1 | archetype (adl_version=1.4)
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2 | openEHR-EHR-CLUSTER.exam-abdomen.v1
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3 | specialize
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4 | openEHR-EHR-CLUSTER.exam.v1
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5 |
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6 | concept
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7 | [at0000.1] -- Examination of the abdomen
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8 | language
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9 | original_language = <[ISO_639-1::en]>
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10 | description
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11 | original_author = <
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12 | ["name"] = <"Heather Leslie">
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13 | ["organisation"] = <"Ocean Informatics">
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14 | ["date"] = <"11/04/2007">
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15 | ["email"] = <"heather.leslie@oceaninformatics.biz">
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16 | >
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17 | details = <
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18 | ["en"] = <
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19 | language = <[ISO_639-1::en]>
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20 | purpose = <"A cluster for recording findings on physical examination of the abdomen">
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21 | use = <"">
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22 | keywords = <"examination", "physical">
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23 | misuse = <"">
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24 | >
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25 | >
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26 | lifecycle_state = <"Initial">
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27 | other_contributors = <>
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28 |
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29 | definition
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30 | CLUSTER[at0000.1] matches { -- Examination of the abdomen
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31 | items cardinality matches {0..*; unordered} matches {
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32 | CLUSTER[at0004] occurrences matches {0..1} matches { -- Normal statements
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33 | items cardinality matches {0..*; unordered} matches {
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34 | ELEMENT[at0005] occurrences matches {0..*} matches { -- Normal statement
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35 | value matches {
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36 | DV_TEXT matches {*}
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37 | }
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38 | }
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39 | }
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40 | }
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41 | ELEMENT[at0002] occurrences matches {0..1} matches { -- Clinical description
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42 | value matches {
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43 | DV_TEXT matches {*}
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44 | }
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45 | }
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46 | CLUSTER[at0008] occurrences matches {0..1} matches { -- Findings
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47 | items cardinality matches {0..*; unordered} matches {
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48 | CLUSTER[at0.2] occurrences matches {0..1} matches { -- Abdominal wall
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49 | items cardinality matches {0..*; unordered} matches {
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50 | ELEMENT[at0.3] occurrences matches {0..1} matches { -- Description
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51 | value matches {
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52 | DV_CODED_TEXT matches {
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53 | defining_code matches {[local::]}
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54 | }
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55 | }
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56 | }
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57 | allow_archetype CLUSTER occurrences matches {0..1} matches {
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58 | include
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59 | archetype_id/value matches {/inspection\.v1draft/}
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60 | archetype_id/value matches {/exam-generic-mass\.v1/}
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61 | archetype_id/value matches {/palpation\.v1/}
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62 | archetype_id/value matches {/inspection-skin\.v1draft/}
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63 | archetype_id/value matches {/exam-generic-lymphnode\.v1/}
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64 | }
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65 | }
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66 | }
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67 | CLUSTER[at0.9] occurrences matches {0..1} matches { -- Abdominal Region
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68 | items cardinality matches {0..*; unordered} matches {
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69 | ELEMENT[at0.10] occurrences matches {0..1} matches { -- Region
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70 | value matches {
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71 | DV_CODED_TEXT matches {
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72 | defining_code matches {
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73 | [local::
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74 | at0.11, -- Left upper quadrant
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75 | at0.12, -- Epigastrium
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76 | at0.16, -- Left upper quadrant
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77 | at0.17, -- Right loin
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78 | at0.18, -- Central/peri-umbilical
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79 | at0.19, -- Left loin
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80 | at0.20, -- Right iliac fossa
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81 | at0.21] -- Left iliac fossa
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82 | }
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83 | }
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84 | }
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85 | }
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86 | allow_archetype CLUSTER occurrences matches {0..1} matches {
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87 | include
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88 | archetype_id/value matches {/palpation\.v1/}
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89 | archetype_id/value matches {/percussion\.v1/}
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90 | }
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91 | use_node ELEMENT /items[at0008]/items[at0.2]/items[at0.3]
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92 | }
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93 | }
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94 | CLUSTER[at0.5] occurrences matches {0..1} matches { -- Abdomen Contents
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95 | items cardinality matches {0..*; unordered} matches {
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96 | allow_archetype CLUSTER occurrences matches {0..1} matches {
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97 | include
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98 | archetype_id/value matches {/exam-generic-mass\.v1/}
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99 | archetype_id/value matches {/exam-generic-lympnode\.v1/}
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100 | archetype_id/value matches {/exam-generic\.v1/}
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101 | archetype_id/value matches {/exam\.v1/}
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102 | archetype_id/value matches {/auscultation\.v1/}
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103 | }
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104 | CLUSTER[at0.13] occurrences matches {0..1} matches { -- Organs
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105 | items cardinality matches {0..*; unordered} matches {
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106 | CLUSTER[at0.14] occurrences matches {0..1} matches { -- Liver
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107 | items cardinality matches {0..*; unordered} matches {
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108 | allow_archetype CLUSTER occurrences matches {0..1} matches {
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109 | include
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110 | archetype_id/value matches {/palpation\.v1/}
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111 | archetype_id/value matches {/percussion\.v1/}
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112 | archetype_id/value matches {/dimensions\.v1/}
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113 | archetype_id/value matches {/relative_position_abdomen\.v1draft/}
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114 | archetype_id/value matches {/size\.v1/}
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115 | archetype_id/value matches {/exam-generic-mass\.v1/}
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116 | }
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117 | use_node ELEMENT /items[at0008]/items[at0.2]/items[at0.3]
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118 | }
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119 | }
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120 | CLUSTER[at0.7] occurrences matches {0..1} matches { -- Spleen
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121 | items cardinality matches {0..*; unordered} matches {
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122 | allow_archetype CLUSTER occurrences matches {0..1} matches {
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123 | include
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124 | archetype_id/value matches {/dimensions\.v1/}
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125 | archetype_id/value matches {/exam-generic-mass\.v1/}
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126 | archetype_id/value matches {/exam-generic\.v1/}
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127 | archetype_id/value matches {/exam\.v1/}
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128 | archetype_id/value matches {/palpation\.v1/}
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129 | archetype_id/value matches {/percussion\.v1/}
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130 | archetype_id/value matches {/relative_position_abdomen\.v1draft/}
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131 | archetype_id/value matches {/size\.v1/}
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132 | }
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133 | use_node ELEMENT /items[at0008]/items[at0.2]/items[at0.3]
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134 | }
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135 | }
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136 | CLUSTER[at0.8] occurrences matches {0..1} matches { -- Kidney
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137 | items cardinality matches {0..*; unordered} matches {
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138 | allow_archetype CLUSTER occurrences matches {0..1} matches {
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139 | include
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140 | archetype_id/value matches {/dimensions\.v1/}
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141 | archetype_id/value matches {/exam-generic-mass\.v1/}
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142 | archetype_id/value matches {/exam-generic\.v1/}
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143 | archetype_id/value matches {/exam\.v1/}
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144 | archetype_id/value matches {/palpation\.v1/}
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145 | archetype_id/value matches {/percussion\.v1/}
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146 | archetype_id/value matches {/relative_position_abdomen\.v1draft/}
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147 | }
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148 | use_node ELEMENT /items[at0008]/items[at0.2]/items[at0.3]
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149 | }
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150 | }
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151 | CLUSTER[at0.15] occurrences matches {0..1} matches { -- Bowel
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152 | items cardinality matches {0..*; unordered} matches {
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153 | allow_archetype CLUSTER occurrences matches {0..1} matches {
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154 | include
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155 | archetype_id/value matches {/palpation\.v1/}
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156 | archetype_id/value matches {/exam-generic-mass\.v1/}
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157 | archetype_id/value matches {/exam-generic\.v1/}
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158 | archetype_id/value matches {/exam\.v1/}
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159 | archetype_id/value matches {/percussion\.v1/}
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160 | archetype_id/value matches {/relative_position_abdomen\.v1draft/}
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161 | }
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162 | use_node ELEMENT /items[at0008]/items[at0.2]/items[at0.3]
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163 | }
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164 | }
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165 | }
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166 | }
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167 | use_node ELEMENT /items[at0008]/items[at0.2]/items[at0.3]
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168 | }
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169 | }
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170 | CLUSTER[at0003] occurrences matches {0..1} matches { -- Detail
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171 | items cardinality matches {0..*; unordered} matches {
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172 | allow_archetype CLUSTER occurrences matches {0..1} matches {
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173 | include
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174 | archetype_id/value matches {/exam-generic\.v1/}
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175 | }
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176 | }
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177 | }
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178 | }
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179 | }
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180 | ELEMENT[at0006] occurrences matches {0..*} matches { -- Image
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181 | value matches {
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182 | DV_MULTIMEDIA matches {
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183 | media_type matches {
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184 | [openEHR::
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185 | 426,
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186 | 427,
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187 | 429]
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188 | }
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189 | }
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190 | }
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191 | }
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192 | }
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193 | }
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194 |
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195 | ontology
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196 | term_definitions = <
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197 | ["en"] = <
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198 | items = <
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199 | ["at0.10"] = <
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200 | description = <"*">
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201 | text = <"Region">
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202 | >
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203 | ["at0.11"] = <
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204 | description = <"*">
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205 | text = <"Left upper quadrant">
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206 | >
