Abdomen Trans part 1 Flashcards

1
Q

Solid viscera

A
Liver
Spleen
Kidneys
Pancreas 
Ovaries
Uterus
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2
Q

The principal mechanical signal to which visceral nocireceptors are sensitive

A

Stretch

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3
Q

Example of mechanoreceptors stimulation

From rapid distention of hallow viscus

A

Intestinal obstruction

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4
Q

Example of mechanoreceptors stimulation

Forceful muscular contraction

A

Biliary or renal colic

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5
Q

Example of mechanoreceptors stimulation

Rapid stretching of solid organs serosa or capsule

A

Hepatic congestion

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6
Q

Example of mechanoreceptors stimulation

Torsion of mesentery

A

Cecal volvolus

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7
Q

Example of mechanoreceptors stimulation

Tension from traction on the messentery or mesenteric vessels

A

Retroperitoneal or pancreatic tumor

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8
Q

Chemical receptor are directly activated by substance

A
H+
K+
Histamine
Serotonin
Substance P
Bradykinin
Vasoactive amines
Calcitonin
Related peptides
Prostaglandin
Leukotrines
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9
Q

Classification of abdominal pain

A

Visceral pain
Somatoparietal pain
Referred pain

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10
Q

Not localized pain

A

Visceral pain

Because most viscera is multi segmental and low nerve endings

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11
Q

Visceral pain is generally described as

A

Cramping
Burning
Gnawing
Aching

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12
Q

Visceral pain

Secondary autonomic effects such as

A
Sweating
Restlessness
Nausea
Vomiting
Perspiration
Pallor
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13
Q

Visceral pain

To relieve the pain

A

Patient move about in an effort

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14
Q

More intense and more precisely localized

A

Somatoparietal pain

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15
Q

Somatoparietal pain

Dermatomes corresponds

A

T6 to L1 region

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16
Q

Somatoparietal pain

Usually aggravated by

A

Movement and coughing

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17
Q

Somatoparietal pain

Palpation over the area is

A

Extremely painful

Patient lies as still as possible

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18
Q

Somatoparietal pain

Overlying abdominal muscles contraction

A

Rebound tenderness

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19
Q

Felt in areas remote to the diseased organ

A

Referred pain

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20
Q

Referred pain

Result of convergence of what neurons

A

Visceral afferent neurons with
Somatic afferent neurons on
2nd order neurons in the spinal cord

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21
Q

Referred pain

Maybe felt in skin or deeper tissues but is usually

A

Well localized

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22
Q

Referred pain

Appears as the noxious visceral stimulus becomes

A

More intense

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23
Q

Most important part of evaluation of a patient with abdominal pain

A

History

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24
Q

Temporal considerations in the evaluation of a patient with acute abdominal pain include the rapidity of onset and the progression and duration of symptoms

A

Chronology

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25
Q

Measure its significance

Pain that is sudden in onset, severe and well localized.

A

Rapidity of onset of pain

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26
Q

Rapidity of onset of pain

Likely to be the result of an intra abdominal catastrophic events such as

A

Perforated viscus
Mesenteric infarction
Ruptured aneurysm

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27
Q

Example of self limited pain

A

Gastroenteritis

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28
Q

Example of progressive

A

Appendicitis

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29
Q

Colicky pain has crescendo-decrescendo patterns that may be diagnostic as in

A

Renal colic

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30
Q

Patient who seek evaluation of abdominal pain that has been present for an extended period are less likely to have an acutely threatening illness than those who do so within hours to days

A

Duration

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31
Q

Pain of less than 24 hours

Not always mandate surgical intervention

A

Acute abdominal pain

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32
Q

Pain present for at least 6 months

Divided into diagnosable and undiagnosable

A

Chronic abdominal pain

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33
Q

Changes in location may represent

Progression from visceral to parietal irritation as in

A

Appendicitis

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34
Q

Changes in location may represent

Represent the development of diffuse peritoneal irritation, as with

A

Perforated viscus

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35
Q

The point of reference varies among individuals depends on

A

Setting in which pain is occuring
Past experienced with various types of pain
Personality
Culture

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36
Q

Intensity and character

Severity of pain is loosely related to the magnitude of the

A

Noxious stimuli

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37
Q

Fatty food development of

A

Biliary colic

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38
Q

Pain with duodenal ulcer is alleviated by

A

Meals

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39
Q

Patients with gastric ulcer or chronic mesenteric may report exacerbation of pain with

