments and private companies contributed to find ways to maximize profits. • Imperialized countries provided European factories and markets with natural resources (old and new) to manufacture products. • Trading posts were strategically placed around imperialized countries to maximize and increase profits. o Such places as the Suez Canal in Egypt which was controlled by the British provided strategic choke hold over many European powers. o Imperial powers competed over the best potential locations for resources, markets, and trade. History of Imperialism • Ancient Imperialism 600 BCE-500 CE o Roman Empire, Ancient China, Greek Empire, Persian Empire, Babylonian Empire. • Middle Age Imperialism (Age of Colonialism-1400-1800s) o Great Britain, Spain, Portugal, France, Netherlands (Dutch), Russia. • Age of Imperialism 1870-1914 o Great Britain, Spain, Portugal, France, Germany, Belgium, Italy, Japan, United States, Ottoman Empire, Russia. • Current Imperialism...? o U.S. Military intervention (i.e. Middle East) o Russia’s Invasion of Ukraine. Imperialism Colonialism • Refers to political or economic control, either legally or illegally. • Refers to where one nation assumes control over the other. • Creating an empire, expanding into neighboring regions and expanding the dominance far outside its borders. • Where a country conquers and rules over other regions for exploiting resources from the conquered country for the conqueror's benefit. • Foreign government controls/governs a territory without significant settlement. • Foreign government controls/governs the territory from within the land being colonized. • Little to no new settlement established on fresh territory. • Movement to settle to fresh territory. Age of Colonialism WHEN? • Started around the late 1400s and ended around the late 1700s/early 1800s. WHY? • Primary Reason: European countries, wished to find a direct trade route to Asia (China & India) and the East Indies. o Quicker and relatively more effective than land routes over Asia. • Secondary Reason: Empire expansion (land power) WHO? • Countries involved: Great Britain, France, Spain, the Dutch & Portugal. • Individuals’ knowns as Mercantilists believed that maintaining imperialized territory and colonizing the region could serve as a source of wealth, while personal motives by rulers, explorers, and missionaries could therefore promote their own agenda. o This agenda being “Glory, God and Gold”. Mercantilism • Mercantilism was a popular and main economic system for many European nations during the 16th to 18th centuries. • The main goal was to increase a nation’s wealth by promoting government rule of a nation’s economy for the purpose of enhancing state power at the expense of rival national power. • It was the economic counterpart of political absolutism. Why did mercantilists want colonies? • Mercantilists believed that a country must have an excess of exports over imports. • By colonizing territory, it provided the nation with indispensable wealth of precious raw materials. • Therefore, the claimed territory served as a market and supplier of raw materials for the mother country. Which, in time, provided an excess of exports for the nation and thus created wealth. o Development of Trading Companies to support this economic system. Hudson Bay Company – (1670). Controlled primarily North America. o Dutch East Indie Trading Company (1682) o East Indian Trading Company (1600) o Royal African Trade Company (1672) WHERE? • European nations begun to colonize the America, India and the East Indies to create a direct trade route. • Great Britain was the leading power in India, Australia and North America, South Africa. • Spain colonized central and South America. • French held Louisiana, coastal land of Africa and French Guinea. • The Dutch built an empire in the East Indies. • The Portuguese was able to take control of present-day Brazil and the southern tip of South America and Japan. Age of Colonialism • As countries started to imperialize these regions, eventually the concept of colonization took hold: • This is what makes the Age of Colonialism extremely different! End of Colonialism • By 1800, colonialism became less popular • Why? o Revolutions (Spain, France & American) o The Napoleonic Wars o Struggle for nationalism and democracy. o Exhausted all money and energy to supervise their colonies. Waiting to wake again • Imperialism would stay quiet for close to 50 years before Great Britain and France’s economies revitalized. • The outbreak of the Industrial Revolution only encouraged and revitalized European nations to begin their conquest for new territory and resources. Age of Imperialism THE SCRAMBLE FOR AFRICA 1870-1914 Conditions Prior to Imperialism of Africa  European interest in exploiting Africa was minimal.  