Abdomen Trans Part 3 Flashcards by joseph dizon

Normally the bladder capacity is

400-500 ml

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Leakage of urine due to increase intra abdominal pressure

Occur in coughing, laughing, exercise, lifting heavy objects

Stress incontinence

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Stress incontinence appears in women when

Weakness of bladder and proximal urethra
Anatomic damage to urethral sphincter
Urethral infection
Post menopausal atrophy

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Stress incontinence appears in men when?

After prostatic surgery

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Inability to hold urine once the urge to void occurs

Detrussor contraction stronger than the normal urethral resistance

Urge incontinence

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Urge incontinence due to

Decrease cortical inhibition of Detrussor contractions
Hyper excitability of sensory pathways
Deconditioning of voiding reflexes

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Urge incontinence

Hyper excitability of sensory pathways caused by

Bladder infection
Fecal impaction
Tumors

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Urge incontinence

Deconditioning of voiding reflexes caused by

Frequent voluntary voiding at low bladder volume

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Type of urge incontinence caused by uninhibited bladder contraction

Reflux incontinence

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Mechanical dysfunction resulting from. An over distended bladder

Overflow incontinence

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Detrussor contractions are insufficient to overcome urethral resistance

Overflow incontinence

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Overflow incontinence

Describe bladder

Typically large even after a effort void

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A continous dripping or dribbing incontinence

Enlarged distended bladder is often found on PE

Overflow incontinence

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Overflow incontinence

Due to

Obstruction of the bladder outlet as in prostatic enlargement
Weakness of the Detrussor muscle ( multiple sclerosis, spinal cord lesion)
Impaired bladder sensation that interrupts the reflex (FM neuropathy)

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With intact urinary tract

Functional incontinence

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Functional incontinence

Due to

Cognitive disabilities
Immobility
Musculoskeletal diseases
Environmental factors

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Drugs may contribute to any type of incontince

Incontinence secondary to medication

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Incontinence secondary to medication

Includes

Sedative
Tranquilizers
Anticholinergics
Potent diuretics
Symphatetic blockers

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Combinations of the different types of incontinence

Mixed incontinence

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Bladder is unable to empty

Urinary retention

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Urinary retention

Due to

Mechanical obstruction of bladder outflow

Loss of Detrussor strength

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Urinary retention

Painful differentiating it from other causes of oliguria/anuria

Acute

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Urinary retention

Develops gradually and is painless. The only symptom may be frequent and is painless. The only symptom may be frequent urination of small amounts or overflow incontinence.

Chronic urinary retention

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It measure the adequacy of bladder emptying

It determine the volume of urine remaining in the bladder after full voluntary voiding

Determination of post void residual urine volume

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Post residual volume can be measured by

Bladder UTZ | Catheterization

Significant residual urine volume is

>100ml

Inspection Note for size

Abdominal circumference | Level of umbilicus

Inspection Shape

Contour - from the rib margin to the pubis Viewed on horizontal plane Describe as flat, rounded, globular or scaphoid

Inspection Symmetry

Note for localized distention or bulges

Inspection Abdominal distention Six F's

``` Fat Fluid Feces Fetus Flatus Fatal growth ```

Inspection Abdominal distention Result from excessive caloric intake or redistribution of adipose tissue caused by hormonal factors.

Obesity

Obesity Abdomen

Round with increase in girth

Obesity Buried deeply on the wall

Umbilicus

Obesity Usually evident in other parts of the body

Excess fat

Inspection Result from accumulation of peritoneal fluid

Ascites

Ascites thru the ff mechanism

Transduction of fluid from splanchnic circulation Eg. Portal HPN Obstruction of lymphatic drainage of the peritoneum Decrease plasma oncotic pressure Eg. Liver cirrhosis and nephritic syndrome

Dullness shifts to the more dependent site, while tympani shifts to the top. Dependent fluid causes an area of dullness in the lowest part, this shift to remain lowest with changes in position of the body

Shifting dullness

A wave in the fluid, elicited by tapping one side of the abdomen, is transmitted to the receiving hand on the opposite side. The wave takes penceptible time to cross the abdomen

Fluid wave

Present with as little as 120 ml of peritoneal fluid | Position patients on hands and knees allowing fluid to accumulate on dependent part of the abdomen

Puddle sign

Place stethoscope at this area and listen for the sound made by flicking the side of the abdomen with finger

Puddle sign

Puddle sign Repeated while stethoscope is moved farther away, the sounds become louder

Flicking

Accumulation of large amount of feces seen in

Mega colon Disorder of myenteric plexus Advanced age Anticholinergic drugs

Masses of feces can often be palpated through

Abdominal wall

Rectal exam show stool in the

Rectal vault

Associated findings in pregnancy during inspection

