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PCM2 Midterm > ABD Exam Lectures > Flashcards

ABD Exam Lectures Flashcards

1
Q

What causes visceral pain?

A
  • distention, stretching, or contracting of hollow organs
  • stretching the capsule of solid organs
  • organ ischemia
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2
Q

Where is visceral pain usually felt?

A

in the midline at the level of the structure involved; not localized

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3
Q

What causes parietal (somatic) pain?

A

inflammation in the parietal peritoneum

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4
Q

How is parietal (somatic) pain described?

A

usually more constant/severe than visceral pain; localized; aggravated by movement and alleviated by remaining still

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5
Q

What is referred pain?

A

pain that originates in the ABD but is felt at distant site which are innervated at approximately the same spinal levels as the disordered structure

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6
Q

What 2 questions from OLDCAAARTS are most important to ask about w/ ABD pain?

A

Location and alleviating/aggravating factors

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7
Q

What are each of the following associated w/ in the ABD: blood thinners, NSAIDs, narcotics, and steroids?

A
  • blood thinners: GI bleed
  • NSAIDs: risk factor for gastritis and PUD
  • Narcotics: constipation
  • Steroids: perforated viscus
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8
Q

Why are smoking, alcohol, and drug use important to ask about with a GI complaint?

A
  • smoking: irritates lining of stomach -> PUD or gastritis
  • alcohol: liver disease
  • Drugs: HTC can cause hyperemesis
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9
Q

What 4 additional questions should you ask with a GI complaint in the SHx?

A
  • stress
  • travel
  • well water
  • ingestion of undercooked meat
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10
Q

What are the 4 steps to an ABD exam?

A
  • inspection
  • auscultation
  • percussion
  • palpation
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11
Q

What are 4 landmarks you should inspect on the ABD?

A
  • xiphoid process of sternum
  • costal margins
  • umbilicus
  • ASIS
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12
Q

Name 5 organs that could cause RUQ pain

A

liver, gallbladder, stomach, SI, LI

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13
Q

Name 4 organs that could cause RLQ pain

A

appendix, ovary, SI, LI

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14
Q

Name 4 organs that could cause LLQ pain

A

sigmoid colon, ovary, SI, LI

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15
Q

Name 4 organs that could cause LUQ pain

A

spleen, stomach, SI, LI

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16
Q

Name 6 organs that could cause epigastric pain

A

pancreas, liver, gallbladder, stomach, SI, LI

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17
Q

Name an organ that could cause suprapubic pain

A

bladder

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18
Q

Name 6 things you should inspect the surface of the ABD for

A

surgical scars, striae, skin colon, dilated veins, rash, ecchymosis

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19
Q

What side of the stethoscope would you use to listen for bowel sounds and bruits?

A

bowel sounds: diaphragm

bruits: bell

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20
Q

What could absent bowel sounds indicate?

A

long lasting intestinal obstruction, mesenteric ischemia

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21
Q

What could decreased bowel sounds indicate?

A

post-surgical ileus, peritonitis

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22
Q

What could increased bowel sounds indicate?

A

diarrhea, early bowel obstruction

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23
Q

What are high pitched bowel sounds and what do they indicate?

A

sounds like raindrops on a metal pipe -> suggests early bowel obstruction

24
Q

Where would you hear bruits in the ABD and what do they indicate?

A

ABD aorta, renal A., iliac A., femoral A. -> suggest vascular obstruction

25
Q

What is a friction rub? Where would you hear it and what does it indicate?

A

grating sounds w/ respiratory variation heard over the liver and spleen -> suggests inflammation of the peritoneal surface of an organ

26
Q

What is venous hum? Where would you hear it and what does it indicate?

A

soft humming nose heard over the epigastric and umbilical region -> increased collateral circulation between portal and canal venous systems

27
Q

What 2 sounds should you hear when you percuss the ABD? Which one is heard more?

A

tympany (heard more): air filled organs

dullness: solid organs or masses

28
Q

When would you consider tympany or dullness abnormal?

A
  • large dull areas from a mass or enlarged organ

- protuberant ABD tympanitic throughout may indicate bowel instruction

29
Q

When the spleen enlarges, in what direction does it expand?

A

anteriorly, downward, and medially

30
Q

What is the normal vertical span of the liver?

A

6-12 cm

31
Q

When palpating the liver, what does it mean if you feel an irregular edge/nodules or firmness/hardness?

A
  • irregular edge/nodules = hepatocellular carcinoma

- firmness/hardness = cirrhosis, hemachromatosis, amyloidosis, or lymphoma

32
Q

What can cause splenomegaly?

