Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PNP: Physical Assessment > Abdomen > Flashcards

Abdomen Flashcards

1
Q

Localizing Pain (3)

A
  1. 1-finger test: show me where the pain is with 1 finger
  2. If pain is all over, the cause is more functional
  3. The closer the pain is to the umbilicus = the more likely it is to be functional EXCEPT for in the first hours of the initiation of appendicitis (which will localize to RLQ later)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Anatomy Review (4)

A
  1. LUQ: pancreas, spleen
  2. RUQ: Gallbladder, liver
  3. LLQ: Colon, intestine, L ovary
  4. RLQ: Intestine appendix, R ovary
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Kidney Palpation (5 steps)

A

1st: Place left hand posteriorly just below the right 12th rib. Lift upwards trying to displace the right kidney anteriorly.
2nd: Palpate deeply with right hand on anterior abdominal wall.
3rd: Have the patient take a deep breath.
4th: Feel for lower pole of kidney as it descends and try to capture it between your hands.
5th: Have the patient release breath. Slowly release the kidney and feel it slide back into place.
* Try the same on the left kidney, but is seldom palpable.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How to palpate for CVA tenderness

A

With patient seated upright, place palm of left hand over each CVA and strike back left hand with ulnar surface or right fist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What does CVA tenderness indicate?

A

Suggests kidney infection such as pyelonephritis or perinephric abscess.

  • pyelonephritis: Inflammation of kidney substance and pelvis.
  • perinephric abscess: Abscess formation in the peritoneal membrane surrounding the kidney
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Guarding may indicate…(3)

A
  1. Peritonitis
  2. Appendicitis
  3. Cholecystitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Point tenderness may indicate (2)

A
  1. Appendicitis
  2. Cholecystitis

Point tenderness: mcburney’s point at right lower quadrant below inguinal fold)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Asymmetry indicates (2)

A
  1. Appendiceal abscess

2. Tumor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

No bowel sounds indicates (2)

A
  1. Peritonitis

2. Infarcted bowels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Palpable m ass indicates (3)

A
  1. Tumor
  2. Cyst
  3. Intussusception
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Nutritional Status is indicated by…

A

Weight, height

Edema – lack of protein

Anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Extraintestinal features that are red flags

A
  1. Arthritis
  2. Ciliary injection
  3. Skin (edema)
    * Think about Crohn’s and inflammatory bowel disease with extraintestinal features
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Abdominal distention indicates (2)

A
  1. perotinitis

2. obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

visible bowel loops indicates (2)

A
  1. Intussusception

2. Obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

High pitched bowel sounds indicates

A

Obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Chronic Abdominal Pain (6)

A
  1. Onset may be associated with an event that the child does not want- test, gym, recess
  2. Cannot be localized
  3. Does not waken the child
  4. Resolves spontaneously when the child has something to do that he likes
  5. Pain is out of proportion to physical exam findings
    - May have hyperactive gut (high level of autonomic reactivity, associated with type A child)
  6. Lab findings are normal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Causes of Epigastric Pain (6)

A

a. Peptic Ulcer disease
b. GERD
c. Gallbladder disease
d. Pancreatitis
e. Trauma
f. Idiopathic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Causes of Periumbilical Pain (7)

A

Usually a functional cause….

a. Functional abdominal pain
b. Abdominal migraine
c. Streptococcal pharyngitis
d. Gastroenteritis
e. Appendicitis
f. Carbohydrate intolerance
g. Lactase deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Pain in RLQ (8)

A

a. Ovarian torsion
b. Appendicitis
c. PID
d. Ectopic pregnancy
e. Mittelschmerz
f. Right lower lobe pneumonia
g. Inguinal hernia
h. Iliopsoas abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Pain in LLQ (2)

A
  1. Constipation

2. Right ovarian or testicular pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Pain in Suprapubic area (4)

A
  1. UTI
  2. Constipation
  3. Urinary retention
  4. Hydrometrocolpos; blood stuck in ovaries
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Characteristics that are NOT worrisome with abd pain (4)

A
  1. Undigested food in stool
  2. Green stool
  3. Child sleeps through the night
  4. Pain occurs in morning and disappears with passing of school bus and tends not to occur on the weekend
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

5 Types of Malformations of the Cecum

A
  1. Non rotation and therefore cecum is found in the left part of the abdominal cavity
  2. Malrotation and the cecum remains below the pylorus
  3. Subhepatic cecum and therefore the cecum is below the liver
  4. Mobile cecum: not fixed to the retroperitoneum
  5. Hyperrotation in which the cecum lies directly at the left colic flexure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Appendicitis Presentation (6)

