Abdominal Exam 2

Question 1

what do you put on your soap note for an abdominal exam

Answer 1

Abd- Soft, NT/ND, BS+ x4, no HSM

Question 2

GERD?

Answer 2

lower esophageal sphincter doesn’t work as much as it should have.

gastric juices or food can come back in.

Question 3

typical symptoms of Gerd? (3)

atypical symptoms?

Answer 3

heartburn
regurgitation
dysphagia -> trouble swallow

• • coughing and wheezing (reflex arcs, stuck in trachea)
• • hoarseness, sore throat
• • otitis media (baby)
• • non cardiac chest pain

Question 4

lifestyle modifications of GERD (5 things)

Answer 4

losing weight

avoid known triggers –> chocolate, citrus juice

avoid large meals

wait 3 hours after a meal before lying down

elevating head by 8 inches

Question 5

Rome 3 criteria for constipation?

what is it required?

Answer 5

Rome 3 criteria

must have experienced at least 2 of the three symptoms over the preceding 3 months:

1) fewer than 3 bowel movements/week
2) straining
3) lumpy or hard stools
4) sensation of incomplete defecation
5) manual maneuvering required to defecate (digital, or enema)

Question 6

Bristol Stool Scale?

Answer 6

types 1-7 are the types, but 3 and 4 are close to “normal”.. formed and easy to pass

Question 7

type 1 and 2 stools?

type 6 and 7?

Answer 7

constipation. . look like rabbit pellets
1) hard lumps or

sausage shaped but lumpy (type 2)

6 and 7 are diarrhea like.

Question 8

associated symptoms of constipation?

Answer 8

abdominal pain

nausea and vomiting if really backed up

Question 9

concerning symptoms needing urgent evaluation?

Answer 9

rectal bleeding

abdominal pain

inability to pass flatus

vomiting

Question 10

abdominal wall hernias?

Answer 10

interfere with generation of intraabdominal pressure required for initiation of defecation

Question 11

how do you check for internal prolapse/rectocele in a woman?

Answer 11

palpate posterior vaginal wall at rest and then while straining.

Question 12

Lifestyle modifications for constipation (4)

Answer 12

Increase in fiber

increase water in diet

use bathroom right away when you have the urge

increase exercise, including walking

Question 13

Gastroenteritis?

2 biggies for virus?

Answer 13

diarrhea but nausea, vomiting, abdominal pain can accompany it.. pt sometimes thinks it’s the “stomach flu”

Norovirus –> cruise ship or casino. (uncontrolled vomiting 12-48 hours after exposure. more vomiting than diarrhea)

Rotavirus –> immunize kids for it..

Question 14

3 bacterial biggies for gastroenteritis?

Answer 14

salmonella –> onset 12-36 hours after. eating something contaminated.

C. Difficile –> exposure to antibiotics, most common hospital acquired GI illness.

E. coli –> food, water, person to person. most common traveler’s diarrhea (starts within 5 days, lasts 2 weeks)

Question 15

parasitic gastroenteritis

Answer 15

Giardia –> person to person, animals to humans through fecal oral route, gotten from infected water

Question 16

what are drug associations with Diarrhea

Answer 16

Sorbitol –> sugar free chocolates, gummy bears, etc

PPIs

Question 17

Irritable Bowel Syndrome

Answer 17

not inflammatory bowel disorder..

altered bowel habits, abdominal pain, abdominal bloating/distention…

postprandial urgency (right after person eats)

alternating constipation episodes or diarrhea episodes

Question 18

malabsorption what does poop look like?

what is it associated with

Answer 18

white and bulky and floats to the top

**gallbladder disease

Question 19

constipation sounds?

Answer 19

hypo or normal

more tenderness in left lower quadrant (where they have a backup)

Question 20

Diarrhea sounds?

Answer 20

hyperactive