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Health Assessment > Abdomen > Flashcards

Abdomen Flashcards

1
Q

Presenting GI complaints

A
  • Abdominal pain, acute and chronic
  • Indigestion, nausea, vomiting including blood, loss of appetite, early satiety
  • Dysphagia +/or odynophagia
  • Change in bowel pattern
  • Diarrhea, constipation
  • Jaundice
  • Weight loss (unintentional)
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2
Q

Abdomen: quadrants

A
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3
Q

9 sections of abdomen

A
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4
Q

Location of spleen

A

lateral to and behind stomach, just above left kidney in left midaxillary line.

upper margin rests against dome of diaphragm.

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5
Q

Which ribs protect most of the spleen?

A

9, 10, 11

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6
Q

Presenting urinary and renal sx

A
  • Suprapubic pain
  • Dysuria, urgency, or frequency
  • Hesitancy, decreased stream
  • Polyuria or nocturia
  • Urinary incontinence
  • Hematuria
  • Kidney or flank pain
  • Ureteral colic
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7
Q

Types of abdominal pain

A
  • Visceral Pain: organ pain, often in hollow organs – intestine, biliary tree. Also liver. Dull & achy, difficult to localize
  • Parietal Pain: often caused by peritoneum. Often sharp, can be localized and very severe. Aggravated by movement/coughing
  • Referred Pain: occurs elsewhere - sites innervated at approximately same spinal levels as disordered structures. Radiating. Superficial or deep but usually localized. E.g. shoulder in cholecystitis
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8
Q

Types of visceral pain

A
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9
Q

Visceral pain: RUQ/epigastric

A

biliary tree & liver

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10
Q

Visceral pain: epigastric

A

stomach, duodenum, pancreas

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11
Q

Visceral pain: periumbilical

A

small intestine, appendix, proximal colon

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12
Q

Visceral pain: suprapubic or sacral

A

rectum

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13
Q

Visceral pain: hypogastric

A

colon, bladder, uterus

colonic pain may be more diffuse than illustrated

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14
Q

Referred pain: duodenal or pancreatic origin

A

to the back

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15
Q

Referred pain: biliary tree

A

right shoulder or right posterior chest

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16
Q

Referred pain: plueurisy or inferior wall MI

A

epigastric area

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17
Q

Possible movement of pain from appendicitis, visceral & parietal

A

visceral periumbilical pain in early acute appendicitis from distention of inflamed appendix

Gradually changes to parietal pain in RLQ from inflammation of adjacent parietal peritoneum

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18
Q

Doubling over w/cramping colicky pain indicates…

A

renal stone

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19
Q

Sudden knifelike epigastric pain indicates…

A

gallstone pancreatitis

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20
Q

Epigastric pain commonly…

A

gastritis and GERD

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21
Q

RUQ pain and upper abdominal pain, think first of….

A

cholecystitis

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22
Q

Dyspepsia

A

chronic or recurrent discomfort or pain centered in upper abdomen

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23
Q

Discomfort

A

subjective negative feeling that is nonpainful, can include bloating, nausea, upper abdominal fullness, heartburn, etc.

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24
Q

Do bloating, nausea, or belching alone meet the criteria for dyspepsia?

A

No. Can be seen w/other d/os.

E.g., bloating w/IBD and belching w/aerophagia (swallowing air)

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25
Q

Functional / nonulcer dyspepsia: what is it?

A

3 month history of nonspecific upper abdominal discomfort or nausea not attibutable to structural abnormalities or PUD. Sx usually recurring and present >6mths

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26
Q

dyspepsia: causes

A

multifactorial, including delayed gastric emptying, gastritis from *H. pylori, *PUD, psychosocial factors

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27
Q

Diagnostic criteria for GERD

A
  • chronic abdominal discomfort/pain w/primary symptoms of heartburn, acid reflux, regurgitation >once/week

OR

  • mucosal damage on endoscopy
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28
Q

Risk factors GERD

A
  • reduced salivary flow - prolongs acid clearance by damping action of bicarbonate buffer
  • delayed gastric emptying
  • selected medications
  • hiatal hernia
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29
Q

Foods and positions that aggravate heartburn

A

etoh, chocolate, citrus, coffee, onions, peppermint

bending over, exercising, lifting, lying supine

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30
Q

atypical respiratory symptoms of GERD

A

cough, wheezing, aspiration pneumonia

pharyngeal symptoms: hoarseness, chronic sore throat, laryngitis

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31
Q

What factors indicate ordering an endoscopy (GERD)?

