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abdomen Flashcards

Patient assessment abdomen lecture

1
Q

Right upper quadrant abdominal structures

list 6

A
  1. liver
  2. gallbladder
  3. pylorus
  4. Duodenum
  5. Hepatic flexure of the colon
  6. Head of pancreas
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2
Q

Left uppper quadrant structures

list 4

A
  1. spleen
  2. splenic flexure of colon
  3. stomach
  4. body and tail of pancreas
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3
Q

Left lower quadrant abdominal structures

list 3

A
  1. Sigmoid colon
  2. descending colon
  3. left ovary
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4
Q

Right lower quadrant

list 5

A
  1. cecum
  2. appendiz
  3. Ascending colon
  4. Terminal ileum
  5. right ovary
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5
Q

what disease process is associated with disorder of the terminal ileum

A

crohn’s disease

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6
Q

Abdominal structures of the epigastric region

list 4

A
  1. abdominal aorta
  2. stomach
  3. body of pancreas
  4. duodenum
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7
Q

abdominal structures of the umbilical region

list 2

A
  1. transverse colon
  2. small bowel
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8
Q

Abdominal structures of the hypogastric region

list 4

A
  1. sigmoid colon
  2. rectum
  3. urinary bladder
  4. uterus and ovaries
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9
Q

What is the costoverterbal angle?

A

lower border of the 12th rib and the transverse process of the upper lumbar vertebra

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10
Q

what is the CVA used for?

A

Used to locate kidney tenderness

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11
Q

concerning symptoms

10 total

A
  1. abdominal pain
  2. indigestion, N/V
  3. hematemesis/coffee emesis
  4. change of appetite
  5. early satiety
  6. dysphagia
  7. odynophagia
  8. bowel function changes
  9. diarrhea
  10. jaundice
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12
Q

Hematemesis

A

blood emesis
* bright red
* indicates esophageal (varicies, mallory wise tear, active bleeding

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13
Q

what is an indicator of mallory wise tear

A

hematemesis

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14
Q

Coffee ground emesis indicates

A

the blood has been in the body for a longer period of time
-stomach bleeding

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15
Q

what is visceral pain?

A
  • originates from an organ
  • vague/difficulte to localize
  • typically midline/diffuse
  • “gnawing” “cramping” “aching”
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16
Q

how is visceral pain described

A

gnawing
cramping
aching

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17
Q

what is parietal pain

A
  • origin= parietal peritoneum, peritonitis
  • MORE SEVERE
  • localized over structure
  • aggravators= movement or cough
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18
Q

what is referred pain

A
  • distant from original pathology
  • develops into intense pain
  • non-tender to palpation at site of referred pain
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19
Q

Area of manifestation of epigastric pain

A

stomach
duodenum
pancreas

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20
Q

areas of manifestation of RUQ OR epigastric pain

A

biliary tree
liver

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21
Q

area of manifestation of suprapubic or sacral pain

A

rectum

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22
Q

area of manifestation for periumbilical pain

A

small intestine
appendix
proximal colon

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23
Q

area of manifestation of hypogastric pain

A

colon
bladder
uterus
colon pain more diffuse

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24
Q

what manifestation of hypogastric pain is more diffuse?

A

colon

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25
Q

describe where kidney pain can be felt on the body?

A

side of the body
near the end of the ribcage
transverse across the lateral body from anterior to posterior

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26
Q
A
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27
Q

describe where ureteral pain can be felt on the body?

