DVBCWST3 ;ALB/RLC STOMACH, DUODENUM, AND PERITONEAL ADHESIONS WKS TEXT - 1 ; 16 JAN 2007 ;;2.7;AMIE;**120**;Apr 10, 1995;Build 4 ; TXT ; ;;A. Review of Medical Records: ;; ;;B. Medical History (Subjective Complaints): ;; ;; Comment on: ;; ;; 1. Nausea, vomiting. ;; 2. Hematemesis or melena (describe any episodes). ;; 3. Treatment - type, duration, response, side effects. ;; 4. For postgastrectomy syndrome: Is there circulatory disturbance ;; after meals, hypoglycemic reactions, etc. (state time of onset ;; in relation to meals, frequency)? ;; 5. Diarrhea, constipation. ;; 6. For peritoneal adhesions: Are there episodes of colic, distention, ;; nausea, and/or vomiting? - frequency, duration, and severity. ;; 7. Are there periods of incapacitation due to stomach or duodenal ;; disease? ;; 8. History of hospitalizations or surgery: reason or type of surgery, ;; dates and locations, if known. ;; 9. History of trauma. ;; 10. Effects of condition on occupational functioning and activities of ;; daily living. ;; 11. Pain - location, type, precipitating, alleviating factors. ;; 12. History of neoplasm: ;; ;; a. Date of diagnosis, diagnosis. ;; b. Benign or malignant. ;; c. Treatment, dates and response. ;; d. Last date of treatment. ;; ;;C. Physical Examination (Objective Findings): ;; ;; Address each of the following and fully describe current findings: ;; ;; 1. Weight gain or loss. ;; 2. Signs of anemia. ;; 3. Tenderness - location. ;; ;;D. Diagnostic and Clinical Tests: ;; ;; 1. For gastritis, endoscopic evidence - describe hemorrhage, ;; ulcerated or eroded areas. ;; 2. For adhesions, X-ray to show partial obstruction, delayed ;; motility. ;; 3. For ulcer diseases, provide specific site. ;; 4. If there is a history of hematemesis or melena (past 12 months) ;; or signs of anemia, obtain hemaglobin and hematocrit. ;; 5. Include results of all diagnostic and clinical tests conducted in ;; the examination report. ;; ;;E. Diagnosis: ;; ;; ;; ;;Signature: Date: ;;END