Abdomen/Rectal/Prostate Exam Flashcards
1
Q
Organs in the RUQ (6)
A
liver GB Pylorus Duodenum Hepatic flexure of colon Head of pancreas
2
Q
Organs in LUQ (5)
A
Spleen Splenic flexure of colon stomach body and tail of pancreas transverse colon
3
Q
Organs in LLQ (3)
A
Sigmoid colon
descending colon
left ovary
4
Q
Organs in the RLQ (4)
A
Cecum
Appendix
Ascending colon
right ovary
5
Q
are the GB and duodenum generally palpated?
A
no
6
Q
abdominal aorta is usually palpable in which quadrant?
A
upper quadrants or EIPgastrum
7
Q
spleen’s position to the stomach
A
later to and behind stomach
8
Q
upper margin of spleen lies against?
A
diaphragm
9
Q
a distended bladder may be palpable above the ?
A
symphysis pubis
10
Q
cramping + colicky pain can suggest?
A
renal stones
11
Q
sudden, knife like epigastric pain that radiates to the back suggests?
A
pancreatitis
12
Q
visceral pain in the RUQ suggests?
A
liver distention against its capsule from the various causes of hepatitis,
13
Q
list the DDs for epigastric pain (3)
A
GERD
Pancreatitis
Perf ulcers
14
Q
List the DDs for RUQ pain (2)
A
cholecystitis
choleangitis
15
Q
will asking about severity of pain helpful in IDing the cause?
A
not as helpful
16
Q
Acute RLQ pain DDs? (3)
A
appendicitis
PID
Ectopic pregnancy
17
Q
Acute LLQ pain DDs? (3)
A
Diverticulitis
bowel obstruction
peritonitis
18
Q
List some Dz’s that cause chronic pain
A
IBS
Colon CA
19
Q
intermittent pain, change in bowel habits and/or change in stool (pellet like) suggests?
A
IBS
20
Q
Describe physical exam findings for IBS
A
- intermittent pain,
- change in bowel habits and/or change in stool (pellet like)
21
Q
change in bowel habits + mass lesion warns of?
A
colon CA
22
Q
visceral pericumbilical pain suggests?
A
early acute appendicitis
23
Q
visceral pericumbilical pain that later, pain moves to parietal pain in the RLQ suggests
A
appendicitis
24
Q
pain disproportionate to PA findings suggests?
A
intestinal mesenteric ischemia
25
describe visceral pain
when hollow organs contract forcefully or distend/stretch
or
solid organs w/ capsule or liver
Difficult to localize:
- gnawing
- burning
- aching
26
Described as difficult to localize pain
- gnawing
- burning
- aching
which pain?
visceral pain
27
describe parietal pain
originates from inflammation of the parietal peritoneum
-easier to localize, pain is usually worse than visceral and worse with movement
steady, aching pain
aggravated by moving or coughing
28
PT trying to move around--attempting to find a comfortable position suggests?
renal stones with peritonitis
29
ischemia causes which kind of pain
visceral pain
30
descr referred pain
felt more in distal sites
caused by which nerve fibers are at the same level of the structures
usually localized
31
pain of duodenal or pancreatic origin can refer to what areas?
back
biliary tree
right scapular region
right posterior thorax
32
pain from pleurisy or inferior wall MI can refer to?
epigastric area
33
define dyspepsia
chronic or recurrent discomfort
or
PAIN in the upper abdomen, characterized by postprandial fullness, early satiety, epigastric pain/burning
34
Define discomfort
subjective
negative feeling that is not painful
-can include symps: bloating, nausea, upper abdominal fullness, heartburn
35
list two Dz where bloating can ocur
lactose intolerance
ovarian CA
aerophagia
IBS
36
sudden knife like epigasric pain often radiating to the back is typical of?
pancreatitis
37
define aerophagia
swallowing air-- can lead to bloating
38
Functional Dyspepsia define
3 MO hx of non-specific upper GI discomfort or nausea not attributable to structural abnormalities or PUD
39
diagnostic criteria for GERD
patient reporting heartburn and regurgitation TOGETHER for over 1 week..... 90% likely its gerd
40
Heartburn define
rising retrosternal burning pain/discomfort occurring weekly or more
41
heartburn can be a sign of?
