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PCM IV Final > 5. Abdominal and Renal Lab > Flashcards

5. Abdominal and Renal Lab Flashcards

1
Q

Order of abdominal exam

A
  1. Observe/inspect
  2. Auscultate
  3. Percuss
  4. Palpate (superficial => deep)
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2
Q

Pathologic causes of striae (Stretch marks)

A

Cushings disease/syndrome due to high dose steroids

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3
Q

Hernia

  • What is it
  • Symptoms
  • Incarcerated vs strangualted
A
  • Break in muscle wall that allows abdominal contents to go through, appearing as a mass in abdomen
  • Local tenderness that worsens when lifting/using muscles
  • Incarcerated = cannot reduce without surgery; strangulated = SURIGCAL MRGNC bc vascular supply is compromised.
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4
Q

Stretch marks on armpit vs stomach

A

armpit = striae alba

stomach = striae rubra

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5
Q

Rectus abdominis muscle seperates, forming a midline ridge by abdominal contents.

    • When is it seen?
    • MC when?
A
  • Diastasis recti: appears when pt is upine and raises head above shoulder
  • BENIGN: Obesity, chronic lung disease, repeated PG
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6
Q

Ascites => accumulation of serous fluid in the peritoneal cavity.

  1. Causes
  2. Appears?
  3. Most sensitive test
  4. Most specific test
A
  • CHF, liver disease, IVC obstruction, portal HTN
  • Stomach unfiformly distended
  • Most sensitive => shifting dullness
  • Most specific => fluid wave
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7
Q

Ascites causes _______ = distension of flank when pt is laying down

A

bulging flanks

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8
Q

________ detects large volumes of free intrabdominal fluid.

  • (+) finding:
  • (-) finding:
A

Fluid wave

  • (+) finding: highly specific for ascites
  • (-) finding: only 50% sensitive, so does NOT exclude ascites.
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9
Q

How is a fluid wave conducted?

A
    1. Patient places ulnar surface of hand only midline of abdomen
    1. Doc places one hand on one flank and taps the opposite flank
    1. (+) sign: doc feels moderate to strong fluid wave on opposite side.
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10
Q

How is a puddle sign, a _______ sign, conducted?

A

Auscultory percussion sign

  1. Patient is on all 4s for 5 minutes
  2. Doc listens with diaphragm of stethoscope while flicking a flinger over flank, starting at lowest point and moving to opposite flank.
  3. (+) sign: 40-50% sensitive in testing ascites
    1. sudden increase in intensity and clarity of sound, signaling that the stethoscope and passed the edge of peritoneal fluid
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11
Q

Signs of liver disease

A
  1. Icterus
  2. Portal HTN (=> caput medusa = congestion of superficial veins)
  3. Asterixis (liver flap)
  4. Palmar erythema = red and warm palms and feet MC in white ppl (if darker => skin tujrns grey)
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12
Q

What is asterixis (liver flap)?

A

Course flapping tremor when the arms are outstretched and hands dorsiflexed. Movements are jerky forward movements every 5-10 seconds.

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13
Q

Small Bowel Obstruction

  • Diagnose
  • Sx
A
  • Dx: 2-view abdominal XR to view air-fluid loops
  • Sx
    1. crampy abdominal pain
    2. Bilous/fecal odor vomitting
    3. Distension (tympanic to percussion and hyperresonant)
    4. High pitched/hyperactive bowel sounds
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14
Q

Treatment of SBO

A
  1. Stabilize (fluid and pain)
  2. NG tube to decrompress cut and stop throwing up
  3. Surgery
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15
Q

Sympathetics for:

  1. Upper GI (+ lower esophagus
  2. Small intestine/Ascending colon
  3. Ascending and Transverse colon
  4. Descending and Sigmoid colon/Rectum
A
  1. Upper GI (includes lower esophagus)- T5-T10
  2. Small intestine/Ascending colon- T9-T11
  3. Ascending and Transverse colon- T10-L2
  4. Descending and Sigmoid colon/Rectum- T12-L2
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16
Q

Parasympathetics for:

  1. Esophagus => transverse colon
  2. Colon => rectum
A
  1. Esophagus => transverse colon: vagus nerve (OA/AA)
  2. Colon => rectum: S2-S4 (pelvic splanchnic and sacrum)
17
Q

ESO chapmans points

A
  1. Anterior: 2nd ICS bilateral
  2. Posterior: T2 bilaterally
18
Q

Pylorus Chapman Points

A
  1. Anterior: sternum
  2. Posterior: right T10 at costotransverse joint
19
Q

Liver Chapman Points

A
  1. Anterior: 5th ICS on R
  2. Posterior: between T5/6 on R
20
Q

Gallbladder Chapman Points

A
  1. Anterior: 6th ICS on R
  2. Posterior: between T5/6 on bilaterally
21
Q

Pancreas Chapman Points

A
  1. Anterior: 7th ICS on R
  2. Posterior: between T7/8 on R
22
Q

Stomach acidicity Chapman Points

A
  1. Anterior: 5th ICS on L
  2. Posterior: between T5/6 on L
23
Q

Stomach Chapman Points

A
  1. Anterior: 6th ICS on L
24
Q

Spleen Chapman Points

A
  1. Anterior: 7th ICS on L
  2. Posterior: b/w T7-8 on L
25
Q

SI Chapman Points

A
  1. Anterior: 8-10th ICS bilaterally
  2. Posterior:
    1. upper: between T8-9 BL
    2. middle: between T9-10 BL
    3. lower: between T11012 BL
26
Q

Appendix Chapman Points

A
  1. Anterior: tip of rib 12
27
Q

Cecum, ascending, and 1st half of transverse colon chapman point

A

Anterior R thigh (proximal to distal)

28
Q

Prostate chapman point

A

Posterior lateral thigh

29
Q

Rectum, sigmoid colon, descending colon, 2nd half of transverse colon chapman point

A

Anterior left thigh

30
Q

Sympathetic region of the:

  • Kidney
  • Ureters (upper)
  • Ureters (lower)
  • Bladder
A
  • Kidney: T10-11
  • Ureters (upper): T10-T11
  • Ureters (lower): T12-L2
  • Bladder: T12-L2
31
Q

What parasympathetic nerve supplies:

  • Kidney
  • Ureters (upper)
  • Ureters (lower)
  • Bladder
A
  • Kidney: vagus nerve (OA/AA)
  • Ureters (upper): vagus nerve (OA/AA)
  • Ureters (lower): pelvic splanchnic nerve (S2-4 sacrum)
  • Bladder: pelvic splanchnic nerve (S2-4 sacrum)
32
Q

What are the anterior and posterior chapmans points of the kidney?

A
  • Anterior: 1 inch lateral and 1 inch superior to belly button
  • Posterior: between TP of T12-L1 on ipsilateral side
33
Q

CP for bladder

A

around BB

PCM IV Final (12 decks)

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