Abdominal Exam Lecture-Dobbs (exam 2) Flashcards
What is diarrhea?
Diarrhea= loose, watery stools (bowel movements). You havediarrheaif you have loose stools three or more times in one day. Acutediarrheaisdiarrheathat lasts a short time. MAKE sure you define what the Pt means by diarrhea
What is considered normal for the Pt? figure out their normal bowel habits
What is constipation?
fewer than 3 stools per week.
ROS- GI
Abdominal pain
Appetite changes
Weight changes
Reflux/belching
Nausea/vomiting
Hematemesis=throwing up blood
Changes in stool frequency/consistency
Frequency of bowel movements
History of laxative use
History of upper GI, Barium enema, colonoscopy
(notes: With weight changes: are they up or down? Are they intentional or unintentional? Do your clothes fit differently
-be careful with the overuse of ex lax!!! It becomes a rebound issue to the point where they NEED a laxative in order to poop
Reflux/beltching=
Vomiting- ask about color, digested or undigested food (achalasia), how many episodes per day, per hour. Is this Pt getting dehydrated or malhourished
-ask the Pt if they have a hx of upper GI issues, Barium enema when was last colonoscopy
Nausea: this nausea that you’re having, how often does this occur? Does it interfere with your daily life? Is this allowing you to go about your daily life?
Stool Changes:
Melena=
**upper GI bleeding (dark sticky feces containing partly digested blood.)
Order for abdominal exam:
-inspect (make sure abdomen is revealed)
-auscultate
-
Hematochezia=
pronunciation= hematokeeezia
- indicates lower GI bleed
- blood that is mixed into the stool (some red, but NOT bright red), may be coming from a polyps, or somewhere in the colon
Steatorrhea=
- *indicates malabsorption
- fatty stool that is greasy and floats= indicates malabsorption. (can be seen with pancreatitis, cholestasis, ***cystic fibrosis) KNOW
BRBPR=
external/internal hemorroids, fissure
ROS- GI
Jaundice Hepatitis Cholecystitis Diverticulitis Polyps Hemorrhoids (Ask the Pt if they have any hx of cholecystitis: do they still have their gallbladder? )
ROS- GU
Frequency of urination Polyuria Nocturia Dysuria Hematuria Urgency Hesitancy Force of stream History of infections History of stones (Increased urinary frequency and urgency DM? UTI? Polyuria= DM Nocturia: prostate issues, or Dysuria= painful or dificult urination– could be UTI
Hematuria= stone, cystitis, CANCER
Urgency:
Hesitancy: do you have any trouble initiating urination (possible BPH)
-have you noticed a weak stream or any changes with that? (Ddx: BPH)
)
whay are knees up (flexed) in abdominal exam?
-in order to relax the abdomen
Chief Complaint: abdominal pain
Onset
Location
Duration
Character- is it sharp(ex: bowel perf., triple A) or dull (ex: IBS, constipation) or crampy or colicky
Associated symptoms- (changes in weight, fever, diarrhea, referred pain, vomiting, changes in appetite, stool, reproductive questions, and cardiac/respiratory hx (referred pain)
Aggravating factors- coughing, movement, with eating, certain foods etc
Relieving factors- postional, meds (quantity and type of med), relief after bowel movement?
Timing- (is it worse in the morning, at night? Post meals. Etc)
Severity-
(my notes: CC of abdominal pain:
-Onset: suddenly or gradually, when DID IT START
Acute abdomen= URGENT pain
-gradual onset of abdominal pain over last 3 weeks DDx:
VS
-acute onset of abdominal pain ddx: appendicitis, pancreatitis, gallstone,
-crampy pain= IBS, gas
-colicky pain= comes and goes in waves, intermittent pain. Usually comes when something is stuck in a tube (ie cholelithiasis, constipation, nephrolithiasis, diverticulitis,
-ask about stools AND urination
-ask about last menstrual cycle and R/O pregnancy, ectopic pregnancies
-if a Pt has fever= infection, peritonitis etc
-
Dysuria=
=*painful urination
(Pts may present with painful burning urination
-the urethra is longer in males and more protective
Pt presents with “burining” while urination, UA comes back clean, denies bleeding in urine. Then pelvic exam reveals HSV (herpes). MUST r/o STD or STI prior to assuming it’s a UTI
Ask is the pain on the inside or outside
Hematuria associated with UTI: is usually not assoc. with dripping blood
)
Hematuria=
might be bright red, or slightly red,
associated with UTI, herpes simplex etc
Chyluria=
whiteish, purulent urine that stems from a parasite infection (rare)
Getting started:
-Pt position for abdominal exam
-Adequate exposure
Supine position
Knees flexed
Use gloves if there are open lesions
Make the Patient Comfortable
Adequate coverage
Empty bladder
Warm hands and short nails
The ticklish patient