Myocardial ischemia
42
non-GI signs
hoarseness
coughing
wheezing
GERD
43
dysphagia define
difficulty swallowing from impaired passage of solid foods or liquids from mouth to stomach
"i feel that food is getting stuck when i swallow"
44
dysphagia to solid food-- list DZs
structural causes like stricture, webbing or neoplasm
45
Dysphagia to liquids list causes
motility disorder such as achalasia
46
Define globus sensation
FB/lump sensation in throat
| unrelated to swallowing
47
Define odynophagia and list causes
pain with swallowing
| causes: esophageal ulceration
48
list alarming symptoms that can present with odynophagia
wt loss
GI bleeding
palpable mass
49
difference b/w retching and vomiting
retching: involuntary spasm of stomach, dia and esophagus that LEADS to vomiting
vomiting: forceful expulsion of gastric contents out of the mouth
50
regurgitation define
raise of esophageal/gastric conents w/o nausea/retching
51
hematemesis define
| *causes
coffee ground emesis or red blood
| causes: esophageal/gastric varices, Mallory-Weise tears or PUD
52
anorexia define
loss of appetite
* fear of abdominal discomfort "food fear"
* self-image/body distortions or appendicitis
53
timing for acute diarrhea
can last up to 2 weeks
54
timing for chronic diarrhea
| *causes
4 weeks or longer
| *non-infectious like CD or UC
55
high volume and frequent watery stools likely coming from what part of colon
small intestine
56
steatorrhea
| causes
fatty diarrheal stools from malabsoprtion
* oily residue + frothy + floating
* celiacl sprue, pancreatic insufficiency
57
tenesmus define
constant urge to defecate accompanied by pain, cramping, and involuntary straining
58
small volume stools + tenesmus =?
rectcal inflammatory conditions
59
pus/mucous/blood in stool occur in?
rectal inflammatory conditions
60
causes of tenesmus
recent use of ABX
recent hospitalization
recent travel
new diet
61
timing for constipation
3 months
with symptoms onset at least 6 months prior to diagnosis PLUS 2 of the following:
1. fewer than 3 BM/week
2. 25% or more BM associated with straining/sensation of incomplete evacuation/hard stool
3. manual facilitation
62
melena vs hematochezia
melena--upper GI bleed, black and tarry
| hematochezia--lower GI bleed (rectal, colon anus), bright red stool
63
blood on surface or toilet paper points to
hemorrhoids
64
primary vs secondary contipation
primary: normal transit, slow transit, impaired expulsion
secondary: pregnancy, adv age, medications, underlying med condition
65
define obstipation
no passage of either feces or gas
66
cause of obstipation
intestinal obstruction
67
jaundice can signify issues with what organs
liver
GB
pancreas
68
acholic stool
MC w/?
other causes
stool without bile-->gray, light colored stoools
MC in obstrcutive jaundice
causes: ETOH, hep A, Hep B, Hep C, liver damage secondary to medications
69
what are caput medusae and what is the cause
dilated veins
| *from portal HTN from cirrhosis
70
asymmetry on exam can suggest
hernia
enlarged organ
mass
71
do you asucultate before or after percuss/palpate
AUSCULTATE BEFORE
72
vascular sounds like heart murmur
bruits
73
grating sound corresponding to respirations
friction rub
74
continuous soft humming noise
venous hum
75
incr bowel sounds suggest
diarrhea
76
decr bowel sounds suggest
ileus
| peritonitis
77
bruit in epigastric/renal artery suggests?
htn caused by renal artery stenosis
78
friction rubs are present in?
Hepatoma
Gonococcal infection around liver
splenic infarction
pancreatic CA
79
venous hum is heard in PTs with?
hepatic cirrhosis
80
tympany vs dull
tympany: hollow drum sound---AIR FILLED (GI tract, gas
Dull: heard over solid structures, or if fluid is beneath
81
what is castell's sign
splenic percussion sign---lowest interspace on the left anterior axillary line
**should be tympanic
82
is castell's sign tympanic or dull
tympanic
83
why do we palpate abdomen
to check for tenderness, guarding or masses
84
guarding can decrease if patient inhales or exhales
exhales----- bc the muscles are relaxed
85
signs of peritonitits-- (4)
1. coughing causes pain
2. guarding
3. rigidity
4. rebound tenderness
86
with rebound tenderness, what hurts more.. pushing down or letting go?
