Abdomen Flashcards
1
Q
When assessing the abdomen for descriptive purposes you want to break it up into 4 or 9
- ______ is used as the center
- 4 quadrants:
- 9 quadrants:
A
- Umbilicus
- RLQ, RUQ, LUQ, LLQ
- Epigastric, Umbilical, Hypogastric or Suprapubic
2
Q
A
3
Q
Palpable structures in the Abdomen
- Firm narrow tube in LLQ
- Part of ascending colon; softer wider tube in RLQ
- (lower margins), below right costal margin
- Pulsations can normally be seen in thinner person, should be palpable in upper abdomen
- Pulsations of these may be felt in the lowre quadrants
A
- Sigmoid colon
- Cecum
- Liver
- Abdominal aorta
- Iliac arteries
4
Q
When examining organs, you want to move in a _____ motion
-
RUQ
- ____: is mostly protected under the rib cage cage but the edge can be palpated at the right costal margin
- ______: which rests against the liver and the duodenum are not palpable
- ________: can be palpated in very thin individuals with relaxed muscles….not always easy to come by when you are trying to examine an abd
- _________: you have the , the
-
LUQ
- is lateral to and behind the stomach, just above the kidney in the left mid axillary line. The tip of the spleen maybe palpable below the left costal margin in a small percentage of people…not common
- P cannot be detected
-
LLQ
- , only palpated in bimanual exam
- Lower midline: and normally a pelvic organ in pregnant women can be a palpable abdominal finding
-
RLQ
- A and loop not palpable
- ______: in women not palpable
*
A
Clockwise
-
RUQ
- Liver
- Gallbladder
- Lower pole of kidney
- Upper midline: Xyphoid process, aorta
-
LUQ
- Spleen
- Pancreas
-
LLQ
- Sigmoid colon, ovaries
- bladder, uterus
-
RLQ
- Appendix and bowel loop
- Ovaries
5
Q
- __________ organs are the kidneys
- ______ by the rib cage (______ portions)
- The costovertebral angle is made up of the _____ rib and the _______ process
- Helps assess for kidney ______.
A
- Posterior
- Protected, upper
- 12th, vertebral
- tenderness
6
Q
History GI
- Abdominal _____, acute vs. chronic
- I______
- N___/V____
- A_____, early _____
- D_____, or O______
- Change in bowel _____
- D____, C_____
- J_____
- _MH
- _MH
A
- pain
- Indigestion
- Nausea/Vomiting
- Anorexia, satiety
- Dysphagia, Odynophagia
- function
- Diarrhea, Constipation
- Jaundice
- PMH
- FMH
7
Q
History Urinary and Renal
- S_____ pain
- Dys____, urgency, frequency
- H_____, decreased stream in men
- ____uria or ___turia
- Urinary ______
- ___turia
- Kidney or ____ pain
- Uretral ____
- PMH
A
- Suprapubic
- Dysuria
- Hesitancy
- Polyuria, Nocturia
- Incontinence
- Hematuria
- Flank
- Colic
8
Q
- Acute, subacute, chronic pain: acute < __ wks, subacute _-_m, chronic > _m
- Abdominal ______: and hospitalizations for abdominal or bladder issues
- Current ______: if a person says that have no GI issues but are taking ____ or ____ then you have a clue that at one time they had _____..ask about ___ they take the medication
- Fam hx of _______: ask about colon____, screening starts at age ___ unless fam hx then age ___, Colorectal cancer screening
- _______: Any change in appetite? L___ of appetite? Any change in ____? How much gained or lost? Over what time period? Is the weight loss due to ____? Dy_____. Any difficulty _____? When did you first notice this?
- Food ______: Are there any foods you cannot eat? What happens if you do eat them: ____ reaction, h_____, belching, bloating, indigestion? Do you use ____? Any abdominal pain? Please ____ to it.
- Nausea/vomiting: Any nausea or vomiting? How often? How much comes up? What is the color? Is there an odor? Is it bloody? Is the nausea and vomiting associated with colicky pain, diarrhea, fever, chills? What foods did you eat in the last 24 hours? Where? At home, school, restaurant? Is there anyone in the family: ?
