Abdomin Exam Flashcards
Distention of the Upper abdomin: Which organs could be affected?
Stomach, Liver, GB, Spleen
Distention of the Lower abdomin: Possible diagnosis
Bladder, Hernia, Prego
Distention of both lower and upper abdomin is what pathology?
Ascities
Purple Striae in the abdomin could indicate?
Cushing’s OR Adrenal tumor that produces cortisol
Describe INC/DEC in peristalsis in both early and late bowel obstruction?
INC = Early Obstruction DEC = Late Obstruction
Pulsations in the abdomin could indicate
Abdominal aneurysm
Diastasis Recti (What is it and would you treat?)
It is a separation of the abdominal muscles towards the lateral sides caused by heavy lifting/Prego.
Not significant.
Grey Turner’s sign (Located where and what doe sit indicate?)
Blood in Flanks Indicates Pancreatitis (Rupture has already occurred)
Caput Medusa indicate?
Portal Hypertension
Definition of Borborygmi
Rumbling sounds heard in abdomin. Bowel sounds.
Tympani indicates?
Air
Dullness indicates?
Fluid
Liver size parasternal and midclavicular?
Parasternal = 4-8cm Midclavicular = 6-12cm
Dullness over the spleen indicates?
Normal spleen unless enlarged.
How do you palpate the liver?
Start at zyphoid and go around coastal margin to posterior axillary line
How do you palpate the KD?
Entrapment – Dr Beings pressing medially and with each breath out the dr moves lateral wo bunny hopping. Dr does this over 3 breaths. The other hand is placed underneath the PT. Dr always observes PTs face for pain.
How do you palpate the spleen?
Start at Anterior axillary line. Pull w left hand and push with right hand.
Name 3 tests and describe how they are performed for Ascities
Shifting dullness = Percuss horizontally across abdomen. If tympany changes to dullness over the center of the abdomen it could indicate air bubble. Have PT side-lying and repeat test. If there is no change in the location of the air then it is most likely gas trapped in the bowel and not from ascities. If it changes location it indicates ascities.
Fluid Wave = PT supine. Dr taps each side of the abdomen and observes for fluid wave indicating ascities.
Puddle Sign =
Name 3 tests and describe how they are performed for Ascities? Which sign is the most sensitive?
Shifting dullness = Percuss horizontally across abdomen. If tympany changes to dullness over the center of the abdomen it could indicate air bubble. Have PT side-lying and repeat test. If there is no change in the location of the air then it is most likely gas trapped in the bowel and not from ascities. If it changes location it indicates ascities.
Fluid Wave = PT supine. Dr taps each side of the abdomen and observes for fluid wave indicating ascities.
Puddle Sign = PT standing. Place Stethescope midline above umbilicus. Have PT forward flex. Percuss a few times to each side of the scope.
Puddle sign is the most sensitive test for Ascities.
Which condition is Blumberg’s Test used for and describe the test?
Blumberg’s Rebound tenderness for GB.
Palpate each of the 4 quadrants by pressing in slowly and releasing quickly. Go deep.
Describe how to perform Obturator and Psoas sign tests for GB
Psoas sign = PT side-lying. Hold PTs leg near knee and extend femur while bracing Hip w other hand. Pain near the GB indicates GB as pain generator bec psoas will irritate the GB.
Obturator sign = PT supine. Flex thigh to 90. To externally rot femur int rot leg.
What is the #1 cause of chest pain
Heart Burn
Hiatal hernia cause?
Weak Diaphragm
What is Achalasia? What disease causes it?
Distal narrowing of the Esophagus.
Cause = Scleroderma
Gastric Vs Duodenal ulcers (Course of pain after eating?)
Duodenal pain 2hrs after eating
Gastric pain during meal otherwise unpredictable.
Gastric Vs Duodenal ulcers (Course of pain after eating?)
Duodenal pain 2hrs after eating
Gastric pain during meal (Could also be cancer so ask if pain unrelieved by position or medication) otherwise unpredictable.