letting go
87
define guarding
VOLNTARY contractions of abdominal wall
88
define rigidity
INVOL contraction of abdominal wall that persists over a few exams
89
why does liver go down when PT takes a deep breath
bc liver is attached to the underside of dia---
90
STEPS TO PALPATE LIVER:
1. place ___(R/L) hand ____ (above/below) patient and press ____ (down/upward)
2. ___(R/L) hand on abdomen ___(below/above) border of ____(dullness/tympany)
3. gently push ___ (up/down) and in with the ___(R/L) hand as patient takes deep breath (in/out)
1. place left hand under patient (11th and 12th rib) and press upward
2. Right hand on abdomen below lower border of dullness
3. gently push up and in with the right hand as patients takes a deep breath in
91
when do we use the hooking technique?
to palpate the liver in obese PT
92
at what age do we palpate the aorta
>50
93
normal width of aorta
no more than 3 cm wide
94
list the special techniques
CVA tenderness
Test for ascites
Appendicitis test
Cholecystitis test
95
+CVA tenderness?
pylonephritis
96
testing for ascites-- what will a + exam result look like
WILL BE a shift in dullness (move to dependent side) and tympany shifts to top
97
McBurney Point
junction of the middle and outer thirds of the line joining the umbilicus to the anterior superior illiac spine
98
Appendicitis is __times more likely when what is tender?
there is McBurney point tenderness
99
List the appendicitis tests
ROvsing sign
Psoas sign
Obturator sign
100
Rovsing sign
worsening RLQ pain with palpation to LLQ
AND
can check if referred rebound tenderness in the LLQ
101
Psoas Sign
worsening abdominal pain with right left extension at hip when patient is lying on their side
OR
place hand above the PT's right knee, ask PT to raise thigh against hand
PAIN= + test
102
Obturator sign
RLQ pain on internal rotation of flexed right hip
* lower leg swings outward
* ***not as reliable
103
test for cholecytitis?
Murphy test
104
typical patient demographic for cholecystitis
Fat
Female
Forty
Fertile
105
non-tender RUQ pain perform what test
murphy test to chest GB
106
how to perform Murphy test
- deeply palpate the RUQ at location of pain
- ask PT to take deep breath in (forces GB and liver down toward fingers)
- sharp halting in inspiratory effort due to pain from palpation of the GB on exam----POSITIVE MURPHY SIGN
107
+ murphy sign _____ likelihood of ____
triples likelihood for acute cholecystitis
108
prostate gland location
anterior rectal wall
below bladder
infront of rectum
109
normal length of prostate
2.5 cm
110
pencil thin stools?
colon CA
111
pain on defication, itching, bleeding/discharge from infection or rectcal abscess suggests?
proctitis
112
rectal intching in peds suggest?
pinworms
113
difficulty starting/stopping urine stream
and/or
frequency at night
benign prostate hypertrophy (BPH)
or
prostate CA
ESP >70 male
114
men: sudden onset of UTI symptoms with perineal and low back pain, malaise and fever chills
acute prostatitis
115
when is the DRE performed?
* when dz is suspected or already IDed
| * screening when there is no suspicion or expectation of DZ
116
patient positioning for rectal exam
PT laying on L side with knee/hip flexed
| *ask PT to beardown and then insert as the sphincter relaxes
117
tender purulent reddened mass with fever
anal abscess
118
abscesses that funnel from anus/rectum to surface of skin may form?
fistula
119
ooze blood, pus or feculent mucus can suggest?
fistula
120
laxity in sphincter tone could suggest?
neurologic dz (S2-S4 cord lesions)
121
normal prostate feels?
rubbery and non-tender
122
rotate fingers in what direction (towards PTs __ side) and then in what direction after?
FIRST rotate clockwise (PTs right) and then counterclockqise (to their left)
123
small tuft of hair surrounded by halo of erythema ?
Pilonidal cyst
124
list some abnormalities of rectum
external hemorrhoid
internal hem
prolapse of rectum
125
Abdomen is protuberant with active bowel sounds. It is soft and nontender; no palpable masses or hepatosplenomegaly. Liver span is 7 cm in the right midclavicular line; edge is smooth and palpable 1 cm below the right costal margin. Spleen and kidneys not felt. No costovertebral angle (CVA) tenderness.”
