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Physical Diagnosis II > Abdomen > Flashcards

Abdomen Flashcards

1
Q

Order of exam for abdomen

A

Inspect
Auscultate
Percuss
Palpate

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2
Q

What does esophagus connect

A

Pharynx to stomach

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3
Q

What valve between ileum and large intestine that prevents backflow

A

Iliocecal valve

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4
Q

Putrefaction. What is is and what does it?

A

Live bacteria decompose undigestion food, I absorbed AA, cell debris and dead bacteria.

Large intestine

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5
Q

Exocrine and endocrine function of pancreas

A

Exocrine: produce digestive juices

Endocrine: produce hormone to regulate body’s level of glucose

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6
Q

Function of white pulp and red pulp of spleen

A

White: lymphoid tissue that filters blood and produces lymphocytes/monocytes (WBCs)

Red: storage and release of blood

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7
Q

Location of kidneys

A

T12-L3

Retroperitoneal

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8
Q

Function of kidney

A

Rids body of water solvable waste

  • produce renin, erythropoietin, and biologically active vitamin D
  • synthesize prostaglandins
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9
Q

Aka for inguinal ligament

A

Poupart ligament

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10
Q

In infant…pancreatic islet cells are developed by when? And do what?

A

12 weeks of gestation and begin producing insulin

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11
Q

Spleen and infants

A

Spleen active in blood FORMATION during development and first year of life

After aids in destruction of blood cells and acts as lymphatic organ

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12
Q

When can fetus begin to produce urine

A

12 weeks

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13
Q

What may happen to skin/muscle postpartum when they separate?

A

Diastasis recti

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14
Q

How to differentiate a minor umbilical hernia from an outie belly button?

A

Does it get worse with valsalva maneuver? If so, hernia.

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15
Q

If limited movement of abdomen during respiration what may it be indicative of?

A

Peritonitis
Respiratory problems
Pain

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16
Q

Indicate what if peristalsis is seen as a rippling movement?

A

Bowel obstruction

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17
Q

Auscultation findings of abdomen

A

Heard as irregular clicks and gurgles 5-35/minute

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18
Q

Long prolonged gurgles

A

Borborygmi

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19
Q

Increased bowel sounds occur with?

A

Gastroenteritis
Early intestinal obstruction
Hunger

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20
Q

High-pitched tinkling sound suggests

A

Intestinal fluid and air under pressure

Early obstruction

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21
Q

Decreased bowel sounds with?

A 
Peritonitis
Paralytic ileus (paralyzed intestines—not just ileum)
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22
Q

Absense of bowel sounds can be determines after how long of listening?

A

5 minutes

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23
Q

What side of stethoscope do you use over liver adn spleen?

A

Diaphragm

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24
Q

Use diaphragm over what organs to listen

A

Spleen and liver

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25
Q

Bell or diaphragm to listen for bruits and where

A

Bell

Aortic
Renal
Iliac
Femoral arteries

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26
Q

Where and when is venous hum heard

A

Epigastric region and around umbilicus as soft, low-pitched, continuous sound

With increased collateral circulation between portal and systemic venous systems (HTN)

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27
Q

Predominant sound during percussion in abdomen

A

Tympany due to stomach and intestines

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28
Q

Greater tympani in small intestines or large?

A

Small

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29
Q

Where do you usually percuss lower boarder of liver? And if percuss below expected?

A

Normal: inferior costal margin

Abnormal: more than 1 inch below costal margin
-hepatomegaly or downward displacement due to depressed diaphragm

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30
Q

Normal upper boarder of liver where?

A

5th intercostal space

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31
Q

What may cause liver to shift up? Down?

A

Up: abdominal mass/fluid
Down: diaphragm depressed

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32
Q

Usually size of liver at midclavicular? At mid sternal?

A

6-12 cm

4-8cm

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33
Q

Who usually has a larger liver span?

A

Males and tall people

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34
Q

How much should liver move descend during inspiration?

A

2-3cm

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35
Q

Where should splenic dullness be heard?

A

6-9th/10th intercostal spaces

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36
Q

What may produce a false positive for splenomegaly?

A

Full stomach
Feces-filled intestine
Left sided pleural effusion

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37
Q

Alternate method to percuss the spleen

A

Percuss at lowest costal interspace at left anterior axillary line. Should be tympanic. Have patient inhale and hold. Sound should still be tympanic.

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38
Q

Determine whether mass is superficial or deep mass

A

Palpate while patient does partial sit-up. If you can’t feel it its deep

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39
Q

Tender gallbladder indicates

A

Cholecystokinin

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40
Q

A non tender but palpable gallbladder indicates

A

Bile duct obstruction

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41
Q

Murphy’s sign

A

If suspected cholecystitis (tender and palpable)

Hook left thumb under costal margin and have patient take deep breath. Positive if pain and halt in inspiration

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42
Q

What kidneys usually not palpable

A

Left

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43
Q

Why is right kidney more palpable

A

Due to the liver

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44
Q

Aorta is where

A

Left of midline

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45
Q

Detect ascites

A

Percuss for tympany and dullness when supine and then recumbent. Boarder of dullness shifts to dependent side (aka approaches midline)

Fluid wave

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46
Q

Fluid wave for what and how

A

Ascites

Supine patient. Patients knife edge upright and middle of tummy. Doctors hands on each side. And hit one side. Will feel impulse of fluid wave if adipose.

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47
Q

Stats on fluid wave tactic

A

If positive its highly likely fluid. If negative, may still have fluid

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48
Q

Appendicitis

A

MC 2nd decade of life

Initial periumbilical pain that then migrates to RLQ
+Pisa’s sign and rebound tenderness

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49
Q

Rebound tenderness. What when

A

Appendicitis

Push deep in area of abdomen and retract hand quick at area other than issue. Pain at McBurney’s point in RLQ = appendicitis

Pain at area of compression = + Blumberg sign = peritoneal inflammation

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50
Q

Iliopsoas muscle test

A

Place hand on thigh and have patient raise straight leg

Pain= irritation of ilipsoas (and inflamed appendix irritates ilipsoas)

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51
Q

Obturator muscle test

When and what

A

Suspect ruptured appendix or pelvic abcess

Flex right leg and hip at 90 degrees and then doctor grabs above knee and at ankle and rotates leg laterally and medically

+ pain in R hypogastric region indicates irritation of obturator (ruptured appendix or pelvic abscess irritates)

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52
Q

Aaron sign

A

Pain in area of heart of stomach on palpation of McBurney’s point

Appendicitis

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53
Q

+ Aaron test

A

Appendicitis

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54
Q

Ballance sign

A

Fixed dullness to percussion in left flank and dullness in right flank that disappears on change of position

Peritoneal irritation

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55
Q

+ ballance sign

A

Peritoneal irritation

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56
Q

Blumberg sign

A

Rebound tenderness

Peritoneal irritation
Appendicitis

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57
Q

+ Blumberg sign

A

Perritoneal irritation

Appendicitis

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58
Q

Cullen sign

A

Ecchymosis around umbilicus

Hemoperitoneum
Pancreatitis
Ectopic pregnancy

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59
Q

Cullen sign +

A

Hemoperitoneum
Pancreatitis
Ectopic pregnancy

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60
Q

Dance sign

A

Absence of bowel sounds in RLQ

Intussusception (ilium goes into cecum)

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61
Q

+dance sign

A

Intussusception

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62
Q

Grey turner sign

A

Ecchymosis of flanks

Hemoperitoneum
Pancreatitis

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63
Q

+ grey turner

A

Hemoperitoneum

Pancreatitis

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64
Q

Kehr sign

A

Abdominal pain radiating to left shoulder

Spleen rupture
Renal calculus
Ectopic pregnancy

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65
Q

+ Kehr sign

A

Spleen rupture
Renal calculi
Ectopic pregnancy

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66
Q

Markle sign

A

Raise up on toes and relaxes that causes abdominal pain

Peritoneal irritation
Appendicitis

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67
Q

+ markle sign

A

Peritoneal irritation

Appendicitis

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68
Q

McBurney sign

A

Rebound tenderness and sharp pain when McBurney’s point palpated

Appendicitis

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69
Q

+ McBurney sign

A

Appendicitis

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70
Q

Murphy sign

A

Abrupt cessation of inspiration on palpation of GB

Cholecystitis

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71
Q

+ Murphy sign

A

Cholecystitis

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72
Q

Romberg-Howship sign

A

Pain down medial aspect of thigh to knees

Strangulated obturator hernia

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73
Q

+ Romberg-Howship sign

A

Strangulated obturator hernia

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74
Q

Rovsing sign

A

RLQ pain intensified by LLQ palpation

Peritoneal irritation
Appendicitis

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75
Q

+ Rovsing sign

A

Peritoneal irritation

Appendicitis

76
Q

Burning

A

Peptic ulcer

77
Q

Cramping

A

Biliary colic/gastroenteritis

78
Q

Colicky

A

Appendicitis with impacted feces

79
Q

Aching

A

Appendiceal irritation

80
Q

Knifelike

A

Pancreatitis

81
Q

Ripping/tearing

A

Aortic dissection

82
Q

Gradual onset

A

Infection

83
Q

Sudden onset

A

Duodenal ulcer
Acute pancreatitis
Obstruction
Perforation

84
Q

In infants scaphoid (concave) abdoment and respiratory distress may indicate what?

A

Diaphragmatic hernia

Other s/s: bowel sounds in chest

85
Q

Enlarged spleen in infancy may indicate what

A

Hemolytic disease or sepsis

Usually spleen is palpable in infant a few weeks after birth

86
Q

Hepatomegaly present in infants when liver is where

A

3 or more cm below right costal margin

87
Q

Duration of acute diarrhea

A

Less than 4 weeks

88
Q

Tenesmus

A

Feeling of incomplete defecation

89
Q

GERD cause

A

Backward flow of gastric contents into esophagus due to relaxation/incompetence of lower esophageal sphincter

**delayed gastric emptying is predisposing factor

**difficulty swallowing

90
Q

Risk factors for GERD

A

Obesity
Hiatal hernia
Pregnancy
CT disorders (scleroderma)

91
Q

GERD has an association with what other issue(s)

A

Asthma

75% of asthma patients experience GERD

People with asthma 2x likely to have GERD

And diabetes

92
Q

IBS

A

Disorder of intestinal motility

Late adolescence and early adulthood (rarely over 50 onset)

93
Q

Alternating constipation and diarrhea is a good indicator of what disease

A

IBS

94
Q

Hiatal hernia

A

Part of stomach passes through the esophageal hiatus into chest cavity

Women 50+

95
Q

Two types of hiatal hernias

A

Sliding and PEH (paraesophageal)

96
Q

Sliding hernia

A

More common, less dangerous

Esophagus pulled upwards

97
Q

PEH (paraesophageal hernia)

A

Part of esophagus and stomach through esophageal hiatus

98
Q

Causes of hiatal hernias

A

MC 50+ females

Weakened muscle allows stomach to bulge through
Injury
Congential Ly large hiatus
Persistent and intense pressure on surrounding muscles (coughing, straining excessive lifting etc)

99
Q

Peptic ulcer causes

A 
Helicobacter pylori infection
Long term aspirin/NSAIDS
Smoking
Alcohol
Men
100
Q

S/s of peptic ulcer

A

A
Localized epigastric pain (burning) when stomach empty
Hematemesis

101
Q

Crohn’s where does it affect

A

Can inflect any part of GI

Terminal ileum and colon MC

102
Q

What might give RLQ pain

A

Crohn’s or appendicitis

103
Q

S/s of crohn’s

A 
RLQ pain
Perianal skin tags
Cobblestone appearance of mucosa on colonoscopy 
Fistulas
Ulcers
104
Q

Risk factors for crohns

A
  • white/Jewish
  • history
  • cigarette smoking (MC risk factor)
  • urban/industrialized country
105
Q

Ulcerative colitis issues where

A

Large intestine and rectum

106
Q

How to differentiate crohns and ulcerative colitis

A

UC: NO fistulae or perianal disease

107
Q

S/s of UC

A

Bloody, frequency watery diarrhea

108
Q

How long is the alimentary tract? And each part

A 
27 feet
Esophagus 10 inches
Stomach
SI-21 feet
LI-4.5-5 feet
109
Q

What does the stomach secrete to do what

A

HCL and enzymes to break down fats and proteins

110
Q

Two functions of LI

A

Water absorption

Putrefaction (live bacteria decompose undigested food etc)

111
Q

What synthesizes, concentrates and stores bile

A

Liver synthesizes

GB: concentrates and stores

112
Q

Path of bile release

A

Into cystic duct—> C. Bile duct —> duodenum

113
Q

When is meconium first produced?

A

17 weeks

114
Q

When is GI tract capable of adapting to extrauterine life

A

36-38 weeks

115
Q

Elasticity, musculature, and control mechanisms continue to develop, reaching adult functioning levels when

A

2-3 years

116
Q

What organ is large at birth

A

Liver

Heaviest organ in the body

117
Q

When can a fetus produce urine

A

12 weeks

118
Q

When does development of new nephrons stop

A

36 weeks

119
Q

What are some things seen with pregnancy

A 
Heartburn 
Gallstones (MC in 2/3rd tri)
Urinary stasis/urgency
Constipation/flats
Hemorrhoids
Linea nigra (was linea alba but when stretched turns dark)
120
Q

Things seen with older adults

A

-motility slows
-secretion/absorption slows
-digestive ability declines —> food intolerances
-increase in biliary lipids—> gallstones
No change in pancreas

121
Q

Inspection of abdoment procedure

A

Look at contour (concave/scaphoid, flat, convex/round) from side and head of table

  • have pt. Take deep breath and hold
  • pt raise head from table (hernias?)
122
Q

During auscultation of abdomen, what abnormal sounds are heard with bell and diaphragm

A

Bell: bruits and venous hum
Diaphragm: friction rubs

123
Q

What does friction rub heard with diaphragm in stomach indicate

A

Inflammation of peritoneal surface of organ from tumor, infection or infarct

124
Q

Where are the upper and lower boards typically of the liver

A

5th intercostal space to inferior costal margin

125
Q

Determining if mass or distended structure (felt as resistance) is voluntary or involuntary

A

Palpate while patient breathes slowly through mouth.

If resistance remains, probably involuntary

126
Q

Rebound tenderness over site that was compressed. Sign? Indicates?

A

Blumberg

Peritoneal inflammation

127
Q

Rebound tenderness over RLQ. Sign? Indicates?

A

McBurney’s sign

Appendicitis

128
Q

If scaphoid abdomen in infant what may it indicate

A

Diaphragmatic hernia

129
Q

Who has more tympany in abdomen?

A

Infants and children because they swallow air when feeding

130
Q

When may an enlarged liver be found in infants

A

Mother with poorly controlled insulin-dependent DM or gestational diabetes

131
Q

Is spleen usually palpable within the first few weeks after birth

A

Yes

1-2cm below left costal margin

132
Q

Bacteria associated with acute diarrhea and travel? Camping/well water?

A

E.coli/samonella/shigella

Giardia/campylobacter

133
Q

What is a predisposing factor for GERD

A

Delayed gastric emptying

134
Q

Stats on IBS

A

1 in 5 Americans

135
Q

What is IBS

A

Disorder of intestinal motility

136
Q

What may a large hernia lead to

A

Allow food and acid backup into the esophagus and causes heartburn

137
Q

Demographics of MC people with hiatal hernia

A

MC in women and 50+

138
Q

Hiatal hernias associated with?

A

Obesity
Pregnancy
Ascites
Tight fitting belts/clothing

139
Q

What causes hiatal hernia with esophagitis

A

Weakened muscles allow stomach to bulge through
Age related
Injury
Congenitally large hiatus
Persistent/intense pressure on surround muscles (coughing/vomiting/straining during bowel)

140
Q

Two types of peptic ulcers

A

Gastric-inside stomach

Duodenal-inside duodenum

141
Q

Hematemesis

A

Vomiting blood

142
Q

Complications of peptic ulcer

A
  • Internal bleeding (anemia/black bloody stool/vomit)
  • Infection (perforate stomach/SI wall)
  • obstruction (swelling/inflammation/scarring)
143
Q

What does Crohn’s disease cause

A

Ulceration, fibrosis and malabsorption

144
Q

Risk factors for Crohn’s disease

A
  • before 30
  • whites/Jewish
  • family history (1/5)
  • cigarette smoking (Most controllable)
  • environmental factors-urban/industrialized —high fat/refined
145
Q

Complications of crohns

A 
Bowel obstruction
Ulcers (anywhere in Dig. Tract)
-fistulas
-anal fissure (when ulcer extend through intestinal wall Mc: perianal)
-malnutrition (B12/Iron)
-colon CA (due to inflammation/scarring)
146
Q

What is a fistula

A

When ulcer extend through intestinal wall

MC perianal

147
Q

Tx for crohns

A

None
Diet and stress aggravate
Anti-inflammatory drugs
Immunosuppressants

Nearly 1/2 have 1 surgery at least

148
Q

S/s of Ulcerative Colitis

A
  • Frequent bloody/watery diarrhea
  • NO fistulae/perianal disease
  • abdominal pain/cramping
  • rectal pain/bleeding
  • urgency to defecate
  • inability to defecate despite urgency
  • fever
149
Q

Risk factors for ulcerative colitis

A
  • family
  • before 30
  • whites
150
Q

Complications of ulcerative colitis

A
  • bleeding
  • perforated colon (infection)
  • severe dehydration
  • osteoporosis (decreased absorption of VitD/Ca plus meds they take decrease bone density)
  • inflammation of skin/joints/eyes
  • increased risk fo colon CA
  • rapid swelling colon (toxic megacolon)
  • increased risk of blood clots
151
Q

Tx of ulcerative colitis

A 
Anti-inflammatory drugs
Immunosuppressants
AB
Anti-diarrheal medications
-pain relievers
-iron supplements
-surgery
152
Q

Where stomach CA usually found

A

Lower half

153
Q

S/s of stomach CA

A
  • decreased appetite
  • feeling full
  • weight loss
  • dysphasia
  • persistent epigastric pain
  • severe,persistent heartburn
154
Q

Risk factors for stomach CA

A
  • GERD
  • high salt/smoked food. Low fruit and veggies
  • family history
  • infection with Helicobacter pylori
  • long term stomach inflammation
  • smoking
155
Q

Diagnose stomach CA upon exam

A
  • mid-epigastric tenderness
  • hepatomegaly
  • enlarged supraclavicular nodes (VIRCHOWS)
  • ascites
156
Q

Diverticular disease/ diverticulitis

A

Saclike mucosal outpouchings that form in a lining of digestive system

157
Q

When is diverticulitis MC?

A

After 40

158
Q

What is affected in diverticulitis

A

Sigmoid colon

159
Q

S/s of diverticulitis

A 
LLQ
Anorexia
Nausea/vomit
Constipation
Decreased bowel sounds
Pain localized to site of inflammation
Abdominal distinction
Tympany with percussion
Lower GI bleeding
160
Q

Risk factors for diverticulitis

A
  • increased age
  • obesity
  • smoking
  • lack of exercise
  • high fat, low fiber diet
  • medications
161
Q

S/s of colon cancer

A 
Change in bowel habits
Blood in stool ***
Abdominal cramps
Fatigue
Weight loss
Early stage may have no s/s
RIBBON/PENCIL like stool
162
Q