``` Breast are engorged Fetal movement maybe felt Parts of fetus are palpable Cervix is softened Fetal heart should be audible ```

Presence of excessive gas within the bowel or free in the peritoneal cavity

Tymphanities

Tymphanities Seen in

Intestinal obstruction ileus

Tymphanities Physical sign

Abdominal distention | Large area of tymphany

Tymphanities Increase force of peristaltic contraction proximal to the obstruction

Colic

Tymphanities Proximal bowel distention by retained luminal contents leading decompression

Vomiting

Tymphanities Present when obstruction is

Distal to the mid-jejunum

Increase peristalsis is proximal to an obstruction is indicated by

Frequent, loud peristaltic sounds (borborygmi) accompanied by cramping, colicky pain.

Epigastric pain is intense Vomiting early and severe Abdominal distention appears late and limited to epigastirum

Proximal small intestinal obstruction

Symptoms are less severe Vomiting is delayed Vomitus may have become feculent Diffuse abdominal distention gradually develop

Distal small intestinal obstruction

``` Abdominal pain is less Vomiting is late Vomitus may be feculent Constipation is invariable Prominent abdominal distention ```

Colonic intestinal obstruction

Localized bowel obstruction causing increased force of peristaltic contraction proximal to the obstruction

Noisy tymphanities with colic and vomiting (mechanical obstruction)

Diffuse decreased in bowel motility and muscular tone, producing a silent abdomen with distended bowel.

Silent thympanies without colic or vomiting (ileus)

Silent thympanies without colic or vomiting (ileus) Peristaltic sounds are

Diminished or absent

Silent thympanies without colic or vomiting (ileus) Only mild abdominal pain,

Colic is absent

Silent thympanies without colic or vomiting (ileus) Etiology

``` Inflammatory disease Infectious Metabolic/toxic Mechanical/trauma Neurologic Vascular ```

Small amount of gas i peritoneal cavity cannot be identified by. PE

Tympanities without ileus

Tympanities without ileus Only found by x-ray findings of free air beneath the diaphragm

In upright position

Skin

Color/discoloration Lesions Scars Blood vessels

Color / Discoloration Also called icterisia/icterus Yellow discoloration of the skin and sclera resulting from deposition of bilirubin

Jaundice

Color / Discoloration Jaundice Visible when conjugated bilirubin is

>2mg/dL

Color / Discoloration Jaundice Associated findings

Pruritus Dark yellow to brown urine Acholic feces

Hepatocellular conditions that may produce jaundice Hepa EBV CMV Herpes

Vital hepatitis

Hepatocellular conditions that may produce jaundice Drug toxicity

Predictable, dose dependent (acetaminophen) | Unpredictable, idiosyncratic (isoniazid)

Hepatocellular conditions that may produce jaundice Environmental toxins

Wild mushrooms- amantia phalliodes or A. VERNA

Hepatocellular conditions that may produce jaundice Others

Wilson disease Autoimmune hepatitis Alcohol

Faintly blue coloration in the umbilicus | Result from hemoperitoneum (acute hemorrhagic pancreatitis)

Cullen's sign

Blue red, blue purple, or green brown Noted on the skin of lower abdomen and flanks Caused by massive non-traumatic ecchymoses