A

below kidney pain
transverse from anterior to posterior on the lateral side of the body
down toward the groin

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28
Q

what are the classic symptoms of GERD

A
  1. heartburn
  2. aggravated by: alcohol, chocolate, citrus, coffee, onions, peppermint or positional changes (bending, exercising, lifting, lying supine)
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29
Q

what are the atypical symptoms of GERD

A
  1. chest pain
  2. cough
  3. wheezing
  4. aspiration pneumonia
  5. hoarseness
  6. chronci sore throat
  7. laryngitis
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30
Q

what are alarming symptoms of GERD

A
  1. dysphagia or odynophagia
  2. recurrent vomiting
  3. Evidence of GI bleed
  4. early satiety
  5. weight loss
  6. anemia
  7. palpable mass
  8. painless jaundice
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31
Q

Risk factors of gastric cancer

A
  1. old
  2. male
  3. obese
  4. smoker
  5. drinks alcohol
  6. eats heavy meat
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32
Q

What is an important question to ask about dysphagia?

A

where do they feel it stuck? Aka- is it dysphagia or globus sensation

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33
Q

what is globus sensation

A

food is stuck in their throat all the time

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34
Q

what is oropharyngeal dysphagia

A

delay in intiating swallowing. postnasal regurg, or repetitive swallowing
trouble with liquids
indicates= problems with the mouth

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35
Q

what are causes of oropharyngeal dysphagia

more specific

A
  1. neurologic (stroke, parkinson, als)
  2. muscular (muscular dystrophy, myasthenia gravis)
  3. structural (hyperactive upper esophageal sphincter, zenker diverticulum)
36
Q

what is Zenker diverticulum

A

outpouching in the lower part of the throat and upper part of the esophagus

37
Q

what is esophageal dysphagia

A

trouble with solids
indicates= trouble with esophagus

38
Q

what causes esophageal dysphagia

A
  1. Mucosal rings/webs
  2. esophageal sphincter
  3. Esophageal cancer
39
Q

what are symptoms specific to esophageal stricture

A
  • intermittent
  • may become progressive
  • long Hx of GERD
40
Q

what are symptoms specific to esophageal cancer

A
  • intermittent then progressive dysphagia
  • chest and back pain
  • weight loss
41
Q

when asking the patient to point where dysphagia occurs

What location on the body suggests esophageal dysphagia

A

below the sternoclavicular notch

42
Q

for dysphagia

what does problems with solid food suggest?

A

esophageal structural causes

43
Q

for esophageal dysphagia

what does problems with solids and liquid suggest?

A

motor/motility disorder

44
Q

what two conditions do you see progressive dysphagia

A

esophageal stricture
esophageal cancer

45
Q

what is motor/motility disorder dysphagia

A

intermittent dysphagia to solids or liquids that is relieved with repeated swallowing, straightening back, raising arms or valsalva maneuver

46
Q

causes of motor/motility disorders causing dysphagia

A
  1. diffuse esophageal spasm
  2. scleroderma
  3. achalasia
47
Q

what can relieve diffuse esophageal spasm? what symptom is associated

A

NTG relieves
symptom: chest pain

48
Q

what is achalasia

A

“bird beak” esophagus
regurgitation (when lying down)
nocturnal cough

49
Q

acute diarrhea is defined by

A

lasting <14 days

50
Q

peristent diarrhea is defined by

A

lasting 14-30 days

51
Q

chronic diarrhea is defined as

A

lasting >30 days

52
Q

what characterstics should you ask about diarrhea

A
  1. timeframe
  2. volume/frequency/consistency
  3. is there mucus, pus or blood?
  4. nocturnal diarrhea
  5. is it greasy or does it float
  6. any changes in your life?
53
Q

what is tenesmus? what are some associated symptoms?

A

constant urge to defecate
associated symptoms: pain, cramping, involuntary straining

54
Q

what is steatorrhea

A

fatty diarrheal stools

55
Q

what are possible causes of diarrhea

A
  1. current meds
  2. recent changes in diet
  3. travel
  4. antibiotic use
56
Q

what medication is associated with high incidence of diarrhea

A

metformin

57
Q

what is the criteria for constipation diagnosis

A

2 or more of
* less than 3 BM/week
* frequent BM with straining or incompleteness
* lump or hard stools
* manual facilitation

58
Q

what is primary (functional) constipation

A

cause cannot be identified from history/physical exam

59
Q

secondary (organic) constipation

A

has an identified underlying cause
-ex. iron, opiods, GLP-1

60
Q

what is Obstipation

A

no passage of gas or stool

61
Q

what is melana and how is it diagnosed

A

passage of black tarry stools
-fecal blood test (positive result)

62
Q

what does melana with a positive fecal blood test indicate?