A
  1. Pain that precedes vomiting
    - Pain starts as periumbilical pain then localizes to lower quadrant
    - Pain is sharp and constant
  2. N/V
  3. Tenderness at McBurney’s point
  4. Fever
  5. Leukocytosis
  6. Tachycardia*
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Signs of appendicitis in toddler (3)

A
  1. Fever and vomiting
  2. Pain may be intermittent and referred to right hip with limp
  3. Abdominal pain may be localized or generalized
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Signs of appendicitis in school aged (5)

A
  1. Abdominal pain and vomiting common
  2. Pain with walking or movement
  3. Fever
  4. Abdominal wall tenderness that tends to be focal to RLQ (unless appendix is displaced)
  5. Involuntary guarding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Appendicitis MANTREL

A 
Migration of pain
Anorexia
N/V
Tenderness on RLQ
Rebound tenderness
Elevated temperature
Leukocytosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Psoas Sign

A

1st: Have child in supine position
2nd: Place hand above right knee
3rd: Direct child to raise leg against pressure
* Positive sign: pain in RLQ when pushing down on leg

or:
Have child drop right leg over exam table
*Positive finding: this will be painful

Positive- indicates appendicitis

extending the thigh of a patient lying on his side with knees extended, or asking the patient to actively flex his thigh at the hip. If abdominal pain results, it is a “positive psoas sign”.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Obturator Sign

A

Flex child’s right thigh at the hip with the knee bent, Rotate leg internally at the hip then externally

Pain occurs when there is internal and external rotation of the flexed thigh = positive sign and indicator of appendicitis

30
Q

Rovsing’s Sign

A

Pain in RLQ with left-sided pressure (press on left side and get pain on right side)

31
Q

Markle Jar Heel Test

A

Up on toes, down hard on heels
Have patient jump op and down

*pain in the right lower quadrant of the abdomen is elicited by dropping from standing on the toes to the heels with a jarring landing.

32
Q

Rebound Tenderness (3)

A
  1. Only do this once and with older children; do not do with young child!
  2. Firmly and slowly push in, hold, then quickly withdraw
    - There will be pain as you withdraw
  3. Take hand, put it on McBurney’s point, distract child, keep hand there for 30 seconds, let go and the removal causes pain

*Occurs with appendicitis

33
Q

Pneumonic for Pancreatitis Causes

A 
Idiopathic
Gallstones
Ethanol
Trauma
Spider/scorpion
Mumps/malignancy
Autoimmune
Steroids
Hyperlipedemia/hypercalcemia/hyperparathryodism
ERCP
Drugs (HIV, furosemide, methanol, salicylates, valproac acid, organophosphates)
34
Q

Signs of Pancreatitis (4)

A
  1. Lipase and amylase elevations
  2. Pain in upper abdomen towards right side or periumbilical pain radiating to back
  3. Hypercalcemia
  4. Ileus, distension, ascites
35
Q

Murphy’ Sign

A

Temporary inspiratory arrest with palpation of right subcostal margin

Patient takes deep breath and you cup under the right side and ask them to exhale; they will feel pain in gallbladder
*Indicates cholecystitis

36
Q

Nonalcoholic Steatophepatitis (NASH) and Nonalcoholic Fatty Liver Disease (NAFLD) (4)

A
  1. Strong association with obesity
  2. Elevation of liver enzymes (AST, ALT)
  3. NASH
    - Fat in the liver, along with inflammation and damage
    - Leads to cirrhosis
  4. NAFLD
    - Fat in liver without inflammation
37
Q

Mallory Weiss Tear

A

tear in the mucosal layer at the junction of the esophagus and stomach
*Can get it from vomiting

38
Q

Signs/Symptoms of Eosinophilic Esophagitis in Children and Adolescents (11)

A

i. Recurrent vomiting
ii. Abdominal pain
iii. Dysphagia
iv. Pain with swallowing (odynophagia)
v. Vomiting often but not always occur in association with eating
vi. Some accompanying nausea.
vii. Intense feeling of discomfort as a swallowed food bolus slowly moves down the esophagus.
viii. Often patients will try to drink liquids to help bring the foods down
ix. Episodes may last for only a few seconds or can be more prolonged and severe, and occasionally result in food becoming stuck in the esophagus ‐ that is food impaction.
x. Severe and chronic symptoms, significant weight loss can also occur.
xi. Heartburn, cough, chest pain, or epigastric (upper abdominal) pain, which does not respond to anti‐reflux therapy.