Grey turner's sign

Pink purple striae

Cushing syndrome

Striae usually locate on

Flanks or lateral aspect of abdomen

Striae may also be areas under chronic lesions as

Shoulder Thighs Breast

Striae etiology

``` Obesity Pregnancy Ascites Subcutaneous edema Cushing's syndrome ```

Fiery red in color | Central body surrounded by erythema and radiating legs

Spider Angiomas

Spider angioma noted in

Abdomen, face, arms, neck Result : chronic liver disease

Spiderangiomas Results

Chronic liver disease Vit. b deficiency Pregnancy

Spider Angiomas kinds

Surgical scars - with suture marks - smooth

Spider Angiomas kinds Usually jagged edges Full thickness burns causes deep, irregular, broad, and un elastic scars

Traumatic scars

Are scars that heal with raised, red, hypertrophic tissues that may progressively thickens overtime

Keloid

Present as tufts of engorgred abdominal veins radiating from the umbilicus Resembles a nest of snakes

Caput medusa

Sing of increased intra abdominal pressure as in ascites and intra abdominal mass

Everted umbilicus

Irregular nodules as exfoliation after completely replacing the umbilicus Signifies metastasis from intra-abdominal malignancy

Sister Mary Joseph nodules

May have discharges - urine through patent urachus - pus from urachal cyst or abscess in abdominal cavity

Umbilical fistula

A hard mass with dirt and desqumated epithelium that accumulate in umbilical cavity and cause inflammation

Umbilicus calculus

Indicative of paralysis or weakening of the diaphragm

Respiratory paradox

Also sign of respiratory muscle weakness and lead to respiratory failure

Respiratory alterans

Abdominal wall may remain immobile during respiration | Diffuse or localized

Peritonitis

Abdomen moves with respiration synchronized with the chest wall

Abdominal respiratory motion

Normally abdominal aorta causes slight pulsations in the epigastirum

Visible pulsations

In the abdominal wall, normal contractions of stomach and intestines maybe visible

Visible peristalsis

Abdominal separation of abdominal rectus muscles | Became apparent only when patient raises his head from examining table

Diastasis recti

Protrusions of abdominal contents through a weak point in the abdominal wall

Abdominal hernias

Abdominal hernias If contents can be easily pushed back into abdomen

Reducible

Abdominal hernias When blood supply of incarcerated contents is interrupted

Strangulated

Abdominal hernias Types Hernia which protrude in the area of surgical scars

Incisional hernia

Abdominal hernias Types Strangulation of part of the circumference of gut wall

Ritchter hernia

Abdominal hernias Types Consist of preperitoneal fat protruding outward between the fibers of linea alba

Epigastric hernia

Abdominal hernias Types Defect in abdominal fascia occurs normally where umbilical exit the abdomen

Umbilical hernia

Umbilical hernia two types

Congenital | Adult

3 signs of ovarian cyst

Abdominal profile reveals 2 curves instead of one Ruler test Supine position

Loud rumbling and gurgling sounds resulting from a rush of gas fluid through the lumen of GIT

Borborygmi

Types of bowel sound Soft or loud, low pitch 5-30/min Bowel sound occur every 5-15 seconds

Normo active bowel sounds

Types of bowel sound >30 or + bowel sounds every 2 seconds Continous and loud

Hyperactive bowel sounds

Types of bowel sound

Hypoactive bowel sounds

Types of bowel sound No bowel sound after 5 minutes of auscultation

Absent bowel sound

Causes of hyperactive bowel sounds

Diarrhea Early pyloric obstruction Early intestinal obstruction Drugs (laxative)

Indicates turbulent flow in a dilated, constricted, or tortuous artery

Arterial bruits

Should be noted in patient with: hepatocellular carcinoma AV malformation Alcoholic hepatitis Heard over the RUQ

Hepatic bruit

Yung palpation, auscultation at percussion

Hindi na gagawan ng BS may recalls naman yun eh

Involuntary loss of urine

Urinary incontinence