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Clin Path II > Abdomen > Flashcards

Abdomen Flashcards

1
Q

What are three chiropractic approaches to abdominal complaints?

A
  • visceral pathology
  • nutritional/ functional problem
  • musculoskeletal/ soft tissue lesion
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2
Q

What are examples of visceral pathology?

A

GERD, GB disease, ulcer, IBD, colon cancer, etc

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3
Q

What are examples of nutritional/ functional problem?

A

Lactose intolerance, IBS, leaky gut, pancreatic insufficiency, etc.

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4
Q

What are examples of musculoskeletal/ soft tissue lesions?

A
  • abdominal wall/back myofascial syndrome, abdominal strain, spinal joint dysfunction, abdominal adhesions
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5
Q

When the patient points all over the abdomen what is the issue?

A

Intestinal issue

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6
Q

What causes pain in the upper right quadrant?

A

?

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7
Q

What causes pain in the lower right quadrant?

A

?

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8
Q

What causes pain in the upper left quadrant?

A

?

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9
Q

What causes pain in the lower left quadrant?

A

?

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10
Q

What are the 9 divisions of the abdomen?

A 
Hypochondriac (right, left)
Lumbar (right left)
Iliac (right, left)
Epigastric
Umbilical
Hypogastric
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11
Q

What causes pain in the right hypochondriac region?

A

?

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12
Q

What causes pain in the left hypochondriac region?

A

?

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13
Q

What causes pain in the right lumbar region?

A

?

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14
Q

What causes pain in the left lumbar region?

A

?

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15
Q

What causes pain in the right iliac region?

A

?

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16
Q

What causes pain in the left iliac region?

A

?

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17
Q

What causes pain in the epigastric region?

A

?

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18
Q

What causes pain in the umbilical region?

A

MOST ISSUES START HERE AND LATERALIZE

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19
Q

What causes pain in the hypogastric region?

A

?

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20
Q

Where does the gallbladder refer?

A

?

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21
Q

Where does the diaphragm refer? What can cause the diaphragm to refer?

A

Shoulder pain

Liver enlargement

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22
Q

Where does the pancreas refer? What can cause it?

A

Thoracolumbar area

Acute pancreatitis, chronic, cancer

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23
Q

Where does the vertebral oint pain refer? What can cause it?

A

?

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24
Q

Where does the rectus abdominals MFTP refer? What can cause it?

A

?

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25
Q

Where does the esophagus refer? What can cause it?

A

?

26
Q

What do you need to learn from the history with abdominal complaints?

A
  • onset
  • pattern
  • quality
  • severity
  • aggravating/relieving factors
27
Q

What do you need to know about their abdominal pain related to the ONSET?

A
  • did they eat something no one else ate?
  • was there foreign travel/ camping/ backpacking?
  • does it occur with a certain food product?
  • does it occur within a few hours after eating (ulcer, GERD, gallbladder)
  • is it a lower GI problem (diarrhea)?
28
Q

What do you need to know about their abdominal pain related to PATTERN?

A
  • does it come and go or is it consistent?
  • what triggers an episode?
  • how often do they get an episode?
  • how long do episodes last?

IBP

29
Q

What do you need to know about their abdominal pain related to QUALITY?

A
  • Is it colicky? (intestine issue)

- is it crampy?

30
Q

What do you need to know about their abdominal pain related to Severity?

A
  • nausea, bloating, pain etc SCORE

- how debilitating is it?

31
Q

What do you need to know about their abdominal pain related to AGGRAVATING/ RELIEVING FACTORS?

A
  • certain foods
    (Esophagitis)
  • relieved by fetal position (pancreatitis)
  • does eating make it better? (gastric ulcer)
  • do antacids relieve (GERD, gastritis)
32
Q

In terms of associated symptoms, what do you need to ask about the GI?

A

UPPER

  • nausea/vomiting (pancreatitis, gall bladder disease)
  • reflux/belching/coughing (GERD)

LOWER

  • change in bowel patterns? (
  • diarrhea?
  • constipation?
  • stool appearance?
33
Q

In terms of associated symptoms, what do you need to ask about the BIG 5?

A
  • feeling fatigue?
  • feeling malaise?
  • have a fever?
  • ## weight change?
34
Q

In terms of associated symptoms, what do you need to ask about the REPRODUCTIVE SYSTEM?

A

CHANGE IN MENSES

35
Q

What are follow up questions for bowel changes?

A
  • diarrhea? (Fluid OR loose stool?) (how long?)
  • blood? (blood with diarrhea = inflammatory bowel disease) (hemorrhoids, anal fissure, inflammatory bowel disease, Crohn’s, ulcerative colitis, colon cancer in patient over 50)
  • mucus? (Crohn’s, ulcerative colitis, inflammatory bowel disease, irritable bowel syndrome)
  • smelly and floats? (Fat in stool = digestive problem) (malabsorption, pancreatic insufficiency)
  • long ribbon? (Spastic colon, physical obstruction = tumor)
36
Q

If a patient has fluid diarrhea for awhile what needs to happen next?

A

Refer for fluids

37
Q

When does a patient have to be scoped?

A

> 50

Blood

38
Q

What is IBS? What is seen with a colon scope?

A

Irritable bowel syndrome

  • nothing
  • distended abdomen/diarrhea/constipation
39
Q

What is IBD? What are common types? What may the patient experience (5)?

A

Irritable Bowel Disease (ulcerative colitis is the single most common type, Crohn’s disease)

  • might run a fever during a flare up
  • may have blood in the stool
  • may have mucus in stool
  • may become anemic
  • may have increased ESR
40
Q

Where/what do you listen for abdominal aorta?

A

Between naval and xyphoid and listen for swishing sound

41
Q

What do you palpate the abdomin for related to musculature

A

look for musculoskeletal lesions such as

  • spasm,
  • tear’s/hernias,
  • MFTPs,
  • Carnett’s sign
42
Q

How is Carnett’s performed? What is a positive?

A

Palpate the abdominal muscle, patient half sit ups, if pain increases that is a positive that the issue is probably musculature

43
Q

What are you palpating for in the abdomen?

A
  • Tenderness/pain
  • organ enlargement
  • visceral adhesions
44
Q

Where do you palpate for the abdominal aorta ?

A

Deep palpation between the renal arteries and common iliac bifurcation

45
Q

What are signs of peritonitis? What cause it?

A
  • rigid abdomen
  • rebound tenderness
  • jar sign
  • result of any condition of abdominal cavity that leaks puss and inflames the peritoneum
  • emergency referral
46
Q

What would you palpate with a AAA? What is the +LR and -LR?

What increases sensitivity?

What type of patient starts with a high sensitivity?

A

Expansile pulsating epi gastrin mass
+LR 7.6, -LR 0.6

Over 5cm increases sensitivity to over 80%

Patient girth <100cm, the sensitivity is 88%

47
Q

Where does appendicitis pain begin? Where does it go? What are signs?

A
  • Classically begins as central pain that over 6-12 hours localizes due to peritoneal irritation
  • Associated with nausea/vomiting and variable increases in WBC
48
Q

How is appendicitis diagnosed? How is it treated?

A
  • Diagnosis with signs of rebound tenderness (for peritonitis) or
    Rovsings
  • Definitive diagnosis with CT (adults) or diagnostic US (children/pregnancy)
  • Tx involves laproscopic removal
49
Q

What is psoas sign

A

Apply pressure to patient’s knee and ask the patient to lift the right thigh against your hand

50
Q

What is obturator sign?

A

Internal rotation of the right leg with knee and hip flexed

51
Q

What is most indicative of appendicitis?

A

Tenderness in RLQ

Leukocytosis

52
Q

What is a “shift to the left”

A

Part of standard CBC
Increase in immature WBC
Indicates an infection or inflammatory response

53
Q

What is the first imaging ordered for most abdominal issues? What is the common second choice?

A

Abdominal ultrasound

CT

54
Q

What is often the first choice for a tube like structure in the abdomen?

A

Endoscopy (in the upper = for ulcer, GERD, etc)

Colonoscopy (In the lower = cancer, ulcerative colitis, diverticulitis )

55
Q

What does a CBC look for?

A

Anemia (normocytic is most common, may be microcytic or macrocytic)

WBC >12000 (infection, cancer, inflammatory disease)

56
Q

What is a Blood chemistry panel for? What are some issues and what are the common raises in blood chem panel for each?

A

“BAAAGL”

  • Bilirubin
  • Alkaline phosphatase (form liver or bone)
  • ALT
  • AST
  • GGPP
  • LDH

Hepatitis = ALP & AST
Hepatitis panel

Obstructive liver = bilirubin and Alk Pho’s

Acute alcoholism = GGPP

57
Q

?

A

Acute pancrease

58
Q

What is FIT/ fecal Hgb for?

A

If there’s blood in the stool

59
Q

What is O&P for?

A

Parasitic infection

60
Q

What are all the labs for abdominal issues? (7)

A
  • CBC (anemia, WBC > 12,000)
  • Blood chemistry panel (BAAAGL)
  • Serum amylase/lipase
  • Hepatitis panel
  • UA
  • FIT/Fecal Hgb
  • O&P

Clin Path II (18 decks)

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