**what is this?
normal
126
Abdomen is flat. No bowel sounds heard. It is firm and board like, with increased tenderness, guarding, and rebound in the right mid-quadrant. Liver percusses to 7 cm in the midclavicular line; edge not felt. Spleen and kidneys not felt. No palpable masses. No CVA tenderness
**what is this suggestive of?
appendicitis poss peritonitis
127
No perirectal lesions or fissures. External sphincter tone intact. Rectal vault without masses. Prostate smooth and nontender with palpable median sulcus. (Or if female, uterine cervix nontender.) Stool brown; no fecal blood
*what is this?
normal
128
Perirectal area inflamed; no ulcerations, warts, or discharge. Unable to examine external sphincter, rectal vault, or prostate because of spasm of external sphincter and marked inflammation and tenderness of anal canal
prostitis
129
No perirectal lesions or fissures. External sphincter tone intact. Rectal vault without masses. Left lateral prostate lobe with 1 × 1 cm firm, hard nodule; right lateral lobe smooth; median sulcus obscured. Stool brown; no fecal blood
prostate CA
130
how is hep a transmitted
```
fecal-oral
poor handwashing
international travel
sick contacts
MSM
homelessness
illicit drug use
shellfish
```
131
how is hep c transmitted
percutaneous exposures--needle sticks, IV drug users, blood transfusions b4 1992
132
how is hep B transmitted
sexual contacts, percutaneous, parenteral and perinatal
133
how to reduce tranmission for hep A
advice hand washing
| clean surfaces with diluted bleach
134
when does CDC reccommend Hep A vaccination? (7)
>1
indv with chronic liver disease
groups at incrs risk--travelers, MSM, IV drug users, ppl who work with non human primates, ppl with clotting disorder
135
a healthy PT is exposed to Hep A.. what is the next step
1. Hep A vaccine
OR
2. single dose of immune globulin (>40) within 2 weeks of exposure
136
Immunocomp PT or Chronic liver Dz PT exposed to Hep A.. what to do next
HAV AND HAV immunoglobulin within 2 weeks of exposure
137
who is at risk for getting Hep B (6)
* born in countries with high endemic HBV infections
* person with HIV
* IV drug user
* MSM
* household contacts or sexual partners have HBV
* any kind of HC worker
138
which PT population ALWAYS gets Hep B screening
Pregnant--first tri
139
CDC reccomendations for Hep B vaccination (5)
1. having sex with someone who has HBV, or person with many sexual partners
2. ppl with percutanoues or mucosal exposure to blood
3. travelers to endemic regions
4. chornic liver dz
5. HIV, correctional facilities,
140
Hep B scheduling for babies
birth
1-2 MO
6-18MO
141
Hep B scheduling for an adult w.o prior Hep B vaccine
3 doses total: 0, 1, 6 MO
142
Hep C becomes chronic illness in ___% of patients
75%
143
is there a vaccine for Hep C?
NO
144
prevention against Hep C?
avoic percutaneous exposures, blood exposures
145
who screening for Hep C?
high risk groups
all pregnant women (1st tri)
screen all adults 18-79 for chronic HCV infection
146
major RF for Hep C (3)
cirrhosis
hepatic CA
liver failure
147
RLQ pain or pain that migrates from the periumbilical region + abdominal wall rigidity on palpation
MC suggests?
-what also could it be suggestive of in a woman PT
appendicitis
WOMAN: PID, ruptured ovarian cyst, ectopic preg
148
cramping pain radiating to the right or LLQ or groin
renal stone
149
LLQ pain
| +palpable mass
diverticulitis
150
diffuse abdominal pain with abdominal distention, hyperactive high pitched bowel sounds and tenderness on palpation
small or large bowel obstruction
151
pain with absent bowel sounds, rigidity, percussion tenderness and guarding
peritonitis
152
```
intermittent pain for 12 weeks
with relief from defecation
change in frequency of BMs
or
change in form of stool (loose, watery, pellet)
```
IBS
153
Regurgitation occurs with? (3)
GERD
esophageal stricture
esophageal CA
154
vomiting + pain can indicate?
SBO
155
fecal odor occurs with?
SBO and gastrocolic fistula
156
Hematemesis can occur with (3)
esophageal or gastric varices, Mallory-Weiss tears or PUD
157
abdominal pain, slight distended soft nontender abdomen and a fear of eating food bc it will hurt?
hallmark of mesenteric ischemia
158
fullness or early satiety (5)
```
diabetic gastroparesis
antichoinergic meds
gastric outlet obstruction
gastric CA
hepatits
```
159
drooling, nasopharyngeal regurgitation, cough from aspiration are indicators of?
oropharyngeal dysphagia
160
gurgling or regurgitation of undisgested food occurs in? (3)
GERD
motility disrodres
structural disroders (Zenkers diverticulum and esoph stricture)
161
PT points to where dysphagia occurs: below the sternoclavicular notch suggets?