Their economic interests & profit in Africa primarily came through coastal trade that took place during the 1500-1700s.  The slave trade became the main source of European profit.  Furthermore, disease, political instability, lack of transportation and unpredictable climate all discouraged Europeans from seeking territory. Slave Trade & the Trans-Atlantic Slave Voyages  Forced labor was not uncommon during the 13-17th Centuries. Africans and Europeans had been trading goods and people across the Mediteranea for centuries.  This all changed from 1526 to 1867, as a new system of slavery was introduced that became highly “commercialized, racialized and inherited”  By 1690, the America and West Indies saw approximately 30,000 African people shipped from Africa. A century later, that number grew to 85,000 people per year.  By 1867, approximately 12.5 million people (about twice the population of Arizona) left Africa in a slave ship. What Changed? 1. End of the Slave Trade- Left a need for trade between Europe and Africa. 2. Innovation in technology- The steam engine and iron hulled boats allowed Europe 3. Discovery of new raw materials- Explorers located vast raw materials and resources and this only spurred imperialism with Europe in the wake of the Industrial Revolution. 4. Politics- Unification of Germany and Italy left little room to expand in Europe. Germany and Italy both needed raw materials to “catch up” with Britain and France so they looked to Africa. The Scramble for Africa  The scramble started in 1870.  Although some coastal land had previously been acquired before 1870, the need for territory quickly accelerated as European countries looked t get deeper into Africa.  Within 20 years, nearly all continents were placed under imperialistic rule. Who was Involved?  Great Britain  France  Germany  Italy  Portugal  Belgium  Spain (kind) Violent Affairs  Violence broke out multiple times when European nations looked to claim the same territory.  Germ Chancellor. Otto van Bismarck. Attempted to avert the possibility of violence against the European powers.  In 1884, Bismarck organized a conference in Berlin for the European nations. The Berlin Conference (1884-85)  The conference looked to set ground rules for future annexation of African territory by European Nations.  Annexation is the forcible acquisition and assertion of legal title over one state’s territory by another state, usually following military occupation of the territory.  From a distant perspective, it looked like it would reduce tensions among European nations and avert war.  At the heart of the meeting, these European countries negotiated their claims to African territory, made it official and then mapped their regions.  Furthermore, the leaders agreed to allow free trade among imperialized territory and some homework for negotiating future European claims in Africa was established. Further Path  After the conference, european powers continued to expand their claims in Africa so that by 1900. 90% of the African territory had been claimed. A Turn towards Colonization?  Upon the imperialization of African territory, European nations and little interest in African land unless it produced economic wealth.  Therefore, European governments put little effort and expertise into these imperialized regions.  In most cases, this emat a form of indirect rule. Thus, governing the natin without sufficient settlement and government from within the mother country. Some Exceptions  There were some exemptions through in Africa as colonization was a necessary for some regions i n Africa.  Some regions where diamonds and gold were present. Government looked to protectorate the regions and establish rule and settlement in the regions.  Protectorates: A state controlled and protected by another state for defense against aggression and other law violations. Would  Some examples include South Africa, Botswana, Zimbabwe and Congo. Conclusion  Although it may appear that the Berlin Conference averted war amid the African Scramble, imperialism eventually brought the world into worldwide conflict.  With the continued desire to create an empire by European nations. World War 1 would break out which can be linked to this quest at imperialism.