- _____ habits: How often do you have a bowel movement? What is the color? Consistency? Any diarrhea or constipation? How long? Any recent change in bowel habits? Use laxatives? Which ones? How often do you use them?
- Past ________ history. Any past history of gastrointestinal problems: ulcer, gallbladder disease, hepatitis/jaundice, appendicitis, colitis, hernia? Ever had any operations in the abdomen? Please describe. Any problems after surgery? Any abdominal x-ray studies? How were the results?
- ________: What medications are you currently taking?
- _______ – How much would you say you drink each day? Each week? When was you last alcoholic drink?
- _______: Do you smoke? How many packs per day? For how long?
- ______________: Now I would like to ask you about your diet. Please tell me all the food you ate yesterday, starting with breakfast.
A
- 4, 1-3 months, >/- 4 months
- Surgery
- Medications: Prevacid, Prilosec, gastritis, why
- Colon CA: colonscopy, 50, 45
- Appetite: Loss, weight, diet, Dysphagia, swallowing
- Intolerance: Allergic, heartburn, antacids, point
- with same symptoms in last 24 hrs?
- Bowel
- Abdominal
- Medications
- Alcohol
- Cigarettes
- Nutritional Assessment
9
Q
Colorectal Cancer Screening
-
High Risk
- _____ hx of colorectal cancer or adenoma
- _____ hx with colorectal cancer or adenoma
- Personal hx of _____ to abdomen or pelvis to treat prior CA
- PMH of (2)
- ___MH of familial adenomatous _____; hereditary __-polposis colorectal CA
A
-
High Risk
- Personal
- First degree relative
- Radiation
- UC or Crohns
- FMH: polyposis, non-polyposis
10
Q
Colorectal Screening
-
Average Risk
- Age ___-___
- Age ___-___ based on individual
- > ___ do not screen, competing causes of mortality preclude, mortality benefit
- ____ based test q__-__ years
- ____ exam q__-__ years
A
-
Average Risk
- 45-75
- 76-85
- >85
- Stool, 1-3
- Visual, 5-10
11
Q
Colorectal Cancer Screening
- In your history if you find the person is at high risk for colorectal cancer than you are going to make sure they are followed by a _________ and as their PCP during their annual exam you are going to make sure that you evaluate to see if they are up to date on their screening
- Greater than ___ if not screened need to outweigh the benefits to the risk, of colonoscopy, polyps take about ___ years to turn into cancer
- FIT DNA stool sample once every - yrs Virtual colonoscopy CT colonoscopy
- Should be screened __ -__
A
- Gastroenterologist
- 76, 10
- 1-3
- 45-75
12
Q
Abdominal Pain
- Take a careful, orderly _____
- _____ of the pain: have patient describe in ___ words
- _____ of pain: have patient _____ to the pain
- ______ of the pain
- Factors p_____ and ______ abdominal pain- f___?
- Patient assessment of pain ______– 0-10
- Assess if the patient looks as uncomfortable as they are rating the pain
A
- history
- Character, own
- Location, point
- Radiation
- precipitating, relieving, food?
- severity
Pain is subjective…so if the person is rating themselves a 9/10 yet they seem perfectly comfortable, you will want to ask about their pain tolerance…have they had a great deal of pain in the past, what has worked, have you been told in the past that you have a high or low pain tolerance. People will often tell you…ya I broke my arm once and I did not realize it for a day or so when I still couldn’t use it…
Remember our oldcart (Onset Location Duration Context Associated symptoms Radiation of pain, timing)
Have them point to it.
