Abdominal Flashcards
What’s the most important part of an abdominal exam?
making sure pt can talk
for an abdomen exam, what are we looking for when we do the following procedures:
inspection?
auscultation?
palpation?
percussion?
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
what conditions may be causing left upper quadrant pain in the abdomen?
GERD
left lower lobe pneumonia
MI
gastritis
pancreatitis
enlarged spleen/splenic trauma
what conditions may be causing right upper quadrant pain in the abdomen?
gallbladder disease (cholecystitis, biliary colic)
acute hepatitis
duodenal ulcer
right lower lobe pneumonia
MI
what conditions may be causing right lower quadrant pain in the abdomen?
appendicitis
diverticulitis
inflamm bowel disease (more often crohn’s disease of ileocecal valve)
irritable bowel syndrome
ectopic pregnancy
ovarian cyst
what conditions may be causing left lower quadrant pain in the abdomen?
diverticulitis
endometriosis
ectopic pregnancy
inflamm bowel disease
irritable bowel syndrome
which organs are located in the right upper quadrant of the abdomen?
liver, gallbladder, duodenum, and common bile duct
which organs are located in the left upper quadrant of the abdomen?
pancreas, stomach, and pancreatic duct
which organs are located in the right lower quadrant of the abdomen?
colon, cecum, and appendix
which organs are located in the left lower quadrant of the abdomen?
ileum (small intestine)
a patient experiencing periumbilical pain (pain around or behind belly button) could have what conditions?
gastritis
GERD
abdominal aortic aneurysm
pancreatitis
appendicitis
what are typical presentations of a MI?
what are atypical presentations (more common in female pts)
can mimic GERD
crushing chest pain
jaw pain
altered mental status in elderly
sharp pain
fatigue
what lab values would be important in diagnosing a MI?
troponin and CKMB
how do we treat MI?
reperfusion via TPA (Tissue plasminogen activator, aka alteplase), PCI (Percutaneous coronary intervention) with or without stent, or CABG
and MONA
Morphine
Oxygen
Nitroglycerin
Aspirin
what is an ectopic pregnancy?
is it life-threatening?
how does it present?
how to we treat it?
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
what is an abdominal aortic aneurysm?
is it life-threatening?
how does it present?
how do we treat it?
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
appendicitis:
presentation?
atypical symptoms?
how can we diagnose using a physical exam?
treatment?
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
Inflammatory bowel disease:
what are the 2 separate associated conditions?
is it more common in men or women?
ulcerative colitis and crohn’s disease
neither, 1:1 ratio
how do we determine if it is ulcerative colitis or crohn’s disease?
ulcerative colitis presents with severe diarrhea symptoms, whereas crohn’s presents with diarrhea and abdominal pain
what is irritable bowel syndrome?
what is the Rome IV criteria for IBS?
is it more common in men or women?
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
GERD:
presentation?
treatment?
-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)
what is the presentation of a gastric ulcer?
duodenal ulcer?
how do we treat peptic ulcers?
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
Diverticulitis/losis?
what is diverticulosis?
what is diverticulitis?
average age of occurrence?
presentation?
treatment?
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
Hepatitis:
causes?
presentation?
treatment?
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
what are the multiple causes of biliary complications?
how do they present?
treatment?
-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
Pancreatitis:
factors that can cause it?
presentation?
treatment?
-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