Note

Studied by 11 people

4.5(2)

Medical Semiology - PA

ANAMNESIS

don’t write anything that is normal/unrelated

Name

Age

Sex

CHIEF COMPLAINT

Admission date, Emergency/ Programmed.

Main cause of admission, main signs and symptoms.

where, onset, severity, type of pain

FAMILY HISTORY

Father : age, alive/death, any pathology, under treatment/ no treatment

Mother:

Brother/ Sister :

Son/ Daughter:

PERSONAL HISTORY

Allergies , Vaccines (# COVID doses,) , Surgery (if any, date and treatments, if no papers it's “undocumented”), Recent or past (childhood) pathology (age of diagnosis, treatments), bleeding tendencies, blood group

Digestive - ask for UC, ulcers, neoplasms, hepatic diseases (Wilson's, hemochromatosis), anemia, transfusions, tattoos, DM

(if female patient)

First menstruation, Last menstruation, Regular/Irregular bleeding, Pregnancies (if any, numbers and description of any problem related to it) , Abortion, hormonal medications

SOCIAL HISTORY

City, Country side/ Center, Garden/Apartment/House, Animals, Alone/Roommates, Job environment, Lifestyle (exercise, diet), Sexual orientation.

Who does the cleaning, shopping, cooking ?

Digestive - hepatotoxins, hepatitis, diet (fiber, intolerances), smoking (→ pancreatic cancer, peptic ulcers), alcohol (→ gastritis, GERD, peptic ulcers, ASH)

RISK FACTORS/ CHRONIC INTOXICATION

Smoking (how long, packs/day, start and end)/ Alcohol (quantity, type, start and end)/ Coffee

(frequency)/ Drugs (start, end)

Smoking index = years smoking/packs per day

66
20-22 is risk for cardiovasc disease

DRUG HISTORY

Mediations (frequency), Treatments

#-#-#, F=tablets

Digestive - amiodarine → hep, contraceptives → cholestasis, paracetamol → acute liver necrosis

HISTORY OF PRESENT ILLNESS / EPICRISIS

Patient, age, sex, presents to hospital emergency/on appointment.

Current + past pathologies

Onset, Setting of development, Manifestations, Treatment.

Each symptoms: Location, Type, Quantity/Severity, Timing.

What exacerbates it ? What relieves it ?

Intoxications that correlate

Meds if related

Ex :The patie wasnt Andrei Ioan has been admitted at the clinic on appointment the 26/04/21 afternoon presenting with nausea, vomiting, epigastric pain and fatigue. The onset was on the 23/04/21 around lunch time when he started to feel a burning sensation of the stomach and chest discomfort. After a while he started to feel nauseated so he decides to lie on the bed where the symptoms relieve after 30 minutes. In the evening same situation appears after dinner and after he vomited later on he decides to take an appointment with the GP. Manifestation seems to be linked to food ingestion. Epigastric pain, nausea and chest discomfort after meals so 2/3 times x day, very sharp and burning pain which the patient describes as 8 on a scale up to 10. Bed rest help the patient relieve the symptoms.

GENERAL PHYSICAL EXAMINATION

write everything, if normal put “according to age and gender”

General state : well, relatively well, influenced, severe, critical

Constitution, nutritional state : ( Hypersthenic/ Normosthenic/ Hyposthenic/)

Height

Weight

BMI = weight/(height)^2

hyposthenic <20
normosthenic 20-24.9
overweight 25-30
obesity I 30-34.9
obesity II 35-39.9
morbid/III >40

Consciousness state : conscious, alert, cooperative

Faces : Normal/Hippocratic/Nephritic/ Febrilis/Mitralis/Plethoric (HTN or polycythemia)/Sclerodermic (mummy face, tiny ulcerations, dry, parrot peak nose, wolf teeth)/Basedow or Graves (bulging eyes, retroocular m hypertrophy, exophthalmos)

Endocrine face : Acromegaly (massive supraorbital arcs, big nose + tongue)/ Cushing (moon face, erythematous) / Thyrotoxic/ Myxedema (dry skin)

Cushing

Symmetry / Paresis

Lymph nodes: Palpable/Not palpable

if palpable → inflammatory (rubbery, painful, not adherent) or tumoral (not painful, tough, attached)
Preauricular, posterior auricular, occipital, tonsillar, submandibular, submental, superficial cervical, posterior cervical, deep cervical chain, supraclavicular
Skin : “normally coloured skin", Color, Hydration (“well hydrated"), “normal skin turgor”, Temperature, Lesions, Mobility, Turgor, Scars
Translucent + thin → chronic hypoperfusion

Mucosa : Color, Patches/Ulcer, Nodules

Eyes - conjunctiva pale → anemia, sclera yellow → icterus, watery/dry
Oral

Connective - Adipose tissue : pear-shaped, apple-shaped, pyknic (short + fat)

Musculo-Skeletal : Hyper/Normo/Hypo Tonic, Hyper/Normo/Hypo Kinetic, Hypo/Normo/Hypertrophic, Gait

Osteo-Articular : “full integrity of bone system”, “no pain in movement”

“good range of motion in all joints. no evidence of swelling or deformity”

spine percussion → “no pain at spine tap”

Appendages :

Nails
Hair

RESPIRATORY SYSTEM

Inspection : Respiratory rate → >20 = tachypnea

COPD
- Blue boater → cyanotic lips, clubbing, congestive conjunctiva, hypercapnia, hypoxia
- Pink puffer → emphysematous thorax, deflated diaphragm, pul HTN, skinny
Cyanosis → tachypneic, blue lips, voluminous breathing, orthopneic position, expressed accessory m, lower limb edema
Lateral decubitus → laying on one side
Symmetrical/Asymmetrical thorax
barrel thorax → ant post diameter is wider, less diaphragmatic mobility, increased intercostal spaces → marker of COPD
funnel chest (pectus excavatum) → depression in the lower portion of the sternum
pigeon chest (pectus carinatum) → sternum is displaced anteriorly, increasing the anteroposterior diameter → hypoventilation
kyphoscoliosis