Cause of Acute Gastritis?
Allergies/Sensitivities
Name one thing to be concerned about in chronic gastritis?
B12 deficiency
Low B12 -> Pernicious anemia -> PLS
Gastric Cancer causes which lymh node to become enlarged?
Left Virchow
Diseases ass w head of pancreas
Pancreatitis, Cancer
Pancreatitis Acute Vs Chronic SS
Acute = Fever, Ridgid Abdomin, Labs Chronic = Quiet, Normal Labs
SS of Pancreas Cancer (Head of pancreas)
Weight loss, jaundice, Pain at T10 straight through and knife like, Bruised flanks, Steatorrhea, Hx of drinking and smoking
If PT has Pain at T10 straight through and knife like think? But ask?
Pancreas; Do you have a Hx of drinking or smoking?
Cullen’s Sign (Which Tests to order?)
CBC, CT, Amylase, Lipase
Diseases ass w tail of pancreas
DM1, DM2, Gestational DM
DM1 and 2 differences (General: Ages, body morphology, Tx)
DM1 = <35yo, thin, INSULIN DEPENDENT DM2 = ?35yo, obese, Diet controled
SS of DM1 or DM2
3Ps: Polydypsia, polyuria, polyphagia
GB (Tests?)
CBC w/ Diff, Bilirubin, UA, Cholecystogram, US cystography
Name 2 conditions ass w Gallbladder
Cholecystitis (AKA Cholangitis) = infection
Cholelithiasis = Stones
Cholelithiasis and Cholangitis Tx
Adjust T5, Diet
Pt has pain in inferior right scapula. What GI organ should you be concerned about?
GB
Name 3/5 diseases ass w spleen
Cancer Leukemia -- Spleen must handle excessive WBC Hodgkin's -- Splenic Enlargement Mono -- Splenic Enlargement Rupture -- From Truama
SS of Spleen disorder
Anemia, Frequent infections, Fatigue, Chronic illness
Spleen (Tests)
CBC, US, Biopsy (Cancer), CT)
What is the function of the Spleen?
Destroy old RBCs, make, store and remove WBCs
Which 4 organs are WBCs made
Thymus (T Lymphocyte maturation), Spleen and Lymph nodes (T and B Lympho), Marrow
MC Cause of Hepatitis?
Viral
Labs for Viral Hepatits
DEC Leukocytes
INC Lymphocytes
Lymphocytes Vs Leukocytes
Lymphocytes are a type of Leukocyte with 3 major types: NK cells, T-cells (Thymus cells) and B-cells (Bone cells).
*Leukocytes refer to ALL WBC types.
Hep A
Oral; Scratch by butt eat my cookies
Viral Hepatitis: Which Ig will be high in Acute Vs Chronic hepatitis?
IgM is Acute
IgG is chronic
Acute Vs Chronic hepatitis tenderness?
Acute the liver is tender. Chronic = NO tenderness
Alcoholism causes which 3 liver conditions?
Cirrhosis and cancer
SS of alcoholic liver?
Jaundice, RUQ tenderness, right shoulder pain, varicosities
SS of alcoholic liver?
Jaundice, RUQ tenderness, right shoulder pain, varicosities (Portal (Liver) and splenic Veins)
Palpation for Cirrhosis and Cancer of liver reveals?
Cirrhosis = Nontender, hard and symmetrical enlargement Cancer = Non-tender, hard and lumpy, not symmetrical
Labs for for Cirrhosis and Cancer of liver reveals?
Cancer = Labs variable Cirrhosis = INC GGT
SGOT is?
1 of the 2 aminotransferases (SPGT and SPGT).
AST; Aspartate transaminase
SPGT is?
1 of the 2 aminotransferases (SPGT and SPGT).
ALT; Alanine transaminase
High after heart, pancreatitis, KD, or liver dx
GGT is?
Gamma-glutamyltransferase
Is a transport molecule that helps body in detox
High in liver cell or bile duct cell damage– when these cells rupture they release GGT.
