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1DVBCWST1 ;ALB/CMM STOMACH, DUODENUM, AND PERITONEAL ADHESIONS WKS TEXT - 1 ; 5 MARCH 1997
2 ;;2.7;AMIE;**12**;Apr 10, 1995
3 ;
4 ;
5TXT ;
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
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