A
  1. gastritis
  2. GERD with reflux esophagitis
  3. peptic ulcer dx
  4. esophageal or gastric varicies
  5. mallory wise tear
63
Q

what can cause black stool with negative fecal blood test?

A
  1. iron
  2. peptobismal
  3. licorice
  4. chocolate cookies
  5. blueberries
    only if patient is asymptomatic
64
Q

what is hematochezia

A

stool with RED blood
positive stool fecal test

65
Q

what most commonly causes hematochezia

A
  1. colon cancer
  2. colon polyps
  3. colonic diverticula
  4. IBD
  5. ischemic colitis
  6. hemorrhoids
  7. anal fissure
66
Q

what can cause reddish stool with a negative fecal blood test?

A

beets

67
Q

what is jaundice

A

a yellowish discoloration of the skin and sclerae from increased bilirubin levelsl
>3mg/dL plasma bili

68
Q

at what plasma concentration of bilirubin is jaundice typically apparent

A

> 3mg/dL

69
Q

what are the additional questions to ask a patient with jaundice

A
  1. what is the color of your urine (dark yellow/brown or tea)
  2. what is the color of your stool (gray or light colored)
  3. pruritus without rash
  4. associated pain?
  5. risk factors
70
Q

what is acholic?

A

stools without bile
typically gray or light colored

70
Q

what is painless jaundice usually caused by

A

malignant biliary obstruction

71
Q

what are the 3 types of jaundice

A
  1. pre-hepatic= blood related
  2. hepatic= liver related
  3. post-hepatic= block of bile into the intestines
72
Q

what disorders are associated with pre-hepatic jaundice

A
  • transfuction reactions
  • sickle cell anemia
  • thalassemia
  • autoimmune dx
73
Q

what disorders are associated with hepatic jaundice

A
  1. hepatitis
  2. cancer
  3. cirrohsis
  4. congenital dx
  5. drugs
74
Q

what disorders are associated with post-hepatic jaundice

A
  • gallstones
  • inflammation
  • scar tissue
  • tumors
75
Q

what are risk factors for liver disease?

A
  1. infectious hepatitis
  2. Nonalcoholic steatohepatitis
  3. alcoholic hepatitis/cirrohsis
  4. toxic liver damage
  5. gallbladder disease
  6. hereditary disorders
76
Q

what causes hepatitis A

A
  • travel/meals with poor sanitation
  • ingesting contaminated water or food
77
Q

what causes hepatitis B

A
  • parenteral or mucous membrane exposure to infectious body fluids
78
Q

what causes hepatitis C

A
  • ilicit injection drug use
  • blood transfusion
  • tattoos
  • sexual contact (less common)
79
Q

what is NASH

A

non-alcohol steatohepatitis
-seen in pts with obesity or metabolic syndrome

80
Q

what causes toxic liver damage

A
  • medications
  • environmental toxins
  • industrial solvents
81
Q

what are hereditary disorders that are risk factors for liver disease

A
  1. hemolytic anemia
  2. hemochromatosis
  3. A-1 antitrypsin deficiency
  4. wilson disease
82
Q

where is kidney pain found? what words describe it

A
  • flank pain at or below posterior CVA
  • may radiate toward anterior umbilicus
  • visceral pain
  • “dull, achy, steady”
83
Q

what is pyelonephritis

A

infection of the kidney
with fever, chills, flank pain

84
Q

where is ureteral colic pain

A

severe colicky flank pain radiating around the trunk into the lower abdomen and upper thigh or groin

85
Q

Ureteral colic is caused by

A

sudden obstruction of a ureter
caused by: renal or urinary stones

patient assessment (19 decks)

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