A

Eating

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40
Q

History considered

A

Associated symptoms and review of symptoms

Information regarding changes in digestive functions

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41
Q

Vomitus clear suggest

A

Gastric outlet obstruction

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42
Q

Vomitus feculent suggest

A

More distal small bowel or colonic obstruction

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43
Q

Patients with a history of these are likely to have recurrences

A

Partial small bowel obstruction
Renal calculi
PID

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44
Q

Systemic illnesses such as ________________ often have abdominal pain as manifestation of their illness

A
Scleroderma
Lupus
Nephritic syndrome
Porphyria
Sickle cell disease
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45
Q

Social and family history

A
Familial disease
Substance abuse
Occupation
Travel to other place
Contact to animals or ill people
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46
Q

Location of the pain suggest

A

Organ involved

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47
Q

Pain that is vagued in onset but steadily worsened overtime suggest a

A

Progressive advancing obstructive lesion or mass effect

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48
Q

Intermittent pain with period of free pain suggest

A

Painful smooth muscle contraction
Dynamic obstruction
Recurrent inflammation
Relapsing infection

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49
Q

Patient with an organic cause for abdominal pain is

A

Generally not hungry

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50
Q

Ask patient to finger point the pain

A

Kapag direct na tinuro significant

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51
Q

The farther from the navel the pain, the more likely it will be organic in origin

A

Apley rule

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52
Q

Patients with non specific abdominal pain keep their

A

Eyes closed during palpation

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53
Q

Patient with organic disease usually keep their

A

Eyes open

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54
Q

Sensation of sticking or obstruction of passage of food through the mouth, pharynx or esophagus

A

Dysphagia

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55
Q

Complete esophageal obstruction which is usually due to bolus impaction and represents a medical emergency

A

Aphagia

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56
Q

Painful swallowing

A

Odynophagia

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57
Q

Is the sensation of a lump lodged in the throat

A

Globus pharyngeus

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58
Q

Fear of swallowing

A

Phagophobia

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59
Q

Sensation of food being hindered in its passage

Food sticks, hang up or that food just won’t go down

A

Dysphagia

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60
Q

Normally orophanyngeal swallowing, peristalsis of esophagus to stomach occurs within

A

10 seconds

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61
Q

Distinct type of Dysphagia

Abnormalities of neuromascular mechanism of pharynx and upper esophageal sphincter

A

Orophanyngeal Dysphagia

62
Q

Distinct type of Dysphagia

Disorders that affect the esophageal body

A

Esophageal Dysphagia

63
Q

Common cause of orophanyngeal Dysphagia

A

Neuromuscular
Mechanical obstruction
Skeletal muscle disorders
Miscellaneous

64
Q

Common cause of esophageal Dysphagia

A

Mechanical obstruction
Motility disorders
Miscellaneous

65
Q

Orophanyngeal Dysphagia

Neuromuscular diseases that affect the

A

Hydropharynx and upper esophagus

66
Q

Orophanyngeal Dysphagia

Coughing episode during a meal indicate

A

Concomitant tracheobronchial aspiration

67
Q

Orophanyngeal Dysphagia

Swallowing associated with a gargling noise may suggest

A

Zenker diverticulum

68
Q

Food stops of sticks after swallowed

Difficulty in transporting the food down the esophagus

A

Esophageal Dysphagia

69
Q

Esophageal Dysphagia

Due to

A

Motility disorder

Mechanical obstruction

70
Q

Esophageal Dysphagia

Sensation of food hanging up somewhere behind the

A

Sternum

71
Q

Esophageal Dysphagia

Types

A

Motility disorder

Mechanical obstruction of esophagus

72
Q

Esophageal Dysphagia

Dysphagia with both solid and liquids

A

Motility disorder

73
Q

Esophageal Dysphagia

Motility disorder. Frequently can be relieve by various manuevers like

A

Repeated swallowing
Raising the arm over the head
Throwing the shoulders back
Valsalva manuever

74
Q

Esophageal Dysphagia

Motility disorder
Associated symptoms

With bland regurgitation of undigested food especially at night
Weight loss

A

Achalasia

75
Q

Esophageal Dysphagia

Motility disorder
Associated symptoms

With chest pain
With sensitivity to either hot or cold liquids

A

Spastic motility disorder

76
Q

Esophageal Dysphagia

Motility disorder
Associated symptoms

With raynaulds phenomenon and sever heart burn

A

Scleroderma of esophagus

77
Q

Esophageal Dysphagia

Dysphagia after swallowing solid foods and never with liquid alone, except in high grade luminal obstruction
If food impaction develops > regurgitate for relief

A

Mechanical obstruction of esophagus

78
Q

Esophageal Dysphagia

Mechanical obstruction of esophagus

Associated with

Episodic or non progressive dysphagia
Without weight loss
Hurried meal after with alcohol