Movement - “Well maintained diaphragmatic mobility “ (no if using accessory m)

posterior thorax → thumbs @ 10th rib
anterior thorax → thumbs @ costal margins

Palpation : Tactile fremitus Hyper/Normo/Hypo resonant (normal, increased, decreased, or absent)
Tactile fremitus - physiologically decereases
- Absent → pleural effusion

Percussion: Hyper/Normo/Hypo resonant with Mobile/Stuck diaphragm.

(locate pathological resonance), ant thorax not necessary

start at supraclavicular
seated patient, hugging arms
not to be done in emphysema
to count intercostals → 7th intercostal space is lower edge of scapula

Hyperresonance → COPD

Hyporesonant → atelectasis

Auscultation : “normally detectable/present bronchial breathing and vesicular sounds”

FIRST - bronchial breathing → lower neck + subclavicular spaces

ask patient to breathe thru mouth
at what point in resp cycle does the sound occur?
left vs right side
Transmitted voice sounds → patient says “ee” → “a” sound = pneumonia
reduced sound → local is pneumothorax, effusion, pneumonia (@ base)
- global is COPD, asthma
Wheeze → continuous musical whistling in ant thorax, narrowed airways → asthma + COPD
- stridor → inspiratory
Crackles (rales) → discontinuous, from fluid, coarse is infection, fine is fibrosis, physio @ base, LHF
Ronchi → low-pitched, “snoring”
Rub → “step in snow”, in both phases, in dry pleuritis (not wet)
Atelectasis → increased tactile fremitus, percussion dullness, abnormal breath sounds
if unsure if physio sound → ask patient to cough, if increased sound it’s patho (pneumonia)

CARDIOVASCULAR EXAMINATION

Patient supine w/ upper body raised 30 degrees, or turned to left or leaning forward - examiner on right side

Inspection of precordium - scars, v collaterals, chest shape (left asymmetry from congenital RVH, precordium bulge from effusion, barrel from cor pulmonale, parasternal bulge from aortic aneurysm), pulsations (→ SVC/subclavian v obstruction, parasternal is a. dilation), abnormal movements (inward apex excavation in systole from adhesive pericarditis)
1. Harzer sign - epigastric pulsation from RVH or in thin patients, visible pulsation of apical beat in DCM
Palpation - apex beat (normal/strong/diffuse/impalpable), Palpable/ Not palpable cardiac thrills, 5th intercostal space on midclavicular line (lay patient on left if can’t feel it), normal diameter is 1 intercostal space
- LVH + dilated cardiomyopathies change 6th intercostal space
Percussion - Cardiac dullness in Normal/Abnormal range showing a Normal/Abnormal sized heart
Auscultation - Rythmic/Arythmic cardiac sounds with/without superimposed pathological sounds or bruits (locate and describe pathological sounds)
- diaphragm - 1 + 2nd heart sounds, systolic murmurs
- bell - 3rd + 4th heart sounds, diastolic murmurs
- l lat decubitus - for mitral stenosis, S3, S4
- sitting + forward - for aortic regurgitation

standing up - mitral valve prolapse

Mitral - 5th interspace, at apex (best for hearing S1)

Tricuspid - 4th interspace, l sternal edge

Pulmonary - 2nd interspace, l sternal edge

Aortic - 2nd interspace, r sternal edge

Erb-Botkin - 3rd interspace, l sternal edge (for aortic insufficiency, pericarditis)

patent ductus arteriosus - 1+2nd interspaces below l midclavicular area

Feel carotid pulse (occurs w/ S1)

Murmurs: must describe timing, intensity, location of max intensity, radiation, pattern, character, variation w/ position

“medium pitched, grade 3/6, blowing holosystolic murmur, best heard at apex, radiating to left axilla” (mitral reg.)

