Abdominal

Question 1

What’s the most important part of an abdominal exam?

Answer 1

making sure pt can talk

Question 2

for an abdomen exam, what are we looking for when we do the following procedures:
inspection?
auscultation?
palpation?
percussion?

Answer 2

I: scars, color changes, distention, rashes, lesions
A: bowel sounds and aortic bruits
palp: masses, guarding, rigidity, rebound and referred rebound tenderness, murphy’s, and psoas
perc: resonance and organomegaly

Question 3

what conditions may be causing left upper quadrant pain in the abdomen?

Answer 3

GERD
left lower lobe pneumonia
MI
gastritis
pancreatitis
enlarged spleen/splenic trauma

Question 4

what conditions may be causing right upper quadrant pain in the abdomen?

Answer 4

gallbladder disease (cholecystitis, biliary colic)
acute hepatitis
duodenal ulcer
right lower lobe pneumonia
MI

Question 5

what conditions may be causing right lower quadrant pain in the abdomen?

Answer 5

appendicitis
diverticulitis
inflamm bowel disease (more often crohn’s disease of ileocecal valve)
irritable bowel syndrome
ectopic pregnancy
ovarian cyst

Question 6

what conditions may be causing left lower quadrant pain in the abdomen?

Answer 6

diverticulitis
endometriosis
ectopic pregnancy
inflamm bowel disease
irritable bowel syndrome

Question 7

which organs are located in the right upper quadrant of the abdomen?

Answer 7

liver, gallbladder, duodenum, and common bile duct

Question 8

which organs are located in the left upper quadrant of the abdomen?

Answer 8

pancreas, stomach, and pancreatic duct

Question 9

which organs are located in the right lower quadrant of the abdomen?

Answer 9

colon, cecum, and appendix

Question 10

which organs are located in the left lower quadrant of the abdomen?

Answer 10

ileum (small intestine)

Question 11

a patient experiencing periumbilical pain (pain around or behind belly button) could have what conditions?

Answer 11

gastritis
GERD
abdominal aortic aneurysm
pancreatitis
appendicitis

Question 12

what are typical presentations of a MI?
what are atypical presentations (more common in female pts)

Answer 12

can mimic GERD
crushing chest pain

jaw pain
altered mental status in elderly
sharp pain
fatigue

Question 13

what lab values would be important in diagnosing a MI?

Answer 13

troponin and CKMB

Question 14

how do we treat MI?

Answer 14

reperfusion via TPA (Tissue plasminogen activator, aka alteplase), PCI (Percutaneous coronary intervention) with or without stent, or CABG
and MONA
Morphine
Oxygen
Nitroglycerin
Aspirin

Question 15

what is an ectopic pregnancy?
is it life-threatening?
how does it present?
how to we treat it?

Answer 15

pregnancy that occurs outside the uterine cavity
yes
vaginal bleeding, pelvic (LLQ & RLQ) pain, pain can radiate to shoulder, normal pregnancy discomforts can be present (breast tenderness, frequent urination)
emergent surgery, or if stable, single or multi-dose methotrexate

Question 16

what is an abdominal aortic aneurysm?
is it life-threatening?
how does it present?
how do we treat it?

Answer 16

swelling of the aorta
it can be (if it bursts)
can be asymptomatic, or symptomatic - either intact or ruptured.
if intact, can cause abdominal pain, fever, or discomfort. if ruptured, can cause severe pain, hypotension, and a pulsatile abdominal mass
surgery

Question 17

appendicitis:
presentation?
atypical symptoms?
how can we diagnose using a physical exam?
treatment?

Answer 17

low-grade fever, RLQ pain, anorexia, N/V

indigestion, flatulence, and bowel irregularity
Mcburney’s point sign (location of appendix), Psoas (RLQ pain with right hip extension), Rovsing’s (RLQ pain by palpating LLQ), Obturator signs
surgery and antibiotics if concern for rupture

Question 18

Inflammatory bowel disease:
what are the 2 separate associated conditions?
is it more common in men or women?

Answer 18

ulcerative colitis and crohn’s disease
neither, 1:1 ratio

Question 19

how do we determine if it is ulcerative colitis or crohn’s disease?

Answer 19

ulcerative colitis presents with severe diarrhea symptoms, whereas crohn’s presents with diarrhea and abdominal pain

Question 20

what is irritable bowel syndrome?
what is the Rome IV criteria for IBS?
is it more common in men or women?

Answer 20

chronic condition with altered bowel habits, including abdominal pain and cramping
Rome IV Criteria: recurrent abdominal pain that occurs on one or more days per week in the last 3 months, associated with 2 or more of the following:
-Related to defecation (either improves or worsens pain)
-Change in the frequency of stool
-Change in stool consistency

female, 2-3:1 ratio

Question 21

GERD:
presentation?
treatment?

Answer 21

-Heartburn, Regurgitation, Cough, Chest pain

-Weight loss in patients who are overweight
-Elevation of bed in patients with hoarseness and/or cough
-Histamine 2 Receptor antagonists (H2RAs) and proton pump inhibitors (PPI)

Question 22

what is the presentation of a gastric ulcer?
duodenal ulcer?
how do we treat peptic ulcers?

Answer 22

abdominal pain worsens with eating
abdominal pain often subsides with eating
if caused by infection with H. pylori: antibiotics and PPI/H2RA,
if caused by NSAIDs: stop NSAID and give PPI

Question 23

Diverticulitis/losis?
what is diverticulosis?
what is diverticulitis?
average age of occurrence?
presentation?
treatment?

Answer 23

presence of diverticula (“pockets” in gut wall
inflammation/infection of diverticula
around 62
N/V, abdominal pain in LLQ, but can occur in RLQ, possible low grade fever
antibiotics, surgery/antibiotics if perforation occurs, or pain control

Question 24

Hepatitis:
causes?
presentation?
treatment?

Answer 24

v-iral (most common), drugs, alcohol, autoimmune disorder
-jaundice, N/V, malaise, chronic liver failure can lead to esophageal varices, hepatic encephalopathy, ascites
-remove offending agent, treat viral hep C

Question 25

what are the multiple causes of biliary complications?
how do they present?
treatment?

Answer 25

-cholecystitis (infection of gall bladder)
-cholelithiasis (gall stones)
-gallstone induced pancreatitis
-obstruction of biliary tract
-cancer

-often intense dull discomfort, which may be triggered by a fatty meal
-surgery is most common

Question 26

Pancreatitis:
factors that can cause it?
presentation?
treatment?

Answer 26

-gallstones, alcohol, hypertriglyceridemia, medications
-rapid pain onset (likely due to gallstones), slow onset pain (likely due to alcohol), pain often radiates to the back, N/V

-pain meds, remove offending agent, bowel rest