This section is from the book "Diseases Of The Intestines", by Max Einhorn. Also available from Amazon: Diseases Of The Intestines A Text-Book For Practitioners And Students Of Medicine.
The examination begins with a thorough interrogation of the patient. Before starting with the narration of the present ailment a general outline of previous sicknesses is of value. Diseases which involve the intestinal canal, like typhoid fever, dysentery, and the like, are of special importance, as they are liable to be etiological factors in the development of consecutive ailments. The mode of living, with regard to habits (drinking, smoking, etc.), should also be inquired into.
The patient is then asked to describe his present complaint. He should state the time when the trouble began and its nature. If the chief complaint refers to pains, it is necessary to inquire as to their location and character. Pains felt in the neighborhood of the navel usually originate in the small intestine; those experienced in the right iliac region often emanate from the appendix; while those in the left iliac region and in and about the rectum have their starting-point in the sigmoid flexure and in the lower portion of the rectum. Are the pains of long duration or do they last only a very short while, a few seconds or minutes? The former variety is usually caused either by an affection of the sensory nerves of the intestines or by some organic lesion, like ulcers, etc. The latter variety, to which the name colic is applied, is due to a strong spasmodic contraction of a certain part of the bowel. Colicky pains are often followed and relieved by the passing of flatus or of fecal matter.
Occasionally these pains also shift from one place of the abdomen to another, and the route of their travel is distinctly felt by the patient.
Abnormal sensations, a feeling of heat or cold may also be experienced over a certain area of the abdomen. A frequent or constant desire for an evacuation (tenesmus) is encountered in dysentery and in many affections of the rectum. It is also advisable to inquire whether the pains and abnormal sensations appear at a certain period of the day or at a certain time after meals (soon after eating or three to four hours later), or whether they are experienced at night or especially in the early morning hours.
The condition of the bowels should always be described in detail. Do the bowels act regularly and is the evacuation of sufficient quantity? What is its consistency? Is the stool of sausage-shape and pliable, or is it hard or very soft, mushy, watery? What is its color? Is it dark brown or light yellow or clay-colored or black? Is there an admixture of mucus or blood? If there is constipation, inquire whether the bowels move without any cathartics after a period of constipation of a few days, and if not, whether mild aperients are sufficient to cause an evacuation, or whether a strong drastic remedy is necessary. Does the constipation alternate with periods of normal movements or with periods of diarrhoea? Are the periods of constipation, if cathartics are not resorted to, accompanied by any marked symptoms (headaches, dizziness, anorexia, etc.) or not? If there is diarrhoea, the patient should state how many movements a day he has. Is he disturbed during the night, or is the diarrhoea confined principally to the 3 morning hours? Does the diarrhoea alternate with periods of constipation; does it disappear after a change of climate, or is it aggravated by mental excitement? Is there a feeling of exhaustion in connection with it? Is the abdomen filled up with gas (meteorism)? Does this phenomenon pertain to a special part of the abdomen (the upper or lower region, right or left side), or does it extend over the entire abdomen? A feeling of tension in the abdomen with frequent passing of wind, belching, and flatus, is commonly designated as flatulency.
It is necessary to inquire whether this symptom is present principally at a certain time of the day or continuously. Absence of flatus is of significance if it occurs in conjunction with obstinate constipation, otherwise it is of no consequence.
In all intestinal disorders it is necessary to inquire as to the state of the stomach. The latter organ being in direct communication with the intestines, it will often be subject to disturbances in intestinal affections. Complaints of a bad taste and smell in the mouth are often made, principally in constipation. Anorexia and nausea are present in the most varied intestinal disorders. Vomiting frequently occurs in intestinal obstruction.