A
  • uncomplicated symptoms of GERD but not responding to empiric therapy
  • >55yo
  • alarm Sx: dysphagia, odynophagia, recurrent vomiting, evidence of GI bleed, weight loss, anemia, risk factors for gastric cancer, palpable mass, jaundice
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32
Q

What are you worried about when ordering an endoscopy (GERD)?

A

esophagitis, peptic strictures, Barrett’s esophagus

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33
Q

Barrett’s esophagus

A

squamocolumnar junction is sisplaced proximally and replaced by intestinal metaplasia

30-fold increased risk of esophageal adenocarcinoma

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34
Q

RLQ pain or pain that migrates from periumbilical region, combined w/abdominal wall rigidity on palpation

A

most likely appendicitis

in women, consider PID, ruptured ovarial follicle, ectopic pregnancy

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35
Q

cramping pain radiating to right or LLQ

A

may be renal stone

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36
Q

LLQ w/palpable mass may be…

A

diverticulitis

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37
Q

Diffuse abdominal pain w/absent bowel sounds and firmness, guarding, or rebound on palpation may be…

A

small or large bowel obstruction

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38
Q

Chronic discomfort

change in bowel patterns w/mass lesion indicates …

A

colon cancer

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39
Q

IBS symptoms

A

Chronic discomfort

Intermittent pain for 12 weeks of preceding 12 months with relief from defecation, change in frequency of bowel movement, or change in form of stool (loose, watery, pellet-like), w/o structural or biochemical abnormalities

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40
Q

retching vs vomiting

A

retching = involuntary spasm of stomach, diaphragm, esophagus - precedes and culminates in vomiting (forceful expulsion of gastric contents out of mouth)

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41
Q

Regurgitation occurs in…

A

GERD, esophageal stricture, esophageal cancer

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42
Q

Fecal odor in vomitus/regurgitated contents indicates…

A

small bowel obstruction or gastrocolic fistula

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43
Q

Hematemesis may indicate…

A

esophageal or gastric varices, gastritis, or PUD

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44
Q

How much blood loss before lightheadedness, syncope

A

Typically >500mL

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45
Q

Abdominal fullness or early satiety, consider…

A

diabetic gastroparesis, anitcholinergic medications, gastric outlet obstruction, gastric cancer

early satiety in hepatitis

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46
Q

dysphagia - structural vs motility d/o

A

solid foods - more structural (e.g., esophageal stricture, web or schatzki’s ring, neoplasm)

solids & liquids: motility d/o more likely

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47
Q

odynophagia (pain on swallowing), consider…

A

esophageal ulceration from radiation, caustic indigestion, infection from candida, CMV, herpes simplex, HIV

can also be pill-induced from aspirin or NSAIDs

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48
Q

Excessive flatus, consider…

A

aerophagia, legumes or other gas-producing foods, intestinal lactase deficiency, IBS

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49
Q

Diarrhea defined

A

increased water content in stool, volume >200g in 24 hours

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50
Q

acute vs chronic diarrhea

A

acute: 2 weeks
chronic: 4+ weeks

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51
Q

quality of diarrhea from small intestine

A

high-volume, frequent watery stools

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52
Q

small-volume stools w/tenesmus, or diarrhea with mucus, pus, or blood occur in…

A

rectal inflammatory conditions

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53
Q

Significance of nocturnal diarrhea

A

usually pathologic

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54
Q

oily, sometimes frothy or floating diarrhea

A

steatorrhea - from malabsorption in celiac sprue, pancreatic insufficiency, and small bowel bacterial overgrowth

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55
Q

Medications commonly assoc w/diarrhea

A

PCN and macrolides, magnesium-based antacids, metformin, herbal and alternative meds

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56
Q

constipation defined

A

at least 12 weeks of prior 6 mths w/at least 2 of following:

  • fewer than 3 bms/week
  • 25% or more defecations w/either straining or sensation of incomplete evacuation
  • lumpy or hard stools
  • manual facilitation
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57
Q

thin, pencil like stools

A

possibly an obstrucing “apple-core” lesion of the sigmoid colon

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58
Q

Medications assoc w/constipation

A

anti-cholinergics, CCBs, iron supplements, opiates

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59
Q

diseases assoc w/constipation

A

diabetes, hypothyroidism, hypercalcemia, MS, Parkinson’s, systemic sclerosis

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60
Q

obstipation

A

no passage of feces or gas - indicates intestinal obstruction

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61
Q

melena

A

black tarry stools - upper GI bleeding

may occur w/as little as 100mL blood

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62
Q

hematochezia

A

stools that are red or maroon colored -

indicates >1000 mL blood, usually d/t lower GI bleed

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63
Q

mechanisms of jaundice

A
  • increased production of bilirubin
  • decreased uptake of bilirubin by hepatocytes
  • decreased ability of liver to conjugate bilirubin
  • decreased excretion of bilirubin into bile, resulting in absorption of conjugated bilirubin back into blood

first 3 result in predominately unconjugated bilirubin

64
Q

conditions resulting in jaundice

A

predominately unconjugated bilirubin: e.g., hemolytic anemia (increased production), Gilbert’s syndrome

impaired excretion of conjugated bilirubin: viral hepatitis, cirrhosis, primary biliary cirrhosis, drug-induced cholestasis, as from OCs, methyl testosterone, chlorpromazine

65
Q

What to ask about if see jaundice?

A
  • Urine color: dark indicates impaired excretion of bilirubin into GI tract (only conjugated ends up in urine)
  • Stool color: excretion of bile into intestine is completely obstructed, so stools are acholic (w/o bile). Occurs briefly in viral hepatitis, common in obstructive jaundice.
  • Pruritis
  • Risk factors for liver Dz
66
Q

Risk factors for liver Dz

A
  • *hepatitis: *A (ass), B (body fluids, IV drugs), C (IV drugs, blood transfusion)
  • *Alcoholic hepatitis/cirrhosis: *
  • Toxic liver damage: meds, industrial solvents, environmental toxin, some anesthetic agents
  • *Gallbladder dz or surgery: *may result in extrahepatic biliary obstruction
  • hereditary d/os: in family Hx
67
Q

Pruritis in jaundice indicates…

A

cholestatic or obstructive jaundice

68
Q

pain in skin w/jaundice indicates…

A

distended liver capsule, biliary colic, pancreatic cancer

69
Q

Symptoms of BPH or urethral stricture

A

Trouble starting, stand close to toilet to void, change in force/size of stream, straining to void, hesitate or stop in middle of voiding, dribbling when finished

70
Q

Men: prostatic pain vs urinary infection pain

A

infection: burning proximal to glans penis

prostatic pain: in perineum and occasionally in rectum

71
Q

Painful urination occurs in…

A

cystitis, urethritis, UTI

72
Q

Dysuria, consider…

A

bladder stones, foreign bodies, tumors, acute prostatitis

73
Q

burning on urination in women

A

internal: urethritis

External: vulvovaginitis

74
Q

urgency in urination suggests…

A

bladder infection or irritation

75
Q

in men, painful urination w/o frequency or urgency suggests…

A

urethritis

76
Q

Urinary frequency: polyuria vs frequency w/small amts

A

polyuria - large amounts

frequency w/o polyuria - bladder d/o, impairment to flow at or below bladder neck

77
Q

Types of incontinence

A
  • Stress: increased abdominal pressure, d/t poor urethral sphincter tone or poor support of bladder neck
  • **urge: **urgency then immediate leakage d/t uncontrolled detrusor contractions that overcome urethral resistance
  • **overflow: **neurologic d/o or anatomic obstruction limits emptying until overflow
  • **functional: **d/t impaired cognition, musculoskeletal problems, immobility
78
Q

Sx acute pyelonephritis

A

kidney pain, fever, chills

typically dull, aching, steady

79
Q

Sx sudden obstruction to ureter, e.g., d/t renal or urinary stones or blood clots

A

Renal or ureteral colic - severe, originates at CVA and radiates around trunk into lower quadrant of abdomen, possibly into upper thigh and testicle or labium. Ask about fever, chills, hematuria

80
Q

Classic signs of alcoholism

A

hepatosplenomegaly, ascites, caput medusa, spider angiomas, palmar erythema, peripheral edema

81
Q

caput medusa

A

collateral pathway of recanalized umbilical veins radiating up the abdomen that decompresses portal vein hypertension

82
Q

Inspection: striae

A

silver normal

Purple – think Cushing’s syndrome

83
Q

Inspection: dilated veins

A

can be indicative of hepatic cirrhosis or IVC obstruction

84
Q

Inspection: ecchymosis of abdominal wall

A

intraperitoneal or retroperitoneal bleeding

85
Q

Contour of abdomen: possibilities

A

flat, rounded, protuberant, scaphoid (markedly concave or hollowed)