S3 - “ken-tuck-y”, gallop

S4 - “da-lub dub”, before S1 (late diastole)

Extra hearts sounds:

Pericardial friction rub - scratching, high-pitched, use diaphragm on Erb point, patient forward

Systolic - midsystolic click (av valve prolapse), high pitched, heard medial to apex, patient sitting + forward

ejection click (semilunar stenosis), high-pitched early in systole, w/ diaphragm at a or p areas

Diastolic - opening snap (mitral stenosis), early in diastole, @ apex at l lat decubitus position

pericardial knock (constrictive pericarditis), in early diastole

Peripheral pulse -
1. JVP (assesses right heart) - OF IJV, supine, 15° trunk elevation, press on liver if you can’t see it (hepatojugular reflux)
2. radial (medial to styloid process), temporal (in front of ear), carotid (for pulse character + waveform, supine, 15° trunk elevation, medial to scm), brachial (medial side of fossa), femoral, popliteal (deep), post tibial (post+inf to medial malleolus), dorsalis pedis (lat to exterior hallucis longus, b2 1+2nd metatarsals)

Rate, Rhythm, Symmetry, Quality (pulsus bisferiens in aortic reg, collapsing, celer + altus, parvus + tardus, filiformis)

Radio-radial pulse + radio-femoral pulse if abd/arcus aortae stenosis

Vital signs - BP, HR, RR, temp

ECG

Cardiac rhythm - origin, rhythmicity (sinus rhythm)

P waves + in leads II and aVF, normal is DII + V1
1 big square - 0.2s
ventricular rhythm - R-R intervals
atrial rhythm - P-R intervals

HR: 300, 150, 100, 75, 60, 50
Axis - are heights of QRS from leads I and aVF + or - ? (physio +) Where do the quadrants overlap?

normal is 0-90°

QRS
ST segments + T waves
PQ + QT intervals

Aortic regurgitation - by asc aortic dissection, RF, IE

LV v overload → increased LV end-diastolic → increased pul p → dyspnea + pul edema
Manifestations - widened pulse p (bw systolic + diastolic), water-hammer pulse, apical beat hyperdynamic, Quincke sign, S3, early diastolic murmur, Austin Flint murmur (mid-diastolic)
Investigations - ecg shows LVH + left axis deviation, pbc and cultures +

Aortic stenosis - by calcification (DM) or RF

increased LV afterload → LVH → decrease systemic flow → MI
Manifestations - angina, syncope, HF, powerful apex beat, ejection click, S3+S4, crescendo-decrescendo systolic murmur, radiates to carotids
Investigations - BNP, ecg shows LVH, AF

Tricuspid stenosis - by RF, IE, lupus

less flow to RV → RAE, obstructed v return (hepatomegaly, less pul flow, edema)
Manifestations - edema, fatigue, increased JVP, RVH, ascites, tricuspid opening snap, diastolic murmur
Investigations - CBC, tall P waves (RAE), AF and atrial flutter (for albin)

Tricuspid regurgitation - by RF, IE, prolapse, diseases causing pul HTN

RV v overload → RHF
Manifestations - of RHF (edema, ascites, hepatomegaly), JVD, S3+S4 (increases w/ ins),
Investigations - no ECG abnormalities, cardiomegaly, dilated RV on echo

Pulmonary stenosis - by congenital diseases

Pulmonary regurgitation

either by pulmonary valve dilation (pul HTN), by infection or congenital
Manifestations - dyspnea, angina, edema, palpitations, abd distention, JVD, palpaple S2, S split, Graham steel murmur (early diastolic decrescendo), holosystolic tricuspid regurgitation murmur
Investigations - ECG shows RVH + E

Mitral stenosis - by RF

Calcified valve → left atrial p increased → pul v HTN → AF
Manifestations - LFH (dyspnea, orthopnea), mitral face, apical impulse lat displaced, opening snap
Investigations - LAE, RVH on ECG

Mitral regurgitation - by RF, myxomatous degeneration

increased preload → increased stroke v → increased left atrial pressure
Manifestations → LHF (dyspnea, orthopnea, pul edema), S2 split, holosytolic murmur towards axilla
Investigations - BNP, LVH + LAE in ECG, AF

ABDOMINAL EXAMINATION

Inspection : In supine position the abdomen Is/Is not in xypho-pubian plane

Participating/Not participating in respiratory movements.

Teguments, collateral circulations, stretch marks

Normal hernia free points With/Without protruding masses.

Auscultation : Normal/Abnormal , Present/Absent peristaltic movement.

Palpation : feet lying or bent

Superficial palpation : on each quadrant

Abdomen is Elastic/Tender in…(which one)… quadrants With/Without specific tenderness or pain.