A

portal HTN, blood malignancies, HIV, splenic infarct, hematoma, mononucleosis

33
Q

Explain the shifting dullness test

A
  • tests for ascites
  • percuss for tympany and dullness w/ pt supine then have pt lay on their side and percuss again
  • Positive = dullness shifts to dependent side and tympany to top side
34
Q

Explain the fluid wave test

A
  • tests for ascites
  • assistant places hand midline of pt’s ABD
  • tap one flank sharply w/ finger tips and feel impulse transmitted to other flank (positive)
35
Q

What is guarding?

A

voluntary contraction of ABD wall to protect inflammed organs from pressure of palpation

36
Q

What is rigidity?

A

involuntary reflex contraction of ABD wall; stiff board-like muscle contraction and may not seen ABD move w/ respirations

37
Q

What is rebound tenderness?

A

occurs when you push deep into ABD and release quickly (positive pain when letting go)

38
Q

What 3 systems should you be thinking about when dx ABD pain?

A

GI, GU, GYN (if female)

39
Q

What are 3 typical sxs of GERD?

A

heartburn, regurgitation, and dysphagia

40
Q

What are 5 atypical sxs of GERD?

A

coughing, hoarseness, otitis media, noncardiac chest pain, enamel erosion

41
Q

What are 5 lifestyle modifications for someone w/ GERD?

A
  • lose weight
  • avoid trigger foods
  • avoid large meals
  • wait 3 hours after meal before lying down
  • elevate head of bed 8 inches
42
Q

What is the Rome III criteria for constipation?

A

must have at least 2 sxs over 3 months:

  • fewer than 3 BMs/week
  • straining
  • lumpy/hard stools
  • sensation of incomplete defecation
  • manual maneuvering required to defecate
43
Q

What is the Bristol stool scale? Which levels are more common w/ constipation? Which levels are considered more normal?

A
  • a scale to agree on the look and feel of stool; levels 1-7
  • type 1 and 2 more common in constipation
  • type 3 and 4 considered more normal
44
Q

What are 4 sxs associated w/ constipation?

A

bloating, low back pain, tenesmus (act of body pushing stool involuntarily), pain on defecation

45
Q

What are 4 concerning sxs of constipation?

A

rectal bleeding, ABD pain, inability to pass flatus, vomiting

46
Q

What 3 exams should you perform for a pt w/ constipation?

A

ABD exam
anorectal exam
pelvic exam (for females)

47
Q

What is the purpose of the pelvic exam for constipation?

A

to check for internal prolapse or rectocele

48
Q

Name 5 lifestyle modifications for someone w/ constipation?

A
  • increase fiber
  • increase water intake
  • use bathroom when needed
  • increase exercise
  • schedule uninterrupted time everyday for BM
49
Q

What is gastroenteritis?

A

nonspecific term that mainly manifests as diarrhea, N/V, and ABD pain

50
Q

Name 2 viral causes of gastroenteritis and exposure

A
  • norovirus: uncontrolled vomiting, some diarrhea -> cruise ship or casino outbreaks
  • rotavirus: seen in children by age 5 if not immunized
51
Q

Name 3 bacterial causes of gastroenteritis and exposure

A
  • salmonella: 12-36 hours after eating contaminated food
  • C Diff: hospital acquired after exposure to Abx
  • E. Coli: food, water, person-to-person transmission; most common cause of traveler’s diarrhea
52
Q

Name 1 parasitic cause of gastroenteritis and exposure

A

giardia: causes diarrhea (greasy stools tend to float); most commonly gotten from infected water (campers, hikers, travelers)

53
Q

Name 4 drugs associated w/ diarrhea?

A
  • antibiotics
  • laxatives
  • sorbitol
  • PPIs (proton pump inhibitors)
54
Q

Difference between IBS and IBD

A

IBS: altered bowel habits, ABD pain, and bloating
IBD: usually Crohn’s disease or ulcerative colitis

55
Q

What history should you ask a pt w/ constipation?

A
  • normal defecation pattern
  • hardness of stools
  • straining
  • what have the tried to help
  • duration of the problem
  • relation to any changes in diet, water, or exercise
56
Q

What history should you ask a pt w/ diarrhea?

A
  • frequency
  • large vs small amounts
  • blood present?
  • travel
  • changes in meds
  • recent hiking/camping
57
Q

What is copious rice water diarrhea associated w/?

A

cholera

PCM2 Midterm (3 decks)

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