39
Q

Causes of Watery diarrhea (2)

A

i. Infection: viral, bacterial, parasitic

ii. Appendicitis with perirectal abscess

40
Q

Cause of hard or large stools

A

constipation

41
Q

cause of decrease in stool frequency (2)

A
  1. constipation

2. obstruction

42
Q

Cause of mucous containing stool

A

colitis (but also can be normal)

43
Q

cause of bright red blood in stool (small volume) (2)

A
  1. fissure

2. hemorrhoids, suggesting constipation

44
Q

Current jelly stool indicates

A

Intussusception

45
Q

Melena stool indicates (2)

A
  1. Gastric ulcer

2. Duodenal ulcer

46
Q

Alcoholic/white stool indicates (2)

A
  1. biliary disease

2. hepatic disease

47
Q

Diagnosing Childhood Functional Abd Pain

A

Must include all of the following criteria at least once a week for at least two months prior to diagnosis:

  1. Continuous or episodic abd pain
  2. Insufficient criteria for other functional GI disorders
  3. No evidence of an inflammatory anatomic, metabolic, or neoplastic process that explains the symptoms
48
Q

Diagnostic Criteria for IBS

A

Must Include both of the following criteria, fulfilled at least once pet week for two months prior to diagnosis. Abdominal pain or discomfort associated with two of the following:

  1. Improvement with defecation
    * Gets better when child poops
  2. Onset associated with a change in frequency of stool
  3. Onset associated with change in form of stool
    * Will have alternating diarrhea and constipation (there are changes in the form of the stool)
49
Q

Functional Dysplesia (3)

A
  1. Persistent or recurrent pain or discomfort centered in the upper abdomen
  2. Not relieved by defecation or associated with the onset of a change in stool frequency or stool form
  3. No evidence of an inflammatory, anatomic, metabolic, or neoplastic process to explain symptoms
50
Q

Bilious Emesis (4)

A
  1. Bilious emesis is a mechanical obstruction unless proven otherwise!
  2. Bilious emesis = green vomit
  3. In infancy the obstruction can result from:
    - Feeding problems with transient episodes of bilious vomiting
    - Failure to thrive with feeding intolerance (Malrotation with volvulus)
  4. In school-aged child, obstruction can result from adhesions from previous surgeries!!
51
Q

Pyloric Stenosis (6)

A
  1. Familial with 5:1 male predominance
  2. Non bilious, projectile vomiting and hungry 30-60 minutes later
  3. Hypochloremic metabolic alkalosis
  4. Not a mechanical obstruction; Narrowing of pylorus valve causing difficulty getting milk from mouth to stomach
  5. Generally presents at 3rd-6th week of life
  6. Comes into ER with non-bilious vomit; child will be puking and dehydrated
52
Q

Malrotation of Volvulus (6)

A
  1. Abnormal fixation of bowel mesentery with twisting around mesenteric artery
    - May be due to perineum not attached well, so the gut twists
  2. Painful distended abdomen
  3. Bilious vomiting present
  4. Blood in stool
  5. Abdominal Pain
  6. May be lethargic on presentation
53
Q

Classic Triad Sign of Intussusception (and dance’s sign)

A
  1. Jelly like stool
  2. Vomiting
  3. Intermittent abdominal pain with palpable sausage-shaped mass
  4. Dance’s sign: concavity in RLQ and RUQ where intestine telescoped in -Empty right lower quadrant
54
Q

Other Clinical Features of Intussusception (6)

A
  1. Colicky abdominal pain
  2. Infant pulls knees up to chest while crying
  3. Normal between episodes of pain
  4. Altered mental status
  5. Palpable sausage shaped mass during crying
  6. Dance’s sign: concavity in the right lower quadrant due to absence of underlying bowel
55
Q

Newborn Hirschsprung’s Disease physical exam (9)

A
  1. Newborn: well constipated with distended soft abdomen with normal or hyperactive bowel sounds
  2. Rectal exam: slight pressure on examining finger with no stenosis or obstruction
  3. Ampulla is empty: on removal explosive evacuation of stool or gas

Ill newborn will present with….

