Abdomen Flashcards
What is in the RUQ?
liver, gall bladder, pylorus, duodenum, pancreas head, R kidney, hepatic flexure, ascending colon, transverse colon
What is in the LUQ?
liver left lobe, spleen, stomach, pancreas body, left kidney and adrenal gland, splenic flexure, transverse colon, descending colon
What is in the RLQ?
right kidney, cecum, appendix, ascending colon, R ovary and fallopian tube and ureter, R sperm cord, Uterus, bladder
What is in the LLQ?
left kidney, sigmoid colon, descending colon, L ovary, ureter, fallopian tube, left sperm cord, uterus, bladder
What is the 9 areas of the abdomen?
R and L hypochondrium Umbilical Epigastic Suprapubic R and L lumbar R and L inguinal
What does the alimentary tract contain?
mouth, esophagus, stomach, small intestine, large intestine, anus
What is the function of the alimentary tract?
ingest and digest food, absorb nutrients, electrolytes and water, excrete waste products
What is peristalsis under control of?
ANS
What are the functions of the liver?
Metabolizes carbohydrates, protein and fats Bile production and secretion Fatty acid oxidations Vitamin and iron storage Produces clotting factors Produces antibodies Conjugation and excretion of hormones Detoxification
What does the gallbladder do?
bile storage
What does bile do?
maintain alkaline pH in small intestine, emulsifies fat
What are the exocrine gland in the pancreas made up of?
acinar cells - digestive
What are the endocrine gland in the pancreas made up of?
islet cells - make insulin and glucagon
What does the white pulp do in the spleen?
produce lymphocytes and monocytes
What does the red pulp in the spleen?
filtration of red blood cells
Where is the kidney?
retroperitoneal space
What does renin control?
controls aldosterone secretion
What does the kidney do?
filters blood via nephrons, renin production, EPO production, produces active form of Vit D
What are some common abdomen symptoms?
Jaundice Abdominal distention Mass Pruritus (itching) Loss of appetite Pain Indigestion Nausea and vomiting Change in bowel movements (BM) Rectal bleeding
What do you want to know about adominal pain in HPI?
Character Duration Pattern Frequency Location Distribution Time of pain Aggravating Factors --Meals --Rest --Defecation --Vascular disorders
What do you want to know about indegestion per HPI?
Feeling of fullness Heartburn Discomfort Excessive belching Faltulence Loss of appetite Severe pain Location --Localize or generalized --Radiating- arms or shoulders Food intake --Amount --Type --Timing Date of last menstrual period Onset --Time of day or night --Sudden or gradual Relief --Antacids --Rest --Activity
What do you want to ask about diarrhea per HPI?
Character --Watery --Copious --Explosive --Color --Presence *****Blood *****Mucus *****Undigested food *****Oil *****Fat Odor # of times/day Assoc Sx --Fever --Chills --Thirst --Weight loss --Abdominal pain --Crapling --Fecal incontinence --Food intake --Stressful life events --Travel history
What is something you want to ask about PMH for adomen?
GI disorders
Abdominal/ Urinary tract injury or surgery
UTI # of episodes and treatment
Major illness
Blood transfusions
Immunizations (Hep A & B)
Cancer- colorectral, breast, ovarian, endometrial
What are the risk factors for colon cancer?
Age >50 FH- Colon CA; adenomatous polyps PMH- colon CA, polyps or inflammatory bowel disease PMH- ovarian or endometrial CA AA Ethnic Background: Jewish, Eastern European descent Diet: low-fiber, high in red meat/processed meat, low F&V intake Obesity Cigarette smoking Lack of regular physical activity Heavy alcohol use Type 2 Diabetes
What family history do you want to illicit from pt with abdomen complaint?
Cancer- Gallbladder disease Kidney disease Malabsorption syndromes Hirschsprung disease Familial Mediterranean fever
What are some cancers you should ask FH about?
colorectal and familial colorectal cancer syndromes
Familial adenomatous polyposis, hereditary nonpolyposis colorectal CA
What are some malabsorption syndromes that you would like to ask FH about?
