Abdominal Exam 2 Flashcards
Normal Findings of Abdominal Exam
Flat, Non-distended, normoactive bowel sounds heard throughout, tympanic throughout, soft, no masses, nontender, no HSM
Abd-soft, NT/ND, BS=$, no HSM
Abnormal Findings of Abdominal Exam
distended, round, obese, scaphoid, hyperactive/hypoactive/ diminished bowel sounds throughout, tenderness to palpation, rebound, guarding, rigid, palpable mass, special test: +
GERD signs and sx:
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
Atypical sx associated with GERD
-coughing, wheezing
-horseness, sore throat
otitis media
non-cardiac chest pain
enamel erosion
Lifestyle modifications for GERD
- 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
Medications/ Therapies for GERD
antacids, H2 receptor antagonists
PPIs
Constipation
most common digestive complaint in teh US
**Symptom not a disease
categorized by:
Rome 3 criteria
Bristol Stool Scale
Rome Criteria
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
Bristol Stool Scale
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
Type 1 bristol Stool Scale
-separate hard lumps
Type 7 Bristol Stool Scale
–watery, no solid pieces
Constipation Physical Exam
abdomen exam
pelvic exam for females
anorectal exam
Constipation: Abdomen Exam
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
Pelvic Exam (Constipation)
palpated posterior vaginal all at rest and while straining to check for internal prolapse or rectocele
Things to look for with Anorectal Exam
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
Lifestyle Modification for constipation
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
Diarrhea
no universal definition
Gastroenteritis
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
Viral Gastroenteritis
Norovirus
Rotavirus
Norovirus
sudden onset of uncontrolled vomiting 12-48 hours after exposure
-more vomiting than diarrhea
resolves 36 hours after symptom onset
*cruise ship
Rotavirus
they will have had it by age 5 if not immunized
prior to immunization 55-70k hospitalization
—severe dehydration
Bacterial Gastroenteritis
Salmonella
C.Diff
E.Coli
Salmonella
bacterial gastroenteritis
- eat contaminated
- onset 12-36 hours after contaminated food
C. Difficile
bacterial gastroenteritis
- most common hospital acquired GI illness
- exposure to antibiotics