Risk factors for colon cancer

A 
AA
Age
History
Inflammatory conditions
Low fiber, high fat
Sedentary 
Diabetes
Obesity 
Smoking
Alcohol
163
Q

Screening recommendations for colon CA

A

Average risk: at 45

Increased risk: before 45

164
Q

Cause of hepatitis

A

Viral infection

Alcohol, drugs, toxins

165
Q

Hepatitis

A

Diffuse or patchy hepatocellular necrosis

166
Q

S/s of hepatitis

A 
A
Anorexia
Fatigue
Abd pain
Jaundice (skin and sclera)
Clay colored stools
Tea colored urine
167
Q

Cirrhosis causes

A

Hepatitis C

Chronic alcoholism etc

168
Q

Exam findings with cirrhosis

A 
Jaundice
Prominent abd vascular
Spider angiomas
Liver enlargement with non-tender boarder
Liver size decrease with scarring
Portal HTN/ascites
Muscle wasting
169
Q

Primary hepatocellular carcinoma

A

Arises in the setting of cirrhosis 20-30 years after injury/disease

High mortality

170
Q

S/s of primary hepatocellular carcinoma

A 
A
Fatigue
Fullness
Clay colored stool
Tea colored urine
Jaundice
Hepatomegaly with HARD IRREGULAR BOARDER *****
-nodules present and palpable (tender or non)

*cirrhosis has large liver with hard non-tender boarder recall

171
Q

Cholelithiasis

A

Gallstones

172
Q

Cholelithiasis s/s

A 
Murphy’s sign +
Colic
RUQ pain
Pain in back and right shoulder
Nausea/vomit

White with black center on X-ray
(Kidney stones are solid white stones)

173
Q

Cholecystitis

A

Inflammation of gallbladder

174
Q

MC cause of cholecystitis

A

Obstruction of cystic duct from cholelithiasis

Acute or chronic

175
Q

Acute cholecystitis

A

90% have stone formation that causes obstructoin and inflammation

176
Q

Chronic cholecystitis

A

Repeated attacks of acute cholecystitis in GB that is scarred and contracted

177
Q

Cholecystitis s/s

Acute and chronic

A 
RUQ pain that radiates to right scapula 
Fiber
Jaundice
Anorexia
Pain abrupt for 2-4 hours

Chronic: may have fat intolerance, flatulence, nausea, anorexia and non-specific abdominal pain

178
Q

nonalcoholic fatty liver disease (NAFLD)

A

Spectrum ranging from steatosis to cirrhosis and hepatocellular carcinoma

Too much fat stored in liver cells
Hepatic cell inflammation and injury thought o arise from accumulation of triglycerides in the liver

179
Q

MC cause of chronic liver disease in US

A

Nonalcoholic fatty liver disease

180
Q

Thought to be cause of NAFLD

A

Inflammation and injury arise from accumulation of triglycerides in liver

Insulin resistance important factor

181
Q

S/s of NAFLD

A 
A
RUQ
Fatigue
Malaise
Jaundice
Physical exam unremarkable
1/2 patients have hepatomegaly
182
Q

Acute pancreatitis causes what

A

Release of pancreatic enzymes that leave to auto digestion

183
Q

Causes of acute pancreatitis

A
  • Biliary disease (cholelithiasis)

- Chronic alcohol abuse

184
Q

S/s of acute pancreatitis

A
  • Sudden onset of persistent epigastric pain
  • RADIATES TO BACK 50%
  • Constant/dull
  • abd distention
  • fever
  • anorexia
  • diffuse abd. Pain
  • decreased bowel sounds
  • Cullen/grey turner signs
  • tachycardia
  • dyspnea
185
Q

Complications of acute pancreatitis

A
  • pseudocyst
  • infection
  • kidney failure
  • breathing issues
  • diabetes
  • malnutrition
  • pancreatic CA

Physical Diagnosis II (6 decks)

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