ALP is?
Alkaline Phos
Hep A and C Labs values for SPGT and SGOT?
Hep A: Very High SPGT and SGOT
Hep C: Mild elevated SPGT and SGOT
*Note: The levels of SPGT and SGOT do not correlate with the exact amount of liver damage. EX: Hep A PTs typically fully recover and Hep C PTs have extensive liver damage
Bilirubin: Direct abnormal (Organs affected and then SS)
Conjugated; Soluble; Post-hepatic: Liver, GB, Pancreas
SS Jaundice, Pale feces, yellow urine
Bilirubin: Indirect abnormal (Organs affected and then SS)
Unconjugated; Insoluble; Pre-hepatic: Liver, spleen, blood, rx
SS Jaundice, green urine
Name 3/5 spleen diseases
Cancer Leukemia - Spleen makes excessive WBC Hodgkins - Spleen enlarged Mono - Spleen enlarged Rupture - trauma
Name a few SS of spleen diseases?
Anemia
Frequent infections
Fatigue
Chronic Illness
What is Coomb’s test for?
Tests for Antibodies to RBCs (IE Anti-globulin test); 2 Types: Direct and indirect
Indirect tests for blood transfusion compatibility. Done before transfusion. Tests blood SERUM.
Direct tests for autoimmune-hemolytic anemia
Tests RBCs and not serum.
Name a few Hemolytic diseases
- Hereditary Spherocytosis
- Hereditary Elliptocytosis
- Sickle Cell
- G6PD deficiency
- Pyruvate kinase deficiency
Autoimmune-hemolytic anemia (IgG attached to RBC which causes the problem): SLE RA IBD Leukemia Infectious (IgM agglutination)
KD Diseases: Name 3 types:
Nephritic KD/Nephritis – Infection
Stones
Nephrotic – Death
Name 6 tests for KD (Includes Labs)
IVP - Intravenous pyelogram Helical CT UA Creatinine Clearence Cystometric US
WHich has RBC casts: Nephritic or Nephrotic disease?
Nephritic
WHich has RBC casts: Nephritic or Nephrotic disease?
Nephritic
Nephrotic Syndrome = KD death.
Name 3 SS?
HTN
Edema (Lots)
Proteinuria (Positive UA)
*Mnemonic is “HEP HEP HEP Me”
Toxemia of Prego will cause: Nephritic or Nephrotic disease?
Nephrotic bec KD will get smashed and will result in death of the KD
“Not only eating for 2 but peeing for 2” – Extra stress on KD
DID you know that Strep throat first infects the throat Then the KD!, Lastly the heart valves
If PT has Fever and LBP ask about “Have you had a sore throat in the last 2 weeks”. Its not the first thing you think when a PT has LBP but fever and LBP could be a strep infection inside the KD!
Strep infection: Nephritic or Nephrotic disease?
Nephritic
Nephritic disease. Name a SS?
Fever
Proteinuria (Not always)
Strep MC cause (Dentist or Infection)
RBC Casts
Name a few labs for diagnosis of Glomerular nephritis?
ASLO = Anti-streptolysin
ANCA = Anti-neutrophil cytoplasmic antibodies – Tests for IgG
Anti-GBM = Glomerular basement mem – Remember thinning of the basement membrane is what occur sin this dx
Complement levels
Anti-nuclear antibodies – Tests for Autoimmune Antibodies
Medical name for Bladder infection?
Cystitis
KD Cancer: Name 2 SS
PainLESS bleeding, unexplained weight loss
KD Stones: Name 3 SS
Painful bleeding
Colicky pain – no position of relief
Writhing Pain = PT cant stop moving or trying to find a position of relief
PT hurts everywhere
KD Stones: Age and Gender
Male; 20s
MC Type of KD stones?
Oxalic Acid
Stones Tx:
INC Fluid
DEC VIT C
DEC Calcium
DEC Green Vegi
Cystitis MC bacteria?
