abdomen Flashcards
Patient assessment abdomen lecture
Right upper quadrant abdominal structures
list 6
- liver
- gallbladder
- pylorus
- Duodenum
- Hepatic flexure of the colon
- Head of pancreas
Left uppper quadrant structures
list 4
- spleen
- splenic flexure of colon
- stomach
- body and tail of pancreas
Left lower quadrant abdominal structures
list 3
- Sigmoid colon
- descending colon
- left ovary
Right lower quadrant
list 5
- cecum
- appendiz
- Ascending colon
- Terminal ileum
- right ovary
what disease process is associated with disorder of the terminal ileum
crohn’s disease
Abdominal structures of the epigastric region
list 4
- abdominal aorta
- stomach
- body of pancreas
- duodenum
abdominal structures of the umbilical region
list 2
- transverse colon
- small bowel
Abdominal structures of the hypogastric region
list 4
- sigmoid colon
- rectum
- urinary bladder
- uterus and ovaries
What is the costoverterbal angle?
lower border of the 12th rib and the transverse process of the upper lumbar vertebra
what is the CVA used for?
Used to locate kidney tenderness
concerning symptoms
10 total
- abdominal pain
- indigestion, N/V
- hematemesis/coffee emesis
- change of appetite
- early satiety
- dysphagia
- odynophagia
- bowel function changes
- diarrhea
- jaundice
Hematemesis
blood emesis
* bright red
* indicates esophageal (varicies, mallory wise tear, active bleeding
what is an indicator of mallory wise tear
hematemesis
Coffee ground emesis indicates
the blood has been in the body for a longer period of time
-stomach bleeding
what is visceral pain?
- originates from an organ
- vague/difficulte to localize
- typically midline/diffuse
- “gnawing” “cramping” “aching”
how is visceral pain described
gnawing
cramping
aching
what is parietal pain
- origin= parietal peritoneum, peritonitis
- MORE SEVERE
- localized over structure
- aggravators= movement or cough
what is referred pain
- distant from original pathology
- develops into intense pain
- non-tender to palpation at site of referred pain
Area of manifestation of epigastric pain
stomach
duodenum
pancreas
areas of manifestation of RUQ OR epigastric pain
biliary tree
liver
area of manifestation of suprapubic or sacral pain
rectum
area of manifestation for periumbilical pain
small intestine
appendix
proximal colon
area of manifestation of hypogastric pain
colon
bladder
uterus
colon pain more diffuse
what manifestation of hypogastric pain is more diffuse?
colon
describe where kidney pain can be felt on the body?
side of the body
near the end of the ribcage
transverse across the lateral body from anterior to posterior
describe where ureteral pain can be felt on the body?
below kidney pain
transverse from anterior to posterior on the lateral side of the body
down toward the groin
what are the classic symptoms of GERD
- heartburn
- aggravated by: alcohol, chocolate, citrus, coffee, onions, peppermint or positional changes (bending, exercising, lifting, lying supine)
what are the atypical symptoms of GERD
- chest pain
- cough
- wheezing
- aspiration pneumonia
- hoarseness
- chronci sore throat
- laryngitis
what are alarming symptoms of GERD
- dysphagia or odynophagia
- recurrent vomiting
- Evidence of GI bleed
- early satiety
- weight loss
- anemia
- palpable mass
- painless jaundice
Risk factors of gastric cancer
- old
- male
- obese
- smoker
- drinks alcohol
- eats heavy meat
What is an important question to ask about dysphagia?
where do they feel it stuck? Aka- is it dysphagia or globus sensation
what is globus sensation
food is stuck in their throat all the time
what is oropharyngeal dysphagia
delay in intiating swallowing. postnasal regurg, or repetitive swallowing
trouble with liquids
indicates= problems with the mouth
what are causes of oropharyngeal dysphagia
more specific
- neurologic (stroke, parkinson, als)
- muscular (muscular dystrophy, myasthenia gravis)
- structural (hyperactive upper esophageal sphincter, zenker diverticulum)
what is Zenker diverticulum
outpouching in the lower part of the throat and upper part of the esophagus
what is esophageal dysphagia
trouble with solids
indicates= trouble with esophagus
what causes esophageal dysphagia
- Mucosal rings/webs
- esophageal sphincter
- Esophageal cancer
what are symptoms specific to esophageal stricture
- intermittent
- may become progressive
- long Hx of GERD
what are symptoms specific to esophageal cancer
- intermittent then progressive dysphagia
- chest and back pain
- weight loss
when asking the patient to point where dysphagia occurs
What location on the body suggests esophageal dysphagia
below the sternoclavicular notch
for dysphagia
what does problems with solid food suggest?
esophageal structural causes
for esophageal dysphagia
what does problems with solids and liquid suggest?