  1. More distention without peritoneal signs unless perforation
  2. React minimally to examiner
  3. Can be lethargic
  4. Fever
  5. Tachycardia
  6. Ominous hypotension
56
Q

Older infant and child with Hirschsprung’s presentation (4)

A
  1. Chronically distended, non-tender abdomen with large fecal masses ON LEFT SIDE
  2. Rectal exam: ampulla is empty
  3. Anal tone is normal
  4. Explosive stool will also occur after examining finger is withdrawn
57
Q

Hematochezia

A

maroon stools which indicated distal GI source or
short transit time from briskly bleeding proximal
source

58
Q

Melena

A

dark or black tarry stools when the bleeding is from

upper tract

59
Q

Hematemesis (3)

A
  1. vomiting of blood or blood per rectum
    - Appearance of coffee grounds or bright red
  2. Can occur if newborn swallows maternal blood during delivery
  3. Esophagitis will occur secondary to reflux (bleeding can occur due to reflux)
60
Q

APT Test

A

Dx whether newborn hematemesis is from swallowing maternal blood during delivery

Mix emesis with 1% sodium hydroxide

  • Fetal blood remains pink or bright red
  • Maternal hemoglobin turns brown
61
Q

Upper GI Bleed Causes (8)

A
  1. Stress
  2. Vascular malformaiton
  3. Gastric/esophageal duplication
  4. Hemorrhagic gastritis
  5. Esophagitis
  6. Varices from portal HTN
  7. Vascular malformations
  8. Bleeding diathesis from such hemorrhagic disease of the newborn
62
Q

Lower GI Bleed Causes (3)

A
  1. Juvenile polyps (may be from Gardner’s syndrome)
  2. Anal fissure
  3. Meckel Diverticuli
63
Q

Meckel Diverticuli (4)

A
  1. Most common source of significant lower GI bleeding in children
  2. Preschooler bleeding is the result of
    - HCL secreted from ectopic gastric mucosa within diverticulum
    - Ulceration forms on ileal mucosa
  3. Painless but can be massive
  4. Part of stomach mucosa in the small intestines because mucosa secrets HCL and they get massive GI bleed
64
Q

Manifestations of Ulcerative Colitis (12)

A
  1. Most diagnosed between 15-30 years old
  2. Acute bloody diarrhea
  3. Cramping
  4. Tensemus
  5. Pallor
  6. Growth retardation

Extraitestinal manifestations:

  1. Arthralgia
  2. Uveitis
  3. Oral ulceration: aphthous ulcers
  4. Liver disease by fatty infiltration or sclerosing cholangitis (15%)

Skin manifestations:

  1. Erythema nodosum
  2. Pyoderma granulosum (non-healing ulcer)
65
Q

Where do ulcerative colitis ulcers occur? (2)

A
  1. Diffuse, continuous superficial inflammation
  2. Edema and shallow ulceration and small pseudopolps in rectum, descending colon as far as ileocecal juncture (limited to colon)
66
Q

Where do Crohn’s Disease ulcers occur? (2)

A
  1. Focal asymmetrical inflammation anywhere on GI tract (from anus to mouth)
  2. Most common in terminal ileum proximal colon and ileocecal junction
67
Q

Crohn’s Disease Manifestations (8)

A
  1. WEIGHT LOSS (90% of the time)
  2. Abdominal pain, typically in RLQ since inflamed edematous terminal ileum (70%)
  3. Diarrhea (67%)
  4. Fever (25%)
  5. Bloody diarrhea***
  6. Anal skin tag
  7. Perianal ulceration***
  8. Same extraintestinal manifestations as ulcerative colitis
68
Q

Neuroblastoma History (7)

A
  1. Hx of vasoactive intestinal peptide
  2. Watery diarrhea with abdominal distention and electrolyte imbalance
  3. Opsoclonus-myoclonus (dancing eyes with myoclonic jerks w/ or w/o cerebellar ataxia)

Catecholamine excess (More common if renal in origin)

  1. Flushing
  2. Tachycardia
  3. Headache
  4. HTN
69
Q

Neuroblastoma head and neck exam and thoracic exam signs (7)

A

Head and Neck:

  1. Visual changes
  2. Exopthalmos
  3. Horner’s syndrome: ptosis, meiosis, anhydrosis
  4. Cerebellar ataxia
  5. Periorbital ecchymosis – raccoon eyes
  6. Heterochromia iridis – different color iris’

Thoracic exam
1. If dumb bell extension into spine- neurological abnormalities, cough, SOB

70
Q

Signs and Symptoms of Wilm’s Tumor

A
  1. Abdominal mass that is firm, flank, non-tender, minimally mobile and doesn’t usually cross midline
  2. Well appearing
  3. Asymptomatic mass
  4. Pain rarely reported
  5. HTN and micro-hematuria

PNP: Physical Assessment (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions