5/6: Abdominal Complaint Flashcards
Where do duodenal and pancreatic pain refer to?
Back
Where does biliary tree pain refer to?
Right shoulder
Specific GI ROS sx to ask
N/V/D, black stools, blood in stool, blood in vomit
Specific GU ROS sx to ask
Dysuria, polyuria, hematuria, flank pain
Specific GYN ROS sx to ask
Vaginal bleeding, vaginal discharge, LMP, possibility of pregnancy
Important meds to ask about for a GI complaint
GI prescriptions, OTC GI meds, NSAIDs, blood thinners, narcotics, steroids
Important social questions to ask for a GI complaint
Smoking, drugs, alcohol, stress, travel, well water outside the US, undercooked meat ingestion
What’s crucial about the abdominal physical exam?
Must be done in the specific order: inspection, auscultation, percussion, palpation
Abdominal bruits
Vascular sounds like a heart murmur, typically from vascular obstruction in abdomen
Friction rub
Grating sound with respiratory variation, typically due to inflammation of the peritoneal surface of an organ
Venous hum
Soft humming noise due to increased collateral circulation between portal and systemic venous systems
A protuberant abdomen that is tympanic throughout might indicate what?
Intestinal obstruction
What % of adults can the tip of the spleen be palpated in?
5%
Fluid wave test
Pt rests their hand over the chest, place one hand on one side of the abdomen and tap the other side sharply with finger tips, feeling for impulse transmission to the other hand
Shifting dullness test
Percuss for dullness with patient supine, then have pt lay on side and percuss again
What is a positive shifting dullness test
Dullness shifts to dependent side and tympany shifts to top side -> ascites
McBurney’s point tenderness
Draw an imaginary line between ASIS and umbilicus, palpate two inches medial to ASIS on that line; tenderness -> positive test
Rovsing’s sign
Palpate deeply in LLQ and if pain is felt in RLQ -> positive test
Murphy’s sign
Palpate deeply under pts right costal margin, ask pt to take a deep breath in and palpate deeper -> sharp increase in tenderness is a positive test
Lloyd’s sign/punch
Hit pts back (deep percussion) in area of costovertebral angle -> pain is a positive test
What do guarding, rigidity, and rebound tenderness indicate
Acute abdomen / peritoneal inflammation
Rigidity
Involuntary reflex contraction of abdominal wall, becomes stiff or board-like
Rebound tenderness
Push down deep into abdomen and let go -> more tenderness in letting go is rebound tenderness
Enteritis
SI inflammation
Colitis
Colon inflammation
Cystitis
Inflammation of urinary bladder
Borborygmi
Significant increase in peristalsis which can cause audible or palpable bowel activity (hunger sounds)
How to do pain scale for vomiting or diarrhea
Dont do the pain scale, ask questions like “what does this keep you from doing? How has this affected your life?”
What is important to consider for the ROS of a pt with diarrhea or vomiting?
How much fluid they’ve lost - do they have dizziness or light-headedness, syncope, dehydration, muscle aches, or fever?
Behavioral model to treat diarrhea
Gut rest (frequent small amounts of food and liquid), hydration with clear liquids, eliminate possible offending agent, address SD as needed
Things that can cause osmotic diarrhea
Mannitol/sorbitol (in sugar free candy), Mg, lactose intolerance
Two things that can cause secretory diarrhea
C. Diff, E. Coli
Rome Criteria of constipation
Two of the following:
- Fewer than 3 BM/week
- 25%+ defecations with straining or sensation of incomplete emptying
- Lumpy/hard stools
- Manual facilitation/disimpaction
Bristol Stool Scale
Pediatric stool scale to standardize look and feel of BM
Four symptoms associated with constipation that could be urgent
Vomiting, rectal bleed, severe abd pain, inability to pass flatus
Constipation + dizziness or syncope could mean?
Anemia or blood loss
Delayed defecation
Waiting to defecate can cause dryer stools -> constipation
Constipation treatment
Assess dietary needs (adding fiber), increase water, go to the bathroom when you feel you need to, exercise, address SD as needed