86
Q

Inspection: Bulging of flanks indicates…

A

ascites

87
Q

Inspection: suprapubic bulge indicates

A

distended bladder or pregnant uterus

88
Q

Inspection: lower abdominal mass indicates

A

ovarian or uterine cancer

89
Q

Inspection: assymetrical abdomen suggests

A

enlarged organ or mass

90
Q

Inspection: increased peristalsis indicates

A

intestinal obstruction

91
Q

Normal bowel sounds

A

clicks and gurgles, 5-34/minute

occasionally borborygmi

92
Q

borborygmi

A

prolonged gurgles of hyperperistalsis, “stomach growling”

93
Q

Auscultation: what indicates renal artery stenosis?

A

bruit in one of the upper quadrants, w/both systolic & diastolic component

(4-20% of healthy individuals have abdominal bruits)

94
Q

Friction rub over liver or spleen indicates…

A

hepatoma, gonococcal infection around liver, splenic infarction, pancreatic carcinoma

95
Q

protuberant abdomen tympanitic throughout suggests…

A

intestinal obstruction

96
Q

Percussion: Why might you find an air bubble on the right and dullness on the left of the abdomen

A

rare condition - situs inversus, organs are reversed

97
Q

How to categorize abdominal masses

A
  • physiologic: pregnant uterus
  • inflammatory: diverticulitis of colon
  • vascular: AAA
  • neoplastic: colon cancer
  • obstructive: distended bladder or dilated loop of bowel
98
Q

Palpating the liver

A

left hand behind pt, parallel to and supporting right 11th and 12th ribs and adjacent to soft tissues below. Remind pt to relax on hand if necessary.

Right hand lateral to rectus muscle, fingertips well below lower border of liver dullness, press gently in and up as pt takes deep breath

99
Q

How does the liver feel in your hands?

A

may not feel it, but if you do, normal liver is soft, sharp, regular, w/smooth surface

may be slightly tender

100
Q

Tenderness over liver suggests…

A

inflammation, as in hepatitis

or congestion, as in heart failure

101
Q

Percussion of spleen

A

Percuss left lower anterior chest wall roughtly from border of cardiac dullness at 6th rib to anterior axillary line and down to costal margin (Traube’s space)

if dullness, palpation correctly detects 80% of time

102
Q

Splenic percussion sign

A

Percuss lowest interspace of left anterior axillary line. Percuss w/deep breath. Should be tympanitic on both.

103
Q

Causes of splenomegaly

A

portal hypertension, hematologic malignancies, HIV, splenic infarct or hematoma

104
Q

2 positions to check for splenomegaly

A
  • 1st, supine. Left hand supports and presses forward lower left rib cage (from below), right hand below Rt costal margin, palpation on inspiration
  • 2nd: right lateral, legs somewhat flexed at hips and knees
105
Q

splenomegaly vs enlarged left kidney

A

if both in left flank, suspect splenomegaly if notch is palpated on medial border, the edge extends beyond midline, percussion is dull, fingers can probe deep into medial and lateral borders, but NOT between mass and costal margin

106
Q

palpate kidney

A

Left from left side

  • right hand behind pt, just below and parallel to 12th rib, fingertips just reaching CVA.
  • Lift.
  • Place left hand on LUQ, lateral and parallel to rectus muscle.
  • On deep inspiration, press left hand firmly and deeply down into LUQ, trying to capture kidney.
  • Ask pt to breathe out then stop breathing briefly. Slowly release pressure as you feel for it to move back into position

OR similar to spleen, from right side

Right kidney: from right side, same method

107
Q

causes of kidney enlargement

A

hydronephrosis, cysts,tumors

bilateral: PKD

108
Q

CVA tenderness indicates

A

pylenephritis or musculoskeletal cause

109
Q

How much bladder volume before dullness?

