Abdominal Exam 2

Question 1

Normal Findings of Abdominal Exam

Answer 1

Flat, Non-distended, normoactive bowel sounds heard throughout, tympanic throughout, soft, no masses, nontender, no HSM

Abd-soft, NT/ND, BS=$, no HSM

Question 2

Abnormal Findings of Abdominal Exam

Answer 2

distended, round, obese, scaphoid, hyperactive/hypoactive/ diminished bowel sounds throughout, tenderness to palpation, rebound, guarding, rigid, palpable mass, special test: +

Question 3

GERD signs and sx:

Answer 3

normal findings:

• heart burn: retrosternal sensation after eating or lying supine
• regurgitation: effortless return of gastric contents into pharynx
• dysphagia: occurs in about 30% of Gerd Patients

Question 4

Atypical sx associated with GERD

Answer 4

-coughing, wheezing
-horseness, sore throat
otitis media
non-cardiac chest pain
enamel erosion

Question 5

Lifestyle modifications for GERD

Answer 5

• lose weight
• avoid known triggers: chocolate, citrus, tomato based products, peppermint, coffee
• avoid large meals
• wait 3 hours after a mean before lying down
• elevate the head by 8 inches

Question 6

Medications/ Therapies for GERD

Answer 6

antacids, H2 receptor antagonists

PPIs

Question 7

Constipation

Answer 7

most common digestive complaint in teh US
**Symptom not a disease

categorized by:
Rome 3 criteria
Bristol Stool Scale

Question 8

Rome Criteria

Answer 8

Must have experienced at least 2 of the following sx over preceding 3 months

• fewer than 3 bowel movement/ week
• straining
• lumpy or hard stools
• sensation of incomplete defecation
• manual maneuvering required to defecate

Question 9

Bristol Stool Scale

Answer 9

look and feel of feces

Types 1-7
Types 3 and 4 are as close to normal as possible…formed and easy to pass

–patients of types 1 and 2 are more likely to complain of constipation

Question 10

Type 1 bristol Stool Scale

Answer 10

-separate hard lumps

Question 11

Type 7 Bristol Stool Scale

Answer 11

–watery, no solid pieces

Question 12

Constipation Physical Exam

Answer 12

abdomen exam
pelvic exam for females
anorectal exam

Question 13

Constipation: Abdomen Exam

Answer 13

distention or masses may indicate colonic stools or tumors
large abdominal wall hernias may interfere with generation of intra-abdominal pressure required with initiation of defecation

Question 14

Pelvic Exam (Constipation)

Answer 14

palpated posterior vaginal all at rest and while straining to check for internal prolapse or rectocele

Question 15

Things to look for with Anorectal Exam

Answer 15

perianal excoriation "chronic skin picking"
skin tags, hemorrhoids
anal fissure
prolapse during straining
anorectal masses
tone of internal anal sphincter
presence of gross blood or occult bleeding
presentation of fecal impaction

Question 16

Lifestyle Modification for constipation

Answer 16

increase fiber in diet
increase water in diet
use the bathroom right when you have the urge
increase exercise including walking
schedule unintterupted time every day for BM

Question 17

Diarrhea

Answer 17

no universal definition

Question 18

Gastroenteritis

Answer 18

non-specific term
primary manifestation is diarrhea but nausea, vomiting, diarrhea, abdominal pain accompany

usually caused by infectious agent
mostly viral, follow by some bacterial and parasites

Question 19

Viral Gastroenteritis

Answer 19

Norovirus

Rotavirus

Question 20

Norovirus

Answer 20

sudden onset of uncontrolled vomiting 12-48 hours after exposure

-more vomiting than diarrhea
resolves 36 hours after symptom onset
*cruise ship

Question 21

Rotavirus

Answer 21

they will have had it by age 5 if not immunized
prior to immunization 55-70k hospitalization
—severe dehydration

Question 22

Bacterial Gastroenteritis

Answer 22

Salmonella
C.Diff
E.Coli

Question 23

Salmonella

Answer 23

bacterial gastroenteritis

• eat contaminated
• onset 12-36 hours after contaminated food

Question 24

C. Difficile

Answer 24

bacterial gastroenteritis

• most common hospital acquired GI illness
• exposure to antibiotics

Question 25

E Coli.

Answer 25

food, water, person-person transmission

most common cause of travelers diarrhea starts within 5 days and lasts 2 weeks

Question 26

Giardia

Answer 26

Parasitic Gastroenteritis
causes diarrhea with stools that float, bloating, abdominal cramping,

person-person, animals to humans, FO route, infected water

Question 27

Drug Associated causes of diarrhea

Answer 27

antibiotics; alters normal flora
laxatives
clochicin
quinidine
sorbitol
PPI

Question 28

IBS

Answer 28

doesnt equal IBD

• altered bowel habits
• abdominal pain
• abdominal bloating, distention
• post prandial urgency
• alternating between constipation and diarrhea with one dominating
• intractability to laxatives
• defecation improves abdominal pain but doesn’t relieve it

Question 29

Diarrhea associated Sx

Answer 29

nausea, vomiting, abdominal cramping, abdominal bloating, fever

Question 30

Malabsorptive stools

Answer 30

white/bulky,

small bowel pathology