Abdominal Lecture Flashcards
Where does the abdominal cavity extend from?
Just below diaphragm to the symphysis pubis
How are the 4 quadrants of the abdomen drawn?
- Vertical line through umbilicus
- Horizontal across umbilicus
Define anorexia
Loss of appetite
What can early satiety indicate?
Gastric outlet obstruction
Hepatitis
Diabetic gastroparesis
What GI-related things can cause unintentional weight loss?
- Malignancy
- Malabsorption
- Liver disease
Define dysphagia
Difficulty swallowing
Define odynophagia
Painful swallowing
How can heartburn radiate?
To neck and epigastrum
Mechanical causes of dysphagia
- Stricture
- Cancer or mass
- Obstruction (FB)
Motor causes of dysphagia
- Neuro disorder
- Spasm
- Scleroderma
If a patient points to their throat, they usually have a/an ___ problem
Transfer
If a patient points to their chest (and it is suspected GI related), then it is often a/an ____ problem
Esophageal
Define transfer dysphagia
- Swallowing is attempted
- Results in aspiration of food into nose/lungs
- Suggests CNS problem
Define achalasia
Esophageal musculature does not relax enough
Regurgitation of food bolus suggests ____ problem
Mechanical
Intermittent solid to liquid mechanical dysphagia suggests:
Stricture
Intermittent solid then progressing to liquid mechanical dysphagia and progressively worsening with pain suggests:
Esophageal cancer
What are common causes of odynophagia?
- Esophagitis (GERD induced)
- FB
- Pharyngitis (MC)
- Achalasia
What is the MC cause of odynophagia?
Pharyngitis
Sharp and burning odynophagia suggests:
Mucosal inflammation (reflux esophagitis or infection)
Sharp and sticking odynophagia suggests:
Mechanical (fish or chicken bone)
Squeezing/cramping odynophagia suggests:
Muscular (esophageal spasm, achalasia)
Define regurgitation (GI)
Bringing up gastric contents without nausea or vomiting
What can cause fecal-like material to be vomited?
Small bowel blockage or fistula
Presence of bright red blood in vomitus indicates:
Esophageal or upper GI bleed
Presence of coffee ground material in vomitus indicates:
Partially digested blood (altered by stomach acid)
Prolonged vomiting will cause:
Fluid and electrolyte imbalance
Aerophagia can cause:
Excessive belching/flatulence
Define obstipation
Constipation occurring as a result of intestinal obstruction
Large volumes of osmotic (watery) diarrhea can indicate:
Lactose intolerance
Soft, watery with blood diarrhea indicates:
IBD (ulcerative colitis)
Small, soft, watery w/o blood diarrhea indicates:
Crohn’s disease
Melena means:
Blood has passed through digestive tract
black, tarry stools
Jaundice can be accompanied with:
Severe itching
Jaundice is caused by:
Hepatic disease or lysis of RBCs
Jaundice causes elevated levels of ____ in the blood
Bilirubin
How do urine and stool change with jaundice?
- Urine becomes like tea
- Stools become light yellow or gray
Stretching of liver capsule can cause ____ pain
Visceral
Quality of visceral pain
- Cramping colicky
- Crescendo/decrescendo
- Can be related to intestinal peristalsis
- Usually not well localized by pt
Severe visceral pain can be accompanied by:
- NV
- Sweating
- Pallor
- Restlessness (writhing)
Function of mesentery
Acts as conduit for BV, nerves, lymphatics usually supported in layers of fat
Describe parietal pain
- Inflammation of parietal peritoneum
- Aka somatic pain
- Steady, aching, severe (worse than visceral)
- Well localized
- Aggravated by movement (pts lie still!)
How does acute appendicitis pain present?
- Initially, periumbilical visceral pain
- Gradually, parietal pain well localized to RLQ as inflammation spreads
Define referred pain
- Pain from original site radiates to distant site
- Often at same spinal level as affected structure
- May be superficial or deep
- Well localized
Abdominal pain is a (reliable/unreliable) guide to severity?
Unreliable - depends on patient
-Chronology may be more useful
How is abdominal contour described?
- Flat
- Protuberant
- Scaphoid
- Obese
Visible peristalsis can be an early sign of:
Obstruction
Define diastasis recti
Separation of rectus abdominis muscles in midline creating a ridge when pt lifts head and shoulders off flat surface
-Not pathological
Describe ascites
Free fluid collection in abdomen
Hyperactive bowel sounds can indicate:
- Diarrhea
- Early obstruction
Hypoactive bowel sounds can indicate:
- Paralytic ileus
- Early peritonitis
Absent bowel sounds indicate:
- Complete obstruction
- Late peritonitis
Gas produces what note of percussion?
Tympanic
Liquid produces what note of percussion?
Dull
Solid produces what note of percussion?
Even more profound dullness than liquid
Areas that contain both gas and fluid will produce what note of percussion?
Lower pitched tympanic
Most notable areas of abdomen for percussion?
- Gastric bubble (LUQ, tympanic)
- Colonic splenic flexure (LUQ, low tympanic)
- Liver (RUQ, dullness)
What does abdominal muscular rigidity indicate?
Peritoneal irritation
How are abdominal masses classified?
- Physiologic (pregnant uterus)
- Neoplastic (tumors)
- Vascular (AAA)
- Inflammatory (diverticulitis)
What does rebound tenderness indicate?
Presence of peritoneal inflammation
A normal size liver may be palpable up to ___ cm below the ____
3 cm below costal margin (in mid-clavicular line)
Describe a normal liver edge
Smooth, soft
What is the purpose of the scratch test?
Can help to locate lower liver margin
Where does the spleen lie?
Between left 10th rib (LUQ)
Purpose of psoas sign
- Tests for appendicitis
- Abdominal pain occurs due to inflamed psoas muscle
Describe Rovsing’s sign
- Aka indirect tenderness
- Rebound tenderness in LLQ
- Positive in appendicitis