Deep palpation : along each quadrant, Elastic/Tender abdomen, Murphy sign Positive/Negative, use 2 hands

Palpate liver - patient takes deep breath, upwards movements w/ fingers, feel surface of liver then edges, Inferior margin of the liver Is/Is not palpable

croash/Murphy maneuver → sticking fingers under ribs after patient takes deep breath

Spleen is/Is not palpable. - palpate from right iliac fossa to other side, patient taking deep breaths

palpable when enlarged, portal htn, you can feel inf pole

Kidneys - one hand pressing on top, the other under to touch kidneys

palpable in liver enlargement, PKD

Percussion : supraumbilical then to lateral borders, liver in interspaces, splenic border, suprapubic

Hyper/Normo/Hypo resonant percussion Alternating/ Not alternating tympanic and dullness sounds.

Fluid wave test for ascites is Negatve/Positive

Shifting dullness - turn on one side and wait, percuss from lat to medial, transmitted on palm thru impulse of movement by liquid → ‘wave sign’ of ascites

Liver - percuss for prehepatic diameter is 12cm, (lowest part you hear dullness) → inf margin, work up

from right iliac fossa → thoracic cage

Spleen - from right iliac fossa to axillary line, bw 7-9th interspaces

Kidney - in acute urinary retention, tympanic sounds physiological

Giordano maneuver bilaterally Positive/Negative

Duodenal ulcer - pain occurs after eating (after an hour)

Dysphagia : difficulty swallowing, check for tumours, achalasia, peptic ulcers, if oropharyngeal it's infections or Zenker's, if esophageal it's tumors or peptic strictures

Odynophagia : swallowing feels painful, caused by chemical irritants

Heartburn : caused by peptic ulcers, GERD

Dyspepsia : indigestion, gastric is nausea and vomiting, intestinal is defecation disorders

Tenesmus : urge to go toilet but can't go, check for rectal cancer if with blood

Nausea and vomiting: in acute cholecystitis, pancreatitis, gastroenteritis, gastroparesis

If morning - alcoholics and pregnant
If after eating - peptic ulcers, psychiatric
If 4h after meal - gastroparesis
Continuous - depression
Irregular - major depression

Green vomit - bile (small bowel obstruction)

Undigested food - achalasia

Partially digested - gastroparesis, gastric outlet obstruction

Hematemesis - upper GI bleed (above angle treitz)

Pruritis - pregnant, cancer, cirrhosis

Gastroparesis : early satiety, post prandial bloating, abd discomfort

Diverticuli - dilations, cause extreme bleeding

Peptic ulcers - episodic pain after meals

Biliary pain - severe, right upper/epigastric, after fatty foods

Pancreatic pain - epigastric radiating to back, relieved by sitting up/leaning

Small bowel obstruction - periumbilical

Colonic pain - like small bowel but relieved by defecation/flatus

Bowel ischemia - right upper/central, exacerbated by eating

Renal colic - lumbar (costovertebral angles), tender to touch

Bladder pain - suprapubic, diffuse, severe

Prostatic pain - dull, in lower abdomen or rectum

Ureteral pain - variable, exacerbated after urination

Topographical divisions

Murphy sign - acute cholecystitis, 9th interspace
Bar from left to right - acute pancreatitis
Appendicitis - McBurney point → 1/3 iliac spine - umbilicus

- Lanz point → 1/3 of the way between the two anterosuperior iliac spines

- Gerota clock - position appendix

- Iacobovici triangle - linea alba, Lanz, McBurney

- Iupsoas manoeuver - raise legs and press on appendix

Courvesier sign - pancreatic head tumour
Virchow/Troisier node - gastric tumour
Acute pancreatitis - Turner sign - flank bruises, Cullen sign - periumbilic bruises

Immobile patient - peritonitis

Patient on all 4s - pancreatitis

Obesity - w/ cholelithiasis (female, fatty, 40)

Peripheral edema - nephrotic syndrome, cirrhosis, malabsorption

Limbs :

Leukonychia, koilonychia - hypoalbuminemia
Clubbing- cirrhosis, IBD, celiac
Blue lunale nails, Keyser Fleischer rings - Wilson's
Palmar erythema - liver
Dupuytrens contracture
Axilla - adenopathies from gastric cancer (Virchows nodes)
Circumoral pigmentation - peutz jager
Tongue - iron/B12 deficiency swollen, leukoplakia in alcohol, candidiasis in iron deficiency
Acanthosis nigricans in axilla - DM

Findings: