Abdominal Exam Flashcards
what is a key to the abdominal exam?
get an accurate description of the problem
when asking about abdominal pain, what should you do?
have the patient point to where they feel the pain and try to identify the size of the pain
what is an extra timing question you must ask for belly pain?
timing in relation to
- food
- BM
- nausea
nocturnal symptoms that affect sleep are
more concerning
BHC / CBH
bowel habit change / change in bowel habits
what can positional changes pain indicate?
adhesional types of pain
what GI problem could surgical history create?
adhesion
what is LNMP?
last normal menstrual period
what are common causes of GI complaints?
DM (slow motility, early satiety, nausea, side effect of medication)
renal
depression
arthritis
hyperlipidemia
endometriosis
what meds can influence GI symptoms?
NSAIDS
new or changes in meds
DM
statins (hepatotoxicity, renal failure)
biphosphonantes (GERD, reflux, esophogeal erosion)
antibiotics (diarrhea)
diuretics
laxatives (abdominal cramping)
what family hx considerations are involved in GI?
IBD
colon CA
liver dz
what special considerations in the social hx involve GI?
IV drug use (liver damage) diet changes/exercise (hemorrhoids) recent travel water source ill contacts tobacco, alcohol use
how can regurg pts be SOB?
at night, they aspirate small amts of the regurgitant products
what is visceral pain?
constriction or dilation of hollow organs
(sheath touching the organ)
-typically felt as a cramp
-comes and goes
what is parietal pain?
inflammation of the peritoneum (sheath touching the abdominal wall) -steady, aching, severe -more precisely localized -aggravated by movement, coughing
what is referred pain?
inflammation along shared nerve roots
what is NUD?
non ulcerative dyspepsia
-no organic source for the pain and symptoms
will the pt be able to localize visceral pain?
not often
what is a less common form of visceral pain?
capsular distention of solid organs (capsule surrounded by fluid)
what do pts do when they have severe visceral pain?
they will become restless and writhing (don’t like to be still)
what do pts do when they have parietal pain?
lie still
how will you know if it is a referred pain?
when nothing matches up
-pressure at site of pain doesn’t increase pain
what is waterbrash?
stomach content taste
what is the difference between vomit and regurgitation?
effort and amount
what is pyrosis?
heartburn
where can pyrosis be located?
epigastric
retrosternal
how is pyrosis relieved?
acid suppression therapy
what will be the next step if acid suppression therapy doesn’t work?
upper endoscopy to look for sphincter problems
what is dyspepsia?
upper abdominal pain (NOT heartburn)
what is odynophagia?
pain with swallowing
what does odynophagia indicate?
inflammation
what is dysphagia?
difficulty swallowing
what are the classes of dysphagia?
obstructive or non oro pharyngeal (neuro/strokes) vs esophageal chocking sensation
how is diarrhea identified?
increased frequency and decreased consistency
-with urgency (pathologic) or without (non-pathologic)
how is constipation identified?
decreased frequency increased consistency difficult passage (straining) painful BM (tumor, tear, ulcer) need manual manipulation
what does pain with thin stools mean?
wierd
what is hematochezia?
blood in stool (maroon or red)
- usually a lower source
- mixing in of blood with stool
- below ligament of treitz (rest of small and large bowel)
what is melena?
black or tarry stool
- usually an upper source
- above ligament of treitz (stomach and duodenum)
what is BRBPR?
bright red blood per rectum (bleeding from the rectum, not from the bowels
what are the screening questions that go along with the GI exam?
alcohol consumption
viral hepatitis
colon cancer screening
what constitutes excessive drinking?
f: > 3 per occasion or 7 per week
m: > 4 per occasion or 14 per week
what is HAV?
hepatitis A virus, food borne illness
-usually goes away on its own
what is HBV?
hepatitis B virus, blood born illness
- more common amongst asians, lived in Vietnam
- latent for a long long time
what is HCV?
hepatitis C virus,
- more common with baby boomers
- latent for a long long time
- has no vaccine
what do all hepatitities cause?
cirrhotic liver
how often do you have a colonoscopy?
every 10 yrs after the age of 50 (average)
- every 5 yrs beginning 10 yrs prior to age of family’s diagnosis age (family hx)
- personal hx of adenomatous polyps at least every 5 yrs
- personal hx of IBD (especially UC) annually beginning 10 yrs post dx
what is a stethescope sign?
push using your stethescope on the painful area