A

Esophageal web or distal esophageal ring (schatzki ring)

79
Q

Esophageal web or distal esophageal ring (schatzki ring)

Bolus of food that sticks up can be passed by

A

Drinking large quantities of liquids

80
Q

Esophageal web or distal esophageal ring (schatzki ring)

Can finish meal without difficulty.
Offending food is a piece of bread or steak

A

Steakhouse syndrome

81
Q

Esophageal web or distal esophageal ring (schatzki ring)

Daily Dysphagia is

A

Unusual

82
Q

Solid food Dysphagia is progressive

A

Peptic esophageal stricture and carcinoma

83
Q

Dysphagia associated symptoms

A

Odynophagia
Weight loss
Vomiting
Coughing or regurgitation

84
Q

Classic manifestation of gastroesophageal reflux

A

Heart burn (pyrosis)

85
Q

Heart burn (pyrosis)

Burning discomfort behind then

A

Breast bone

86
Q

Heart burn (pyrosis)

Often begins ______ and radiates up to the entire _______ to the neck; occasionally to the _____ and rarely to the arm

A

Inferiorly
Restrosternal area
Back

87
Q

Heart burn (pyrosis)

Patient usually signifies the relationship with the open hand moving from

A

Epigastric to the neck or throat

88
Q

Heart burn (pyrosis)

May have ______ and ______ in the mouth

A

Bitter acidic

Salty fluid

89
Q

Heart burn (pyrosis)

Regurgitation should be distinguished from vomiting. The absence of nausea,retching and abdominal contractions suggest

A

Regurgitation

90
Q

Sudden filling of mouth with clear, slightly salty fluid, not regurgitated but secretions from salivary glands as part, vagus mediated reflex from distal esophagus

A

Water Brash

91
Q

Water brash aggravated by multiple factors

A

Food and drugs
Manuevers( bending over, straining at stool)
Cigarettes

92
Q

Lump or tightness in the throat unrelated to swallowing

A

Globus sensation or globus pharyngeus

93
Q

Globus sensation or globus pharyngeus

Described

A

Lump
Tightness
Choking
Strangling

94
Q

Globus sensation or globus pharyngeus

It is present in

A

Between meals

95
Q

Globus sensation or globus pharyngeus

May give temporarily relief

A

Swallowing of solids or large liquids boluses

96
Q

Globus sensation or globus pharyngeus

Absent

A

Dysphagia

Odynophagia

97
Q

Globus sensation or globus pharyngeus

Worsen by

A

Frequent dry swallowing

Emotional stress

98
Q

Globus sensation or globus pharyngeus

Psychological factors may be important genesis such as

A
Anxiety 
Panic disorder
Hypochondriac 
Somatization
Introversion
99
Q

Subjective feeling of a need to vomit

A

Nausea

100
Q

Oral expulsion of upper gastrointestinal contents resulting from contractions of gut and thoracoqbdominal wall musculature

A

Vomiting (emesis)

101
Q

Effortless passage of gastric contents into the mouth

A

Regurgitation

102
Q

Repeated regurgitation of stomach contents which are often re-chewed and swallowed

A

Rumentation

103
Q

Components of vomiting

A

Nausea
Fetching
Emesis

104
Q

Emetic stimuli cause vomiting by

A

Activating afferent vagal stimuli or sympathetic pathway

Indirectly by stimulating chemoreceptors trigger zone

105
Q

Vomiting of blood

Indicates upper GI site of bleeding, almost always proximal to ligament of Treits,

A

Hematemesis

106
Q

Blood may be either fresh, bright red or coffee ground

A

Hematemesis

107
Q

Passage of black, tarry, foul-smelling stools

A

Melena

108
Q

Melena confused with greenish character of

A

Ingested iron

109
Q

Can be see in both UGIB and LGIB

Loss of atleast 60ml of blood

A

Melena

110
Q

Melena

Black tarry

A

Due to degradation of blood to hematin

111
Q

Passage of bright red blood from the rectum that may or may not be mixed with stool

A

Hematochezia

112
Q

Hematochezia

Usually from

A

Lower GI bleeding

Massive upper GI bleeding (1L lost)

113
Q

Bleeding that is not apparent to the patient
Result from small amounts of GI bleeding
No change in color of the stool

A

Occult GI bleeding

114
Q

Occult GI bleeding

Positive for

A

Guaic’s test

115
Q

Can be occult or obscure
Manifest as hematemesis, melena or Hematochezia
It difficult to pinpoint on routine examination ( as endoscopy )

A

Bleeding of obscure origin

116
Q

Common cause of acute upper GI bleeding

A

Gastric ulcer
Duodenal ulcer
Esophageal varices
Mallory Weiss tear

117
Q

Rare causes of acute upper GI bleeding

A
Esophageal ulcer
Erosive duodenitis
Antroenteric fistula
Hemobilia
Pancreatic source
Crohn's disease
No lesion identified
118
Q

Common cause of acute lower GI bleeding

A

Diverticula

Vascular ectasia

119
Q

Rare cause of acute lower GI bleeding

A

Dieulafoy’s lesion
Colonic ulceration
Varices

120
Q

Take note, kung wala sa common at rare it means na nasa uncommon or less common.