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207 | ["at0.12"] = <
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208 | description = <"*">
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209 | text = <"Epigastrium">
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210 | >
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211 | ["at0.13"] = <
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212 | description = <"*">
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213 | text = <"Organs">
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214 | >
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215 | ["at0.14"] = <
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216 | description = <"*">
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217 | text = <"Liver">
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218 | >
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219 | ["at0.15"] = <
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220 | description = <"*">
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221 | text = <"Bowel">
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222 | >
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223 | ["at0.16"] = <
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224 | description = <"*">
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225 | text = <"Left upper quadrant">
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226 | >
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227 | ["at0.17"] = <
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228 | description = <"*">
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229 | text = <"Right loin">
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230 | >
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231 | ["at0.18"] = <
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232 | description = <"*">
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233 | text = <"Central/peri-umbilical">
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234 | >
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235 | ["at0.19"] = <
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236 | description = <"*">
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237 | text = <"Left loin">
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238 | >
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239 | ["at0.2"] = <
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240 | description = <"*">
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241 | text = <"Abdominal wall">
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242 | >
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243 | ["at0.20"] = <
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244 | description = <"*">
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245 | text = <"Right iliac fossa">
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246 | >
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247 | ["at0.21"] = <
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248 | description = <"*">
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249 | text = <"Left iliac fossa">
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250 | >
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251 | ["at0.22"] = <
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252 | description = <"*">
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253 | text = <"New element">
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254 | >
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255 | ["at0.23"] = <
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256 | description = <"Clinical description of finding">
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257 | text = <"Description">
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258 | >
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259 | ["at0.3"] = <
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260 | description = <"Clincial description of findings">
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261 | text = <"Description">
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262 | >
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263 | ["at0.4"] = <
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264 | description = <"Shape of abdomen">
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265 | text = <"Shape">
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266 | >
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267 | ["at0.5"] = <
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268 | description = <"*">
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269 | text = <"Abdomen Contents">
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270 | >
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271 | ["at0.6"] = <
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272 | description = <"Clinical description">
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273 | text = <"Description">
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274 | >
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275 | ["at0.7"] = <
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276 | description = <"*">
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277 | text = <"Spleen">
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278 | >
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279 | ["at0.8"] = <
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280 | description = <"*">
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281 | text = <"Kidney">
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282 | >
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283 | ["at0.9"] = <
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284 | description = <"*">
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285 | text = <"Abdominal Region">
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286 | >
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287 | ["at0000"] = <
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288 | description = <"Basic examination cluster for describing findings on physical examination when there is no named focus of examination">
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289 | text = <"Examination">
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290 | >
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291 | ["at0000.1"] = <
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292 | description = <"For recording findings on physical examination of the abdomen">
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293 | text = <"Examination of the abdomen">
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294 | >
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295 | ["at0002"] = <
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296 | description = <"Textural description of the part examined">
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297 | text = <"Clinical description">
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298 | >
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299 | ["at0003"] = <
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300 | description = <"More focused examination findings">
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301 | text = <"Detail">
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302 | >
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303 | ["at0004"] = <
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304 | description = <"A group of statements about the normality of the examination">
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305 | text = <"Normal statements">
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306 | >
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307 | ["at0005"] = <
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308 | description = <"A specific statement of normality">
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309 | text = <"Normal statement">
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310 | >
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311 | ["at0006"] = <
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312 | description = <"Drawing or image of the area examined">
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313 | text = <"Image">
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314 | >
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315 | ["at0008"] = <
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316 | description = <"Clinical findings">
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317 | text = <"Findings">
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318 | >
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319 | >
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320 | >
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321 | >
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