E-Coli
Cystitis: Age and Gender
Younger Female
Older Male esp w prostate problems
Cystitis Name 2 SS
Urinary Urgency
Burning
SI VS LI issue: Endoscopy or Colonoscopy
LI = Colonoscopy
Colon Cancer SS
Painless Bleeding
TX for all Colon issues?
Fiber
Crohns Disease marked by lesions where?
Skip Lesions
MC in Distal ileum
String Sign AKA
Skip Lesions
Crohns Disease invovles narrowing of the lumen forming strictures called Skip lesions
Name 2 SS
Rectal bleeding - Red streaks
INC WBC
Ulcerative Colitis (UC) is marked by?
Local Megacolon
How does Megacolon occur in UC?
Sacral Plexus becomes damaged so GI cant contract and the colon spreads out. Can also be caused by repetitive straining or holding of stool – IE waiting 30min to finish a move.
How does Megacolon occur in UC?
Sacral Plexus becomes damaged so GI cant contract and the colon spreads out.
Name MC location of UC
Descending Colon
Name 3 SS of UC? (BAI)
Bloody Diarrhea
Arthritis (Large Joints)
Iritis/Uveitis
HLA-B27 Suggests?
UC or Crohns
Crohns Tx:
Restrict Raw foods and high calorie foods
Adjust
Fecal Transplant – Taking Stool from healthy person and implanting it into Crohns PT to restore GI microbiota – For C. difficile colitis
UC Tx:
Electrolytes bec diarrhea
Avoid Milk
Adjust
Fecal Transplant
IBS AKA?
Spastic Colon
Mucous Colitis
IBS is defined by what SS?
Alternating Diarrhea and constipation
Diverticulosis cause:
Repetitive straining or holding of stool – IE waiting 30min to finish a move. This weakens the lumen and allows out-pouching
Outpouching occurs MC where?
Distal Colon
Outpouching is a SS of?
Diverticulosis
Diverticulosis Tx:
Avoid Nuts and seeds and popcorn
INC Water intake
Diarrhea lasting 2-4 hrs indicates?
Staph food poisoning
Diarrhea lasting a full day indicates?
Salmonella Food poisoning
What is an IVP
Intravenous pyelogram
Used to look for KD Stones
Uses Radiography and a dye
Describe Cystometric test?
Pumps water into the bladder. The device then measures the amount of fluid present in the bladder when you first feel the need to urinate, when you are able to sense fullness, and when your bladder is completely full.
The time required to begin voiding and the size, force, and continuity of the urinary stream is recorded. The amount of urine, how long the voiding took, and the presence of straining, hesitancy, and dribbling are also recorded.
What is the Cystometric test for?
Urinary Incontinence
UA is used as a KD screen
Looks for Proteinuria
Creatinine Clearance
For End stage Renal disease
PT will be very Swollen
Used to determine if PT needs dialysis that day and if they need a KD transplant
UCRAPE B27
AKA
U CRAPe B27
Ulcerative Collitis Crohn's Reiter's AS Psoriatic Enteropathic
HLA - B27
*Neg sign means its Seroneg
Seroneg arthritis:
Which are the Seroneg arthritis?
RAPE from UCRAPE
Reiters, AS, Psoriatic, Enteropathic
**These are the arthritides that attack the spine and make SYNDESMOPHYTES
Which conditions Make Syndesmophytes?
RAPE
Reiter’s
AS
Psoriatic
Enteropathic
Which conditions Make Syndesmophytes?
RAPE
Reiter’s
AS
Psoriatic
Enteropathic
What are Syndesmophytes?
Calcified ligs of the spine
Name 2 SS of enteropathic arthritis?
Back Ache and Bloody Diarrhea
Calcification of the Lig around the spine indicate what radiological finding?
Osteophytes unless Reiter’s, AS, Psoriatic, or Enteropathic
Then Syndesmophytes
What tissue does RA and OA target?
RA – Synovium of joints (Cartilage)
OA – Targets end plates and Joints
