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PCA > Abdomen > Flashcards

Abdomen Flashcards

1
Q

You are evaluating a 16-year-old female who presents to the ED with acute onset of right lower quadrant pain. She rates this pain 9/10 since onset 3 hours ago. The pain radiates to the right flank.

What organ systems could be involved?

A

Kidney, appendix, it could be something GI, reproductive (ovaries)

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2
Q

Where are the kidneys located?

A

Posterior to the peritoneum
Upper border of 12th rib and T-process of upper lumbar vertebrae
Costovertebral Angle

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3
Q

What are the structures within the pelvis?

A

Terminal Ureters
Bladder
Pelvic Genitals
Occasionally loops of small and large bowel

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4
Q

Why do we have to be cautious with elderly, peds, intoxicated, pt’s with intellectual disabilities when it comes to taking an abdominal exam

A

-Elderly may become tachy and will be hypotensive.
-Peds pts will have compensatory measures in place that could potentially misguide you.
-Wont be able to describe where the pain is.

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5
Q

What are abdominal pain associated symptoms

A

-fever, indigestion, nausea, vomiting- including hematemesis, anorexia, early satiety
-Dysphagia or Odynophagia
-Change in bowel habit
*Diarrhea
*Constipation
-Jaundice

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6
Q

What are urinary symptoms?

A

Suprapubic pain, dysuria, urgency, frequency, nocturia, polyuria, urinary incontinence, hematuria
*Flank pain/ureteral colic

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7
Q

What are the 3 categories of abdominal pain

A
  1. visceral
  2. parietal
  3. referred
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8
Q

What is visceral pain?

A

Crampy, Dull, Achy
Intermittent (Colicky) vs constant
May include pallor, diaphoresis, vomiting
E.g appendicitis

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9
Q

What organs does visceral pain typically affect?

A

Typically affects hollow organs(stomach, intestine, small bowel) and capsule of solid organs
Typical pain radiates toward the MIDLINE
Poorly localized! (ask pt where is most of your abdominal pain and if they arent sure its poor localization)

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10
Q

What is parietal pain (somatic)

A

Irritation of the parietal peritoneum
Fibers cause pain in specific area
Think inflammatory causes!
Patients will not want to lay flat as their peritoneum (and its pain fibers) will be stretched (they will be curled up in fetal position)
Described as sharp, severe, well-localized
Often can localize with one finger to the maximal point of pain
Cough will worsen pain
pain will be travel on the same side as the organ

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11
Q

What is referred pain?

A

Pain felt at location distant from diseased organ
Develops as initial pain increases
Typically, very well localized
Occurs on same side as affected organ
Examples:
Spleen > Left Shoulder
Flank > Testicle
Gallbladder > Right Scapula

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12
Q

Upper abdominal pain/heartburn

A

pain vs discomfort
discomfort- feeling that is negative but not true to pain
-bloating, nausea, upper abd fullness, heartburn

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13
Q

What disease is realted to chronic upper abdominal symptoms

A

Dyspepsia

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14
Q

What are the 3 characteristics of dyspepsia?

A
  1. Chronic/recurrent discomfort in upper abd
  2. Epigastric pain/burning
  3. Post-prandial fullness or early satiety
    -Belching, nausea, bloating common
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15
Q

What are the 3 characteristics of dyspepsia?

A
  1. Chronic/recurrent discomfort in upper abd
  2. Epigastric pain/burning
  3. Post-prandial fullness or early satiety
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16
Q

What is heart burn?

A

Retrosternal burning pain or discomfort

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17
Q

What are alarm symptoms for heartburn?

A

uncomplicated GERD who fail empiric tx
>55 years old
Broad differential

XFWATCH FOR INFERIOR MI SYMPTOMS

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18
Q

In acute lower abdominal pain, _______ and _______ is key

A

onset and exact location

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19
Q

What are the 3 G’s of acute lower abdominal pain?

