| 1 | DVBCWST1 ;ALB/CMM STOMACH, DUODENUM, AND PERITONEAL ADHESIONS WKS TEXT - 1 ; 5 MARCH 1997
 | 
|---|
| 2 |  ;;2.7;AMIE;**12**;Apr 10, 1995
 | 
|---|
| 3 |  ;
 | 
|---|
| 4 |  ;
 | 
|---|
| 5 | TXT ;
 | 
|---|
| 6 |  ;;A.  Review of Medical Records:
 | 
|---|
| 7 |  ;;
 | 
|---|
| 8 |  ;;
 | 
|---|
| 9 |  ;;
 | 
|---|
| 10 |  ;;B.  Medical History (Subjective Complaints):
 | 
|---|
| 11 |  ;;
 | 
|---|
| 12 |  ;;    1.  Vomiting.
 | 
|---|
| 13 |  ;;
 | 
|---|
| 14 |  ;;
 | 
|---|
| 15 |  ;;    2.  Hematemesis or melena (describe any episodes).
 | 
|---|
| 16 |  ;;
 | 
|---|
| 17 |  ;;
 | 
|---|
| 18 |  ;;    3.  Treatment - type, duration, response, side effects.
 | 
|---|
| 19 |  ;;
 | 
|---|
| 20 |  ;;
 | 
|---|
| 21 |  ;;    4.  Circulatory disturbance after meals, hypoglycemic reactions 
 | 
|---|
| 22 |  ;;        (state time of onset in relation to meals, frequency).
 | 
|---|
| 23 |  ;;
 | 
|---|
| 24 |  ;;
 | 
|---|
| 25 |  ;;    5.  Diarrhea, constipation.
 | 
|---|
| 26 |  ;;
 | 
|---|
| 27 |  ;;
 | 
|---|
| 28 |  ;;    6.  Episodes of colic, distention, nausea, and/or vomiting - 
 | 
|---|
| 29 |  ;;        frequency, duration, and severity.
 | 
|---|
| 30 |  ;;
 | 
|---|
| 31 |  ;;
 | 
|---|
| 32 |  ;;C.  Physical Examination (Objective Findings):
 | 
|---|
| 33 |  ;;
 | 
|---|
| 34 |  ;;    Address each of the following and fully describe current findings:
 | 
|---|
| 35 |  ;;    1.  Specific site of any ulcer disease.
 | 
|---|
| 36 |  ;;
 | 
|---|
| 37 |  ;;
 | 
|---|
| 38 |  ;;    2.  Weight gain or loss.
 | 
|---|
| 39 |  ;;
 | 
|---|
| 40 |  ;;
 | 
|---|
| 41 |  ;;    3.  Signs of anemia.
 | 
|---|
| 42 |  ;;
 | 
|---|
| 43 |  ;;
 | 
|---|
| 44 |  ;;    4.  Pain or tenderness - location, type, precipitating factors.
 | 
|---|
| 45 |  ;;
 | 
|---|
| 46 |  ;;
 | 
|---|
| 47 |  ;;D.  Diagnostic and Clinical Tests:
 | 
|---|
| 48 |  ;;
 | 
|---|
| 49 |  ;;    1.  For gastritis, endoscopic evidence - describe hemorrhage, 
 | 
|---|
| 50 |  ;;        ulcerated or eroded areas.
 | 
|---|
| 51 |  ;;    2.  For adhesions, X-ray to show partial obstruction, delayed 
 | 
|---|
| 52 |  ;;        motility.
 | 
|---|
| 53 |  ;;    3.  Include results of all diagnostic and clinical tests conducted
 | 
|---|
| 54 |  ;;        in the examination report.
 | 
|---|
| 55 |  ;;
 | 
|---|
| 56 |  ;;
 | 
|---|
| 57 |  ;;E.  Diagnosis:
 | 
|---|
| 58 |  ;;
 | 
|---|
| 59 |  ;;
 | 
|---|
| 60 |  ;;Signature:                             Date:
 | 
|---|
| 61 |  ;;END
 | 
|---|