A

:)

121
Q

Causes of nausea and vomiting

Intra peritoneal

A
Obstructing disorders
Enteric infections
Inflammatory disease
Impaired motor function
Biliary colic
122
Q

Causes of nausea and vomiting

Extra peritoneal

A
Cardiopulmonary disease
Labyrinthine disease
Intra cerebral disorders
Psychiatric illness
Postoperative vomiting
Cyclic vomiting syndrome
123
Q

Comparison of common causes of acute abdominal pain

Onset

Gradual

A
Appendicitis
Diverticulitis
Small bowel obstruction
Gastroenteritis
PID
124
Q

Comparison of common causes of acute abdominal pain

Onset

Sudden

A

Perforated pelvic ulcer
Mesenteric ischemia infarction
Ruptured abdominal aortic aneurysm
Ruptured ectopic pregnancy

125
Q

Comparison of common causes of acute abdominal pain

Onset

Rapid

A

Cholesystitis

Pancreatitis

126
Q

Comparison of common causes of acute abdominal pain

Location

Periumbilical

A

Appendicitis ( early)
Small bowel obstruction
Mesenteric ischemia infarction
Gastroenteritis

127
Q

Comparison of common causes of acute abdominal pain

Location

Either LQ or pelvic

A

PID

Ruptured ectopic pregnancy

128
Q

Comparison of common causes of acute abdominal pain

Location

Abdominal back, flank

A

Ruptured abdominal aortic aneurysm

129
Q

Comparison of common causes of acute abdominal pain

Location

Epigastric

A

Perforated peptic ulcer

130
Q

Comparison of common causes of acute abdominal pain

Location

RUQ

A

Cholesystitis

131
Q

Comparison of common causes of acute abdominal pain

Location

Epigastric, back

A

Pancreatitis

132
Q

Comparison of common causes of acute abdominal pain

Location

LLQ

A

Diverticulitis

133
Q

Comparison of common causes of acute abdominal pain

Character

Localized

A
Cholesystitis
Pancreatitis
Diverticulitis 
PID
REP
134
Q

Comparison of common causes of acute abdominal pain

Character

Diffuse

A

SBO
MII
RAAA
Gastroenteritis

135
Q

Comparison of common causes of acute abdominal pain

Character

Localized early diffuse later

A

PPU

136
Q

Comparison of common causes of acute abdominal pain

Description

Ache

A

Appendicitis
Diverticulitis
PID

137
Q

Comparison of common causes of acute abdominal pain

Description

Agonizing

A

MII

Gastroenteritis

138
Q

Comparison of common causes of acute abdominal pain

Description

Constricting

A

Cholesystitis

139
Q

Comparison of common causes of acute abdominal pain

Description

Boring

A

Pancreatitis

140
Q

Comparison of common causes of acute abdominal pain

Description

Burning

A

PPU

141
Q

Comparison of common causes of acute abdominal pain

Description

Crampy

A

SBO

142
Q

Comparison of common causes of acute abdominal pain

Description

Tearing

A

RAAA

143
Q

Comparison of common causes of acute abdominal pain

Description

Light headed

A

REP

144
Q

Comparison of common causes of acute abdominal pain

Radiation

None

A
Diverticulitis
PPU
SBO
MII
Gastroenteritis
REP
145
Q

Comparison of common causes of acute abdominal pain

Radiation

Upper thigh

A

PID

146
Q

Comparison of common causes of acute abdominal pain

Radiation

Back, flank

A

RAAA

147
Q

Comparison of common causes of acute abdominal pain

Radiation

Midback

A

Pancreatitis

148
Q

Comparison of common causes of acute abdominal pain

Radiation

RLQ

A

Appendicitis

149
Q

Comparison of common causes of acute abdominal pain

Radiation

Scapula

A

Cholesystitis

150
Q

Comparison of common causes of acute abdominal pain

Intensity

Pinak grabe

A

Pancreatitis and diverticulitis

Pero pancreatitis talaga

151
Q

Normally not palpable but when distended by gas or fluid, may be felt

A

Hollow viscera