A

400-600mL

110
Q

how to palpate aorta

A

press firmly deep in upper abdomen, slightly to left of midline. If >50, assess width

Normal is

111
Q

Risk factors for AAA

A

>65yo, hx smoking, male, 1st degree relative w/hx of AAA repair

112
Q

Distinguishing mass of abdominal wall from abdominal mass

A

abdominal wall: remains palpable if does half sit up or bears down

intra-abdominal: obscured by muscle contraction

113
Q

history taking: significance of aspirin, steroids, PPIs

A
  • Aspirin : increased risk of bleeding, assoc w/gastric ulcers
  • Steroids: increase risk bleeding & ulceration
  • PPIs treat reflux dz
114
Q

Pain and structures: epigastric

A

Esophagus, stomach, duodenum, liver, gallbladder, pancreas, spleen

115
Q

Pain and structures: upper right corner

A

Esophagus, stomach, duodenum, liver, gallbladder, pancreas, spleen

116
Q

Pain and structures: upper left corner

A

Esophagus, stomach, duodenum, liver, gallbladder, pancreas, spleen

117
Q

Pain and structures: periumbilical

A

jejunum, ileum, appendix, ascending colon

118
Q

Pain and structures: lower abdomen

A

GU structures: bladder, prostate, uterus

119
Q

Pain and structures: Right lower quadrant

A

appendix, fallopian tube, ovary

120
Q

Pain and structures: Left lower quadrant

A

sigmoid colon, fallopian tube, ovary

121
Q

Pain and structures: Flanks

A

kidneys

122
Q

Differential Dx: pain in RUQ

A
  • Duodenal ulcer
  • Hepatitis
  • Hepatomegaly
  • Pneumonia
  • Cholecystitis
123
Q

Differential Dx: Pain in RLQ

A
  • Appendicitis
  • Salpingitis
  • Ovarian cyst
  • Ruptured ectopic pregnancy
  • Renal/ureteral stone
  • Strangulated hernia
  • Diverticulitis
  • Regional ileitis
  • Perforated Cecum
124
Q

Differential Dx:​ pain in LUQ

A
  • Ruptured spleen
  • Gastric ulcer
  • Aortic aneurysm
  • Perforated colon
  • Pneumonia
  • Pyelonephritis
125
Q

Differential Dx:​ pain in LLQ

A
  • Sigmoid diverticulitis
  • Salpingitis
  • Ovarian cyst
  • Ruptured ectopic pregnancy
  • Renal/ureteral stone
  • Strangulated hernia
  • Perforated colon
  • Regional ileitis
  • Ulcerative colitis
126
Q

Differential Dx: periumbilical pain

A
  • Intestinal Obstruction
  • Acute pancreatitis
  • Early appendicitis
  • Mesenteric thrombosis
  • Aortic aneurysm
  • Diverticulitis
127
Q

Differential Dx: Pelvic pain

A
  • Bladder
    • Distension
    • Infection
    • Stones
  • Prostatitis
  • Uterus
  • Urethritis, vulvovaginitis,
128
Q

Preparation for abdominal exam

A
  • Empty bladder
  • Ask patient to point to painful areas
  • Distract patient with conversation – esp when beginning palpation.
  • Ensure proper draping
  • Position properly
    • Pillow under head
    • Pillow under knees
    • Arms at sides or cross chest
129
Q

Linea nigra

A

black line down abdomen, normal in pregnancy

130
Q

bruits: bell or diaphragm?

A

bell

131
Q

friction rubs & venous hums: bell or diaphragm?

A

diaphragm

132
Q

Abdomen: what to percuss

A
  • 4 Quadrants for masses, fluid or gas
  • Liver
  • Spleen
  • Costovertebral angle
133
Q

Characteristics of tympany

A
  • High pitch note
  • Predominates due to gas in the intestines
  • Protuberant abdomen with tympany may be intestinal obstruction
134
Q

Characteristics of dullness

A
  • Short, no resonance
  • Scattered: feces
135
Q

Dullness over large areas may be…

A
  • Organ
    • Enlarged liver
    • Distended bladder
  • Mass: ovarian tumor
  • Pregnancy
136
Q

Dulness at flanks may be…

A

Ascites

137
Q

normal vertical span of liver

A

Adult:

6-12 cm in MRCL
4-8 cm at midsternal line

138
Q

Image - location of abdominal pain and etiology

A
139
Q

Fluid Wave test

A
  • For ascites
  • Patient or assistant presses edges of both hands down midline of abdomen
  • Hold your hand on one flank, tap opposite side with other hand
140
Q

Shifting dullness

A
  • for ascites
  • Percuss border of tympany and dullness with patient supine
  • Ask patient to rotate to side and repeat
  • In ascites, dullness shifts
141
Q

Mc Burneys point

A

test for appendicitis

2 inches from anterior superior spinous process of ilium (1/3 way between ASIS & umbilicus) - pain w/pressure

142
Q

Rovsing’s sign

A

test for appendicitis

Press gently on LLQ elicits pain in RLQ

143
Q

Rebound tenderness

A

test for appendicitis

Quickly withdraw hand elicits increase in RLQ pain

144
Q

Psoas sign

A

test for appendicitis

  • Place hand above right knee
    • Ask patient to raise leg
  • Or patient turned on left side, extend right leg at hip
145
Q

Oburator sign

A

test for appendicitis

  • Flex patients right thigh at hip
  • Knee bent
  • Rotate leg medially and laterally
146
Q

Special test for cholecystitis

A

Murphy’s sign

  • Ask pt take deep breath out. When in full expiration, Hook left thumb and fingers of right hand under costal margin. Then ask to take deep breath in.
  • A sharp increase in tenderness with sudden stop in inspiratory effort is positive sign
  • Acute cholecystitis
147
Q

Red alerts for abdominal emergency: subjective

A
  • Progressive intractable vomiting
  • Lightheadedness on standing (bleeding)
  • Acute onset of pain
  • Pain that progresses in intensity over hours
148
Q

red alerts for abdominal emergency: objective

A
  • Involuntary guarding
  • Progressive abdominal distension
  • Orthostatic hypotension
  • Fever
  • Leukocytosis (elevated WBC)
  • Decrease urine output
149
Q

Potential surgical emergencies

A
  • Perforation: look for signs of peritonitis (generalized pain, fever, elevated WBC)
  • Ectopic pregnancy: in any woman of childbearing years (positive pregnancy test, vag bleeding, abd pain)
  • Appendicitis: RLQ pain (mean age, 22 – increases teenage years, starts to decline)
  • Obstruction: elderly (tendency, +meds that cause. Hyperactive BSs above obstruction, diminished or absent below, + nausea, vomiting)
  • Ruptured abdominal aortic aneurysm: when back pain is present (severe sharp back pain, can be fatal)
  • Intussusception: in infants (telescoping of intestine onto self. Currant jelly stool, vomiting or lump in abdomen)
  • Malrotation: infants < 1 month old (congenital abnormality; organs displaced w/in abdomen)
150
Q

RED ALERTS: Peritonitis

A
  • Pain: front, back, sides
  • Electrolytes full-shock ensues
  • Rigidity or rebound of anterior abdominal walls
  • Immobile abdomen and patient
  • Tenderness with involuntary guarding
  • Obstruction
  • Nausea and vomiting
  • Increasing pulse rate, decreasing blood pressure
  • Temperature falls and then rises, tachypnea
  • Increasing girth of abdomen
  • Silent abdomen: no bowel sounds
151
Q

Lab Tests - abdomen

A
  • Complete blood count with diff (leukocytosis)
  • Qualitative urine (hCG)
  • Erythrocyte Sedimentation Rate (inflammation marker)
  • Urinalysis (urinary Sx, or older adults w/vague Sx)
  • Urine C&S (for antibiotics)
  • Cultures of STDs
  • Fecal Occult Blood Tests
  • LFT’s (e.g., if hepatomegaly)
  • Amylase and Lipase (pancreatitis)
  • Cardiac Enzymes (esp in women, who present w/MIs differently)
152
Q

Diagnostic tests, abdomen

A
  • Electrocardiogram (suspect MI)
  • Radiography
  • Anteriorposterior
  • Abdominal/pelvic ultrasound (appendicitis, esp kids when don’t want to subject to radiation)
  • Computed Tomography/ MRI
  • Colonoscopy
153
Q

Screening for ETOH abuse: who and how

A

US Preventive Services Task Force (USPSTF) recommend screening for all adults

CAGE
AUDIT

154
Q

Screening for colon cancer: who and how

A

assess for risk beginning at age 20 and if high risk, refer for complex mgmt

If avg risk, offer screening options at 50yo

  • High-sensitivity fecal occult blood test (annually)
  • Sigmoidoscopy every 5 years w/ FOBT every 3 yr
  • Screening colonoscopy every 10 years.
155
Q

Life of bilirubin

A
  • bile pigment derived chiefly from breakdown of hemoglobin
  • Hepatocytes conjugate bilirubin (combine unconjugated bili w/other substances) so that it is water soluble, then excrete into bile.
  • Bile passes through cystic duct into common bile duct, which also drains extrahepatic ducts from liver.
  • More distally, common bile duct and pacncreatic ducts empty into duodenum at ampulla of Vater

Health Assessment (14 decks)

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