CF and celiacs
What do you need to ask for SH in abdomen?
Nutrition 1st day last menstrual period Alcohol use, Smoking, Drug use Stressful life events/chronic daily stress Infectious disease exposure Trauma
What is the steps in physical exam?
Inspection –> auscultation –> percussion –> palpation
What are you inspecting for on abdominal exam?
Surface characteristics Skin color Linea nigra Scars Venous blood flow
What are some unexpected findings of the skin?
Cyanosis Jaundice Redness Bruises Discoloration Striae Skin lesions
What is ecchymosis around umbilicus?
Cullen’s sign
What is ecchymosis of the flanks?
Grey Turner Sign
What is seen in pregnancy due to increased melanocyte-stimulating hormone made by placenta?
linea nigra
What do you see with portal HTN in the abdomen?
caput medusae
How do you describe the contour of the abdomen?
flat, round, scaphoid
How do you evaluate for unseen masses?
pt take and breath and hold it and lifts head from table
What is generalized distention related to?
obesity, enlarged organs, fluid or gas
What does distention at upper half of abdomen indicate?
tumor pancreatic cyst, gastric dilation
What does lower half of abdomen distention mean?
ovarian tumor, pregnancy, uterine fibroids, distended bladder
What are the Fs of distention of abdomen?
fat, fluid, feces, flatus, fibroid, full bladder, false pregnancy, fatal tumor
What is rippling across the abdomen?
peristalsis
What is pulsation in the abdomen associated with ?
AAA
What are prolonged gurgles of stomach, early bowel sounds?
borborygmi
When is absent bowel a concern?
after 5 min, SURGICAL EMERGENCY
What does increased sounds in abdomen mean?
gastroenteritis, early intestinal obstruction, hunger
What does high pitched tinkling in abdomen mean?
increased pressure of intestinal fluid or air
What does decreased bowel sound mean?
peritonitis and paralytic ileus
What are harsh sounds reflecting turbulent blood flow, use bell of stethoscope?
bruits
What is heard with increased collateral circulation btw portal and system venous system?
Venous hum
What are high pitched sounds associted with respiration due to inflammation?
Friction rubs
What are two organs that cause friction rubs?
liver and spleen
What does percussion over air filled visceral sound like?
high pitched tympany
What does base of left lung sound like to percussion?
medium pitch, hyper resonance
What does lung tissue and abdomen sound like to percussion?
resonance, sustained note of moderate pitch
What does solid organs sound like to percussion?
short, high pitched dullness
Didn’t put slide 48 in
Give me a 5
How do you check for kidney issues/pyelo?
CVA tenderness
What do you need to note about masses on PE of abdomen?
location, size, shape, consistency, tenderness, pulsation, mobility, mvmnt w/ resp
What is the sign for cholecystitis?
Murphy Sign - deep palpation at lateral border of abdominis m and pt takes a deep breath
What is the sign for appendix?
McBurney Sign
What are the two maneuvers for appendicitis?
obturator or psoas
Where does spleen pain refer to?
Left shoulder
What does spleen pain (over the region of spleen) called?
Kehr Sign
What are the two signs for ascites?
shifting dullness and fluid wave
What is the sign for peritonitis?
Blumberg sign - rebound tenderness
What is the sign with abdominal pain radiating to left shoulder?
Kehr sign
What is the sign for appendicitis?
Rovsing sign
What are the signs of peritonitis?
ballance, blumberg, markle
What is fixed dullness to percussion in left and right flank, disappears with change in position?
ballance
What is pt standing, raises on toes and drop heels or jarring of the bed?
markle
What causes epigastric pain?
cholecystitis, diverticulitis, intestinal obstruction, GERD
What can cause generalized pain?
peritonitis
What can umbilical pain be?
intestinal obstruction, volvulus
What can cause pelvic pain?
ectopic pregnancy, pelvic inflammatory disease, ruptured ovarian cyst
What can cause back and flank pain?
leading AAA, renal calculi