13
Q
Visceral Pain
- Occurs from _______ or stretching of ____
- ______ to localize
- ______ can stimulate visceral pain fiber
- _____ in quality
- Described as g____, b_____, c_____ or a_____
- _____ can be associated with sweating, pallor, n/v
A
- distention, organs
- Difficult
- Ischemia
- Varies
- gnawing, burning, cramping, aching
- Severe
14
Q
Parietal Pain
- ______ in the parietal _______
- It is _____ aching pain
- More _____ than visceral
- Located over affected ______
- ______ with movement or coughing
- Patient prefers to lie ____
A
- Inflammation, peritoneum
- steady
- severe
- structure
- worse
- still
- Visceral periumbilical pain may signify acute appendicitis from distention of the inflamed appendix, which gradually changes to parietal pain in the RLQ from inflammation of the adjacent parietal peritoneum*
- Visceral pain- comes from structure in the abdomen. Peritoneum can get worse and lead to parietal pain.*
15
Q
Referred Pain
- Felt in ____ sites:
- Which are _____ at approximately the ___ spinal levesl as the disordered structure
- Develops as pain _____
- Usually _____
A
- distant
- innervated, same
- intensifies
- localized
16
Q
Referred Pain
- When a person gives a history of abdominal pain, the pains location may not necessarily be directly over the involve organ. This is because the human brain has no ___ ____ for internal organs.
- Rather, the pain is often referred to a site where the organ was located in ____ development. Although the organ ______ during fetal development, its _____ persist in referring sensations from the _____ location.
- Right shoulder/scapula: (2)
- Left scapula: ______ along with lower thoracic Back/ right flank pain: _______
A
- felt image
- fetal, migrates, nerves, former
- liver, duodenal ulcer
- Pancreatitis, Cholecystitis
17
Q
RUQ Differentials
- Acute ______, _____ colic
- Acute _____
- Perforated _____ ulcer
A
- cholecystitis, biliary
- Hepatitis
- Duodenal
18
Q
RLQ Differentials
- A_______
- Small Bowel ______
- ____ Calculi
- _______ enteritis
- Female (3)
A
- Appendicitis
- SBO
- Renal
- Mesenteric
- PID, Ectopic Pregnancy, Ovarian Torsion
19
Q
LUQ Differentials
- Acute ______
- ____ ulcer
- ____tritis
- _____ enlargement
A
- Pancreatitis
- Gastric
- Gastritis
- Splenic
20
Q
LLQ Differentials
- D______
- C______
- Bowel ______
- ____ calculi
- _____ enteritis
- Female (3)
- When a patient is describing their abdominal pain, you will start to build a differential in your mind based on the location and history of the pain*
- Mesenteric adenitis, inflammation of the mesenteric lymph nodes usually caused by viral or bacterial infection, most commonly occurs on the ____ side and can often mimic an ______, ___ is performed to eval the nodes as well as the appendix*
A
- Diverticulitis
- Constipation
- Bowel Obstruction
- Renal
- Mesenteric
- PID, Ectopic Pregnancy, Ovarian Torsion
right, appendicitis, US
21
Q
Epigastric
- _ _ D
- G____
- Abominal ____ _____
- _____ pain
A
- PUD
- GERD
- AAA
- Pancreatic
22
Q
Periumbilical
- _____enteritis
- _____citis
- ____ bowel obstruction
A
- Gastroenteritis
- Appendicitis
- Early
23
Q
Suprapubic
- Bladder _____
- C_____
- Bladder _____
- P______
A
- Bladder infetion
- Constipation
- CA
- Prostatitis
24
Q
Diffuse Pain
- Acute _______
- Mesenteric ______
- ____enteritis
- Dissecting or rupture _____
- ______ obstruction
A
- Pancreatitis
- thrombosis
- Gastroenteritis
- aneurysm
- Intestinal
25
Q
Associated Sx with Pain
(3)
A
Nausea
Vomiting
Anorexia
26
Q
Nausea
- Nausea:
- Assocaited with disorders of the ____ and ____ especially _____ gastric emptying
- _____ symptoms - perspiration, salivation, skin pallor and vagal discharge that may cause _____ and _____
- Ask about? Association with f___, m_____, stooling _____, change in ____, du____
A
- Unpleasant feeling or sensation that person will vomit
- stomach, duodenum, delayed
- Autonomic, bradycardia, hypotension
- food, medicine, pattern, diet, duration
27
Q
Nausea
- You are going to ask about how ____ you feel nauseous is it related to certain ____
- With vomiting, ask about what ____ it is, how often it occurs how much is coming up…what does it ____ like, ____ odor present with sbo or gastrocolic fistula,
- Is there _____ in it?..gastric juice is clear and mucoid, small amounts of yellow or greenish bile is common, brown or black “_____ ______” blood altered by gastric juices
- _________ associated with esophageal or gastric varices, gastritis, peptic ulcer disease (frank red)
- Ask about _____, last time urinated, color, remember that in diabetic ketoacidosis, anorexia, n/v are present, obtaining urine to assess for _______ for dehydration and _____for diabetes a good idea
A
- often, foods
- color, smell, fecal
- blood, “coffee ground”
- Hematemesis
- dehydration, ketones, glucose
28
Q
Vomiting
- Ask about association with f____, d____, s___ symptoms
- Is it the ____ symptom?