A

GI, GU, GYN

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20
Q

Acute lower abdominal pain: RLQ

A

Appendicitis, Nephrolithiasis, Ectopic Pregnancy, Rupture Ovarian Cyst, PID

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21
Q

Acute lower abdominal pain: LLQ

A

Diverticulitis, SBO
*Fever, loss of appetitite, N/V, constipation, no flatus

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22
Q

What is important to rule out in a child bearing aged female patient with acute lower abdominal pain?

A

pregnancy

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23
Q

What are the abdominal pain and associated symptoms?

A
  1. Fever
  2. Nausea/Vomiting
    Retching: involuntary spasm of stomach, diaphragm, esophagus -> Vomiting
    VS
    Regurgitation: Esophageal or gastric contents without vomiting
    Inspect and note if possible- color, odor, quantity
  3. Hematemesis– “Coffee ground”
  4. Anorexia
  5. Early Satiety
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24
Q

What is dysphagia?

A

trouble passing food from mouth to stomach
globus sensation

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25
Q

What is Xerostomia?

A

insufficient saliva; common > 70 y/o’s

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26
Q

What is Odynophagia?

A

pain on swallowing

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27
Q

What are questions you want to ask patients pertaining to change in bowel habits?

A

1.How are your bowel movements?
2. How often do they occur in a week?
3. Any change in stool pattern?
4. Excess Flatus
-Excessive swallowing of air, ingestion of certain foods, IBS

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28
Q

What are symptoms that indicate change in bowel movements?

A

Diarhhea
constipation
jaunduce

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29
Q

Polyuria/Nocturia

A

Significant urine increase in 24hours – 3L
Waking > 1x overnight

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30
Q

Urinary Incontinence

A

Stress
Urge
Stress + Urge = Mixed
Overflow
Functional

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31
Q

Hematuria

A

Gross vs Microscopic
Myoglobin
Painless hematuria

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32
Q

Flank pain

A

Kidney pain- Visceral – dull, achy, steady
Ureteral Colic
Fever/chills + Flank pain
Pyelonephritis

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33
Q

RUQ organs

A

liver
gallbladder
duodenum
pancreas
right adrenal gland
kidney
hepatic flexure of colon
section of ascending colon

34
Q

LUQ organs

A

left lower part of liver
upper lobe of kidney
splenic flexure of colon
section of transverse colon
section of descending colon
stomach
spleen
pancreas
left adrenal gland

35
Q

RLQ organs

A

lower lobe of right kidney
section of ascending colon
R fallopian tube
right ovary
part of uterus
R spermatic cord
cecum
appendix
right ureter

36
Q

LLQ organs

A

lower lobe of left kidney
section of descending colon
left spermatic cord
part of uterus
sigmoid colon
left ureter
left ovary
left fallopian tube

37
Q

Suprapubic pain

A

Sudden pain- often from bladder distention/retention–> bladder scan

38
Q

Urinary Incontinence

A

Stress
Urge
Stress + Urge = Mixed
Overflow
Functional

39
Q

Hematuria

A

Gross vs Microscopic
Myoglobin
Painless hematuria

40
Q

Flank pain

A

Kidney pain- Visceral – dull, achy, steady
Ureteral Colic
Fever/chills + Flank pain
Pyelonephritis

41
Q

What are two different red flag symptoms that are associated with an abdominal complaint?

A
  1. Visceral – affects hollow organs (stomach, intestine, small bowel) pain typically radiates midline, poorly localized
  2. Parietal- irritation of parietal peritoenium, pain in a specific area, pt will not want to lay flat
  3. Referred pain- pain felt at a location distant from disease occurs as same side as affected organ
42
Q

What are two different red flag symptoms that are associated with an abdominal complaint?

A

fever, N/V, retching, vomiting, regurgitation, anorexia, early satiety

43
Q

What should be ruled out first in a 30-year-old patient (female) presenting with 2 days of abdominal pain and nausea?

A

pregnancy

44
Q

What are some additional history questions that are pertinent in the patient with a CC of abdominal pain?

A

Prior sx, colorectal cancer

45
Q

What is the order of the abdominal exam?

A

IAPP
INSPECTION
AUSCULTATE ***
PERCUSS
PALPATE

46
Q

What are two factors you want to ensure you do while performing the abdominal exam?

A
  1. keep pts knees flexed
  2. WHILE EXAMINING THE ABDOMEN , KEEP YOUR EYES ON THE PATIENT’S FACE
47
Q

Caput Medusae

A

Dilated Veins over mid abdomen
Portal Hypertension
Cirrhosis
Inferior Vena Cava Syndrome

48
Q

Cullens sign

A
49
Q

Grey turners sign

A
50
Q

Mary josephs nodule

A
51
Q

What does a marked pulsation suggest?

A

AAA

52
Q

When doing ausculatation of the abdomen, you want to note the change in sequence BEFORE you ____ or ____

A

percussion or palpation
DO NOT PALPATE OR PERCUSS BEFORE AUSCULTATION

53
Q

FIVE minutes of auscultation are necessary to declare a person has no audible bowel sounds—— with associated

A

with abdominal pain and rigidity a surgical emergency

54
Q

Loud prolonged gurgles

A

borborygmi

55
Q

Increased bowel sounds

A

gastroenteritis, intestinal obstruction, hunger

56
Q

High-pitched tinkling

A

intestinal fluid/air under pressure (obstruction)

57
Q

Decreased bowel sounds

A

peritonitis paralytic ileus, early obstruction

58
Q

Absent bowel sounds

A

abdominal pain/rigidity; surgical urgency

59
Q

When percussing the stomach, _____ is the predominant sound

A

tympanny

60
Q

_________ is heard over the organs and solid masses

A

dullness

61
Q

Tymnpanny

A

Musical note of higher pitch than resonance

Over air-filled viscera or hollow structure such as a gastric bubble

62
Q

Hyper-resonance

A

Pitch lies between tympany and resonance

Base of left lung

63
Q

Resonance

A

Sustained note of moderate pitch

Over lung tissue

64
Q

Dullness

A

Short, high-pitched note with little resonance, flat tone

Over solid organs adjacent to air-filled structures, muscle

65
Q

Measuring the distance of the liver, it should be _______ cm

A

6-12

66
Q

What is the castell sign?

A

Splenic percussion sign
Percuss at lowest interspace in left axillary line
Take deep breath
Should remain tympanic unless splenomegaly

67
Q

When palpating the abdomen, the abdominal muscles may tense up. What are the two ways this is done

A
  1. Voluntary guarding- pt anticipating provider
  2. Involuntary guarding- muscles are tensing up on their own
68
Q

_______of the abdominal musculature to protect inflamed viscera should alert you to be careful

A

Guarding, tensing

69
Q

What is one of the symptoms you want to lookout for when looking for perotinitis

A

rigidity

70
Q

As the inflamed gallbladder comes in contact with fingers, the patient will experience pain and abruptly halt inspiration and this is called _______

A

MURPHY SIGN

71
Q

What is ascites?

A

pathologic increase in fluid in the peritoneal cavity
Ascites fluid settles with gravity, expect to hear dullness in dependent parts of the abdomen and tympany in the upper parts with lighter bowel has risen

72
Q

In the patient without ascites, the borders will remain

A

consistent

73
Q

What does a positive murphys sign suggest?

A

acute cholecystitis

74
Q

Rebound tenderness / guarding at McBurney’s point in the lower right quadrant suggests

A

Appendicitis (positive McBurney’s sign)

75
Q

You always want to perform a _________ for assessing POSSIBLE APPENDICITIS OR ACUTE ABDOMEN

A

rectal exam

76
Q

In women you have to include a ____

A

pelvic exam

77
Q

Spinder angioma

A

blanches with pressure
Normal in pregnancy, liver disease and aging

78
Q

Diastatis Recti

A

Very common in females 30s 40s who have had some children and some kids. Separation of two rectus muscles can cause bulging and can be mistaken for a hernia

79
Q

Linea Nigra

A

brown hyperpigmetned line that comes down midline and seen in darker skin pts

80
Q

Signs of liver disease

A

Icterus
Jaundice
Asterixis- would have pt hold arm straight out and they are unable to keep their hanf up in stop position the.

PCA (17 decks)

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