motor/motility disorder
what two conditions do you see progressive dysphagia
esophageal stricture
esophageal cancer
what is motor/motility disorder dysphagia
intermittent dysphagia to solids or liquids that is relieved with repeated swallowing, straightening back, raising arms or valsalva maneuver
causes of motor/motility disorders causing dysphagia
- diffuse esophageal spasm
- scleroderma
- achalasia
what can relieve diffuse esophageal spasm? what symptom is associated
NTG relieves
symptom: chest pain
what is achalasia
“bird beak” esophagus
regurgitation (when lying down)
nocturnal cough
acute diarrhea is defined by
lasting <14 days
peristent diarrhea is defined by
lasting 14-30 days
chronic diarrhea is defined as
lasting >30 days
what characterstics should you ask about diarrhea
- timeframe
- volume/frequency/consistency
- is there mucus, pus or blood?
- nocturnal diarrhea
- is it greasy or does it float
- any changes in your life?
what is tenesmus? what are some associated symptoms?
constant urge to defecate
associated symptoms: pain, cramping, involuntary straining
what is steatorrhea
fatty diarrheal stools
what are possible causes of diarrhea
- current meds
- recent changes in diet
- travel
- antibiotic use
what medication is associated with high incidence of diarrhea
metformin
what is the criteria for constipation diagnosis
2 or more of
* less than 3 BM/week
* frequent BM with straining or incompleteness
* lump or hard stools
* manual facilitation
what is primary (functional) constipation
cause cannot be identified from history/physical exam
secondary (organic) constipation
has an identified underlying cause
-ex. iron, opiods, GLP-1
what is Obstipation
no passage of gas or stool
what is melana and how is it diagnosed
passage of black tarry stools
-fecal blood test (positive result)
what does melana with a positive fecal blood test indicate?
- gastritis
- GERD with reflux esophagitis
- peptic ulcer dx
- esophageal or gastric varicies
- mallory wise tear
what can cause black stool with negative fecal blood test?
- iron
- peptobismal
- licorice
- chocolate cookies
- blueberries
only if patient is asymptomatic
what is hematochezia
stool with RED blood
positive stool fecal test
what most commonly causes hematochezia
- colon cancer
- colon polyps
- colonic diverticula
- IBD
- ischemic colitis
- hemorrhoids
- anal fissure
what can cause reddish stool with a negative fecal blood test?
beets
what is jaundice
a yellowish discoloration of the skin and sclerae from increased bilirubin levelsl
>3mg/dL plasma bili
at what plasma concentration of bilirubin is jaundice typically apparent
> 3mg/dL
what are the additional questions to ask a patient with jaundice
- what is the color of your urine (dark yellow/brown or tea)
- what is the color of your stool (gray or light colored)
- pruritus without rash
- associated pain?
- risk factors
what is acholic?
stools without bile
typically gray or light colored
what is painless jaundice usually caused by
malignant biliary obstruction
what are the 3 types of jaundice
- pre-hepatic= blood related
- hepatic= liver related
- post-hepatic= block of bile into the intestines
what disorders are associated with pre-hepatic jaundice
- transfuction reactions
- sickle cell anemia
- thalassemia
- autoimmune dx
what disorders are associated with hepatic jaundice
- hepatitis
- cancer
- cirrohsis
- congenital dx
- drugs
what disorders are associated with post-hepatic jaundice
- gallstones
- inflammation
- scar tissue
- tumors
what are risk factors for liver disease?
- infectious hepatitis
- Nonalcoholic steatohepatitis
- alcoholic hepatitis/cirrohsis
- toxic liver damage
- gallbladder disease
- hereditary disorders
what causes hepatitis A
- travel/meals with poor sanitation
- ingesting contaminated water or food
what causes hepatitis B
- parenteral or mucous membrane exposure to infectious body fluids
what causes hepatitis C
- ilicit injection drug use
- blood transfusion
- tattoos
- sexual contact (less common)
what is NASH
non-alcohol steatohepatitis
-seen in pts with obesity or metabolic syndrome
what causes toxic liver damage
- medications
- environmental toxins
- industrial solvents
what are hereditary disorders that are risk factors for liver disease
- hemolytic anemia
- hemochromatosis
- A-1 antitrypsin deficiency
- wilson disease
where is kidney pain found? what words describe it
- flank pain at or below posterior CVA
- may radiate toward anterior umbilicus
- visceral pain
- “dull, achy, steady”
what is pyelonephritis
infection of the kidney
with fever, chills, flank pain
where is ureteral colic pain
severe colicky flank pain radiating around the trunk into the lower abdomen and upper thigh or groin
Ureteral colic is caused by
sudden obstruction of a ureter
caused by: renal or urinary stones
