Ascites & Cirrhosis HISTORY_LIST jaundice anorexia nausea fever abdominal distention abdominal pain increased abdominal girth weight gain vomiting diarrhea malaise fatigue amenorrhea somnolence confusion personality change alcohol use pruitus early satiety heartburn INFECTIOUS DISEASES encephalopathy CHRONIC DISEASE SYSTEMIC DISORDERS GI bleeding alcoholism hepatitis SURGERY PREVIOUS HOSPITALIZATIONS abdominal surgery blood transfusion PREVIOUS TESTS hepatotoxin exposure TRAUMA OR INJURIES abdominal trauma pelvic trauma SOCIAL HISTORY smoking alcohol caffeine illicit drugs - cocaine IV drug use ALLERGY medications foods seasonal FAMILY HISTORY liver dz. hepatitis alcoholism MEDS_LAB_TESTS **** MEDS **** LAB Electrolytes BUN creatnine CBC LFT conjugated bilirubin unconjugated bilirubin anti-HAV HBsAg HBeAg anti-HBc anti-HBs anti-HBe anti-HCV anti-HDV HIV PT/PTT UA **** TESTS abdominal X-ray adbominal ultrasound abdominal paracentesis abdominal CT abdominal MRI REVIEW_OF_SYSTEMS_1 GENERAL weight changes appetite changes anorexia difficulty sleeping fever chills polyphagia hypophagia changes in thirst sleeping habit change bowel habit change fatigue hypertension previous physical exams SKIN pigmentation changes texture changes lesions eruptions pruritis easy bruising easy bleeding unusual hair loss changes in hair distribution skin masses finger/toe nail change rashes hives striae skin atrophy uremic frost hirsutism plethora neurofibromatosis lesion HEENT head trauma skull fractures head masses hearing loss vertigo chronic ear infection ear discharge ear pain hearing aid use loss of vision recent change in vision photophobia diplopia (double vision) glaucoma exudates dry eyes eye pain cataracts eye surgery itchy eyes excessive tearing corrective lenses nose bleeds chronic sinusitis nasal fractures nasal drainage polyps changes in sense of smell edentulous (without teeth) partial plate full plate recent dental work oral lesions tonsillitis strep throat tongue problems voice changes chronic hoarseness chronic halitosis NECK neck masses enlarged thyroid gland brachial cleft cysts neck injury REVIEW_OF_SYSTEMS_2 CHEST chronic coughing sputum production hemoptysis wheezing pneumonia bronchitis TB TB exposure SOB SOB altered by position edema chest pains pacemaker HEART MI coronary artery disease heart murmur heart valve disease left ventricular hypertrophy mistral valve stenosis pericarditis palpitations DOE paroxysmal nocturnal dyspnea orthopnea edema hypertension rheumatic fever cardiomyopathy ectopic heart beats arrhythmia exercise intolerance claudication heart medications ABDOMEN abdominal pain nausea vomiting diarrhea constipation hematochezia hematemesis hemorrhoids GI x-rays GI scopings rectal bleeding ulcers bowel polyps bowel incontinence gall bladder disease gall stones hepatitis cirrhosis hepatomegaly splenomegaly GU renal insufficiency renal failure dialysis kidney stones kidney disease kidney cyst flank pain hematuria pyuria dysuria chronic cystitis nocturia anuria hesitancy enuresis change in urine color prostatitis epididymitis scrotal problems TURP pain on intercourse genital lesions genital discharge REVIEW_OF_SYSTEMS_3 OB/GYN metorrhagia menorrhagia irregular menses problems in pregnancy use of contraception breast masses nipple discharge breast skin changes changes in axillary nodes monthly breast exam breast feeding children EXTREMITIES difficulty with gait weakness joint swelling joint stiffness muscle pain muscle swelling muscle injuries sagittal plan scoliosis coronal plane scoliosis fractured bones SLE osteoarthritis rheumatoid arthritis fibromyalgia NEURO seizures head injury LOC loss of coordination difficulty in balance sciatica difficulty in fine motor skills difficulty speaking CVA (stroke) weakness in arms weakness in legs tingling in legs and feet tingling in arms PSYCHIATRIC depression bipolar disorder suicide attempts hospitalization for psychiatric problems personality disorders ENDOCRINE goiter exophthalmos dry skin dry hair intolerance to heat intolerance to cold changes in growth sterility impotence decreased libido LYMPHATIC AND HEMATOLOGICAL lymphadenopathy transfusion anemia PHYSICAL_EVAL_1 VITALS BP Pulse Temp Heart rate GENERAL fetor hepaticas (odor of breath & urine caused by mercaptans) SKIN jaundice bronze skin discoloration (hemochromatosis) spider angioma palmar erythema HEENT Ksyser-Fleischer rings (bronze corneal pigmentation, Wilson's dz.) PHYSICAL_EVAL_2 NECK JVD (fluid overload) CHEST bibasilar crackles gynecomastia ABDOMEN bulging flanks tenderness rebound tenderness fluid wave shifting dullness "puddle sign" (examiner flicks over lower abdom while auscultating for dullness with patient on all fours; detect ( 120 ml) Couvoisier's sign (palpable nontender gallbladder with jaundice; pancreatic or Biliary malignancy). hepatomegaly liver atrophy liver margin blunt liver margin irregular liver margin firm liver tenderness umbilical hernia groin hernia GU edema of scrotum edema of penis testicular atrophy RECTAL guaiac (occult blood) EXTREMITIES lower extremity edema NEURO confusion asterixis (jerking movement of hand with wrist hyper-extended). DIFF_DIAGNOSIS Cirrhosis hepatitis (see MedNote) neoplasm nephrotic syndrome heart failure hemochromatosis Wilson's Dz. malnutrition protein-losing enteropathy Budd-Chiari syndrome chylous ascites ovarian dz. biliary cirrhosis alpha antitrypsin deficiency schistosomiasis