- If Emesis is B_____, F____, F_____, B_____, C_____ G_____
- Association with pain
- Pain prior to vomiting, concern for:
- Pain after vomiting: non-surgical emergency such as:
- Gastric acid with make food or milk curl and smell ___*
- Bilious emesis with the first episode is concern for ______, 2-3 hours after forceful wretching is ____*
- Food with emesis when the food was consumed 12 hours ago or longer, concern for: _________*
- ____ may come from a tear from mucosal surface or maybe a bleed from an ulcer*
- Coffee grounds _____ of blood by gastric ____*
A
- fever, diarrhea, systemic
- only
- Bilious, Food, Fecal, Blood, Coffee Ground
- Pain
- Acute Abdomen
- Acute gastroenteritis
- foul*
- obstruction, common*
- delayed gastric emptying*
- Blood*
- digestion, acid*
29
Q
Anorexia
-
Anorexia or loss of appetite is important but _____ symptom
- Seen with neo____, de____, anorexia nervosa, r____ failure, viral _____, m____, ____ diseases
- Is it related to food (e.g. ____ deficiency) or reluctance to eat because of anticipated _____
- Ask about early ____
- seen with _____
- Ask about abdominal _____
- Gastric _____ obstruction, gastric ____, _____ meds, diabetic gastro_____
- Is important but nonspecific*
- Often related to some type of food ______*
- Is it because you’re getting full very ____? Like after 2-3 bites*
- Or do you feel your abdomen is ____ or full?*
A
- nonspecifc
- neoplasm, depression, renal, hepatitis, medications, chronic
- intolerance (eg lactase), pain
- Satiety
- Hepatitis
- Fullness
- outlet, CA, anticholinergics, gastroparesis
- intolerance*
- quickly*
- distended*
30
Q
Swallowing
-
Dysphagia
- Food seems to ____ “not go down right”
- Suggests ______ disorder or ______ anomalies, can be __ or ____
- Ask about ____ of food associated with dysphagia
- Solids that progress to _____ concern for _____ cancer
A
-
Dysphagia
- stick
- motility, structural, CA or GERD
- types
- liquids, esophageal
31
Q
Swallowing
-
Odynophagia
- _____ with swallowing
- Can be medication induced from (2)
- Consider esophageal ______
- Mouth ______ can cause or they swallow something too ___
A
-
Odynophagia
- Pain
- NSAIDs or ASA
- Ulceration
- dryness, big
32
Q
Bowel Function
- Ask about f_____, c____, c___, st____, __ of constipation or diarrhea, ____ in bowel function, is it associated with abdominal ___?
- If complaining of diarrhea; ask about recent t____, f____, m____ exposure to ____, s____ symptoms
- Diarrhea- ask about presence of m____, occurs at ____, is it g___ or o___, does the stool f____
- Any blood in stool (2)
- Is the blood in stool or on the toilet paper - on paper consider ______
A
- frequency, consistency, color, straining, hx, change, pain
- travel, food, medications, ill, systemic
- mucus, night, greasy, oily, float
- Melena or Hematochezia
- hemorrhoids
33
Q
Bowel Function
- ___ color stools ____ the excretion of bile into the intestine, occur with _____
-
Acute diarrhea ___weeks, Chronic diarrhea ___weeks or more
- Acute usually ______
- Chronic usually non-infectous and is related to (2) Changes in stooling related to abdominal pain can mean ___\_
- Diarrhea with mucus can be ______cause
- Oily or frothy can mean ____ diarrheal stools known as streatorrhea, due to malabsorptions as seen in ____ disease, ______ insufficiency, small bowel _____ overgrowth
- Black tarry stool means _____ …black stool can also be from ____ supplements or use of _____
- Bright red blood in stool = _______\_
A
- Grey, lack, bile, hepatitis
- 2, 4
- infectious
- UC or Crohns, IBS
- inflammatory
- fatty, celiac, pancreatic, bacterial
- melena, iron, bismuth
- hematochezia
34
Q
Jaundice
- Extrahepatic
- ____ obstruction
- _____ cell
- Intrahepatic
- _____ hepatitis
- _____ hepatitis
- D____
- S____
- M_______
A
- Extrahepatic
- Biliary
- Sickle
- Intrahepatic
- Viral
- Alcoholic
- Drugs
- Sepsis
- Malignancy
35
Q
Jaundice
- Risk Factors for liver disease
- Hepatitis A:
- Hepatits B:
- Hepatitis C:
- ____ use
- M___
- ____ surgery or disease
- Remember other diseases besides the A, B and C can cause hepatitis, such as ___ ior in gallbladder any surgery or illness can cause ______ obstruction*
- Normal bili = ___-___ mg/dl*
- Serum bili needs to be __-___ mg/dl before jaundice is clinical 1st visible in the ____*
A
- Risk factors
- recent travel with poor sanitation
- expsoure to infectious bodily fluids
- IV drug use, blood transfusion
- Alcohol
- Meds
- Gallbladder
- EBV, extrahepatic*
- 0.1-1.2*
- 2-3, sclera*
36
Q
Urinary Tract
- Ask about difficulty _____, f_____, dy____, u____, n____, altered urinary ____, associated ____
- H_____
- K____
- Trouble with in_____
- Kidney pain can be _____ dt distention of kidney such as in acute ____ or it can be ____ with ____ of ureter from s___ or ____
A
- passing, frequency, dysuria, urgency, nocturia, stream, pain
- Hematuria
- Kidney
- Incontinence
- visceral, pyelonephritis, parietal, obstruction, stones, clots
37
Q
Incontinence
- Stress: increased abdominal _____, increases bladder pressure to exceed urethral sphincter ____, dt ___ urethral sphincter tone or poor ____ of bladder
- Urge; (_____ bladder) urgency is immediately followed involuntary ____ dt uncontrolled ____ muscle
- Overflow: n_____ disorder or _____ limits emptying until bladder is over distended
- Functional: impaired _____, m____, or mo____
A
- pressure, tone, poor, support
- overactive, leaking, detrusor
- neurologic, obstruction
- cognition, mask, mobility
42
Q
Hernias
- ____ hernias result from ____ in the abdominal wall
- Hernias are typically classified by e____ and l____
- Incisional hernias result from prior _____
- Epigastric, Umbilical, Femoral, and Inguinal are _____
A
- Ventral, defects
- etiology, location
- surgery
- spontaneous
47
Q
Auscultate Vascular Sounds
Where and What are we assessing?
A
50
Q
Percuss for Tympany/Dullness
- ______: should predominate bc ___ in intestines ___ when person is supine
- Note any large areas of ______: underlying ___ or ____ organ, _____ uterus, ovarian ____, ____ bladder, ____ liver or spleen
-
Dullness in both flanks prompts eval for?
- In a protuberant abdomen - note where abdominal _____ changes from ____ to ____ of solid posterior structures
- Obesity = scattered _____
- Ascites = ____ on both sides of the ______
A
- Tympany, air, rises
- dullness, mass, enlarged organ, pregnant, tumor, distended, enlarged
-
Ascites
- tympany, resonant to dullness
- dullness
- dullness, flanks
51
Q
Shifting Dullness with Ascites
- If you suspect ascites dt a protuberant belly - you should assess for ____ dullness
- In ascites, fluid characteristically ____ with gravity, whereas a gas filled bowel rises. Percussion gives a dull note in dependant abdomen
- To test for shifting dullness - after ____ the borders of tmpany and dullness, ask the patient to ___ to one side. Percuss and mark the borders again.
- In a person without ascites, the borders between tympany and dullness usually?
- In ascites, dullness ____ to the more ____ side, while tympany shifts to the ____.
A
- shifting
- sinks
- mapping, turn
- stay constant
- shifts, dependent, top
52
Q
Fluid Wave Test
- Fluid wave - have patient or assistant put hands down ____ of abdomen (this helps ___ transmission of wave through ____)
- ___ one flank with fingertips, feel ____ flank for an _____.
- Impulse suggests ______ - must be large
A
- midline, stops, fat
- Tap, opposite, impulse
- Ascites
53
Q
Percussion of Liver Span
- Liver span - At the ___ _____ line start in area of lung _____ and percuss ____ to change to ___ quality
- ___ spot
- Find abdominal tympany and percuss __. Mark change from tympany to ___ (or keep going down from previous mark) *s/b __-__cm midclavicular line and __-__cm midsternal line
- If span of liver dullness is increased when liver is ____ such as in (2)*
- Span of liver dullness is decreased when liver is _____ such as when there is free ___ below the diaphragm.
- Liver dullness may be displaced downward by a low diaphragm associated with _____
A
- Right midclavicular, resonance, down, dull
- Mark
- up, 6-12, 4-8
- enlarged, hepatitis, CHF*
- small, air
- COPD
54
Q
Percussion of the Spleen
- Splenic dullness or enlargement
- Often spleen is obscured by _____ contents but you may locate it by a ___ note close to the ___ base just behind the ____ mid-axillary line
- Now percuss in the lowest _____ in the in the left anterior _____ line
- You should hear tympany (over the stomach). Ask the person to take deep ____ which will make the spleen ____, if the spleen is normal ____ remains
- If you change from tympany to a dull sound on ______, this is a ___ splenic percussion sign and indicates ________
- You can detect mild-moderate splenomegaly before the spleen becomes ______, as in (3)
A
- stomach, dull, rib, left
- interspace, anxilary
- breath, rise, tympany
- inspiration, + , splenomegaly
- palpable, **mono, malaria, cirrhosis**
57
Q
Palpate Kidney for Tenderness
- Pressure from ____ or a ____ of ____ may produce tenderness due to (2)
- Use force sufficient to cause ______ but ____ jar in a normal person
- Usually performed at ___ of thoracic eval prior to have the patient supine
A
- fingertips, thrust of fist, kidney infection, musculoskeletal reason
- perceptible, painless
- end
58
Q
Normally Palpable Structures
- When palpating, a tip to remember is to keep your hand ___ as the patient takes deep _____ to see if you can feel the edge of either the ____ or ____ on your examining hand.
A
- still, inspiration, liver, spleen
59
Q
Palpate Liver
- Liver - Place your ___ hand under the person’s ____ under lower rib cafe and ___ up to support the abdominal contents.
- Place ____ hand on RUQ with fingers _____ to midline, lateral to muscle
- Push gently in and up. Then have the person take a deep ____
A
- left, back, lift
- Right, parallalel
- breath
62
Q
Palpate Liver - Hook Method
- Hooking technique - an _____ method of palpating the liver is to stand at the person’s _____ (facing their ___) and ___ your fingers under the costal margin from above
- Ask the person to take a deep _____ and assess liver edge that way
A
- alternative, shoulder, feet, hooking
- breath
63
Q
Smooth, Large Liver
- ______ may produce an ____ liver with a ___, _____ edge
- The liver is ___ ____ enlarged in this condition, however, and many other diseases may produce similar findings
- An enlarged liver with a smooth, _____ edge suggests _____ as in (3)
A
- Cirrhosis, enlarged, firm, nontender
- not always
- tender, inflammation
- Hepatitis, Venous Congestion, R-sided HF
64
Q
Irregular, Large Liver
- An enlarged that is firm or hard AND has an _____ edge or surface suggests _____. There may be one or more _____. The liver may or may not be ____.
A
- irregular, malignancy, nodules, may or may not be tender
65
Q
Palpate Spleen
-
Is the spleen normally palpable?
- Must be __ times normal size to be felt
- ___ if you can palpate it
-
How do you search for it? Whats the maneuver?
- Reach your left hand over the _____ and ____ the L side at the lower L rib cage. Lift up for support, place your R. hand obliquely on the ___ with fingers pointed toward _____and under the rib margin. Push hand deep under L costal margin and ask pt to take a deep breath. You should feel nothing firm.
A
-
NO
- 3x
- Bad
- Abdomen, behind, LUQ, axilla
75
Q
Acute Appendicitis
-
______ Point is 2” form the anterior superior iliac crest in a straight line drawn from the umbilicus - where ____ of appendix is attached to the ____ (most _____ location of pain)
- Psoas: ___ tenderness
- Rosving sign: pain felt in the ____ when the ____ is ______
- Obturator sign: pain in the pt lying ____ when internally and externally _____ the ____ hip
- ___ scan
A
- McBurney’s, base, cecum, common
- muscle
- RLQ, LLQ, palpated
- supine, rotating, flexed
- CT
76
Q
Psoas
- Place hand on ____, raise leg against _______ - pain suggests _____ of psoas muscle by inflamed appendix
A
- thigh, resistance, irritation
77
Q
Obturator
- ____ patients right thigh at hip, rotate leg ______ at hip - stretches obturator muscle
- ____ sided pain = ____ obsturator sign, suggesting irritation from inflamed appendix
A
- flex, internally
- Right, positive
78
Q
Rovsing’s Sign
- Press _____ and evenly in ___
- Quickly _____ your hand
- Pain the _____ considered positive sign
A
- deeply, LLQ
- withdrawal
- RLQ
79
Q
Cholecystitis
-
Inflammation of the _______ usually from _____ of the ____ ___ of the gallbladder
- May have history of biliary ____ pain
- S____ a____ pain in the ____ radiating to ____ or right _____
- Jarring ____ breathing ____ pain
- Associated with a_____, v_____, f_____
A
-
gallbladder, obstructing, cystic duct
- colic
- Steady aching, RUQ, back, scapula
- deep, increases
- anorexia, vomiting, fever
82
Q
Acute Pancreatitis
- _______ tenderness, ______ tenderness, abdomen ____
- Pain radiates to the _____
- Severe d____, c_____ pain
- Worse when _____ better with ____ or ___ position
- Associated with _/_
- Associated with _____ intake, _____ attack, ____ meal
- Abdominal _____, _ _ _ and ____ tenderness
- ____ murphy’s sign
- Can be associated with f_____, j_______
A
- Epigastric, rebound, soft
- back
- dull, constant
- supine, sitting, fetal
- n/v
- alcohol, previous, heavy
- distention, LUQ, epigastric
- Negative
- fever, jaundice
- In many but not all cases, the abdomen is soft - pts are usually in SEVERE dull/constant pain*
- The pain of pancreatitis is classivly relieved by sitting up and leaning forward*
83
Q
Acute Diverticulitis
- Usually involves s____ c____
- Resembles a left sided ______
- Pain is:
- Chang in ____ habits
- Abdominal ______, B_____
- F___, _/_
- Hx of D________
- Acute diverticulitis
- Less commonly, abdominal pain that may be mild at first and become worse over several days, possibly fluctuating in intesnity
- History of diverticulosis =
- Differential includes _____ adenitis along with _____ cyst for women
A
- sigmoid colon
- appendicitis
- sudden, severe and often located in lower left side
- bowel
- distention, bloating
- Fever, n/v
- Diverticulosis
- outpouching of large colon
- mesenteric adenitis, ovarian cyst