Esophageal dysphagia
162
if solid food dysphagia consider?
structural causes: esoph stricutre, webing or Schatzki ring, neoplasm
163
if dysphagia to solid and liquid consider?
motility disorder like achalasia
164
flatus
causes?
define?
excessive gas
* aerophagia
* legumes
* intestinal lactase deficiency
* IBS
165
acute diarrhea MCC?
infectious
166
high volume, frequent and watery stools are coming from where in the colon?
small intestine
167
small volume stools with tenesmus
or
diarrhea with mucus pus or blood occur in?
rectal inflammatory conditions
168
diarrhea is comon with which drugs (4)
PNCs
macrolides
magnesium antacids
metformin
169
patient recently hospitalized + diarrhea.. consider what?
C Diff
170
list secondary caues of constipation (3)
amyloidosis
DM
CNS disorders
171
drugs tht cause constipation (4)
| dz that cause it? (6)
anticholinergics
ccb
iron
opiates
```
dm
hypothyroidism
hypercalciemia
MS
PD
systemic sclerosis
```
172
ostipation signifies?
obstruction
173
drugs that cause cholestasis (3)
OCPs
methyl testosterone
chlorpromazine
174
dark urine indicates?
impaired excretion of bilirubin into the GI tract
175
painless jaundice
malignant obstruction of bile ducts
176
painful jaundice
infectious in origin--hepatitis A and cholangitis
177
acholic stools
viral hep
| obstrucitve jaundice***
178
pink tinged urine
myoglobin from rhabdo
179
protuberant abdomen that is tympanic thorughout suggests?
intestinal obstruction or paralytic ilius
180
dull areas on abdomen characterize?
pregnant uterus
ovarian tumor
distended bladder
large liver or spleen
181
dullness in both flanks suggests
ascities
182
air bubble on the right... liver dullness on left suggests?
sinus inversus
183
liver dullness is displaced downward by the low diaphragm if PT has what dz
COPD
| *span stays normal
184
what can falsely increase liver size
dullness from a right pleural eff or consolidated lung if adjacent to the liver
185
what is a positive splenic percussion sign
change in percussion note from tympany to dullness on inspiration
186
causes of splenomegaly
portal HTN
hematologic malignancies
HIV
infiltrative dz--amyloidosis, splenic infarct or hematoma
187
enlarged left flank mass can be?
splenomegaly or an enlarged left kidney
188
palpating spleen area: palpable notch on medial border, the edge extends beyond the midline, percussion is dull and fingers can probe deep to the medial and lateral borders but not between the left flank mass and costal margin
splenomegaly
189
tympany in the LUQ + probe fingers b/w the mass and costal margin suggest
enlarged kidney
190
RF for AAA
>65
smoking
male
first degree relative with hx of AAA
191
RUQ pain
| -sharp increase in tenderness with inspiratory effort is a + ______ sign?
+ murphys sign
192
timing of GERD?
agrivating factors?
location of discomfrt
after meals esp spicy food
-lying down, bending over, exercise,
chest or epigastric
193
pain is whre for PUD
| +radiation to?
epigastric
| can radiatie to the baack
194
which ulcer is more likely to wake the PT in the night?
duodenal ulcer
195
which ulcer is more liley to occur intermittently over a few weeks and then disappers for months and then reappears
duodenal
196
persistent abdominal pain--slowly progressive--
Gastric carcinoma
197
pain in gastric carcinoma or PUD is shorter
gastric carcinoma
198
if pain subsides temporarily with acute appendiits.. what do you want to suspect?
perforation
199
where is the pain for small bowel obstruction vs large bowel obstruc
SBOO: periumbilical or upper abdom
LBO: lower abdmoinal or generlzed
200
time for acute diarrhea
<14 days
201
chronic diarrhea time
>30 days
202
dz that cause melena (3)
BLACK TARRY STOOL
- GERD
- gastritis
- PUD
203
dz that cause hematochezia
BRIGHT RED BLOOD
- colon CA
- hyperplasia or adenomatous polyps
- diverticula of colon
- UC
- CD
- infectious diarr
- proctitis
- ischemic colitits
- hemorrhoids
- anal fissure
204
MCC of protuberant abdomen
fat
205
bulging flanks?
ascities
206
venous hum has both?
diastolic and systolic components
207
venous hum indicates
hepatic cirrhosis
