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Pharmacy Practice V > Abdominal Pain > Flashcards

Abdominal Pain Flashcards

1
Q

What is the correct order of the abdominal exam?

A 
Talk
Inspect
Auscultate
Palpate
Percuss
(No rectal and vaginal exams)
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2
Q

What are the two emergency/life threatening conditions?

A

myocardial infarction

ectopic pregnancy

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3
Q

What are you listening for in auscultation?

A 
Bowel sounds (hypo or hyperactive), pitch, NL, in which quadrants (hopefully all)
Aortic bruits
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4
Q

What are you looking for in inspection?

A

Distention, symmetry, color changes, scars, rashes, lesions

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5
Q

What are you palpating for in an abdominal exam?

A

Masses, discover guarding, rigidity, referred and rebound referred tenderness, Murphys, psoas, obturator signs, PVA

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6
Q

What are you wanting to notice while percussing during an abdominal exam?

A

Resonance

Organomegaly

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7
Q

What are some key things to remember when taking an abdominal history?

A

Anatomy knowledge
Take a good history
Remove preconceived ideas

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8
Q 
Where could those that have these disorder have pain?
Diverticular disease
Ectopic pregnancy
Ovarian cyst and torsion
Endometriosis
IBS
PID (pelvic inflammatory disease)
A

Left lower quadrant

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9
Q 
Where could those that have these disorders have pain?
Appendicitis
Diverticular disease
IBS
IBD (ulcerative colitis and Crohn's
Ectopic pregnancy
Ovarian cyst and torsion
PID
A

Right lower quadrant

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10
Q 
Where could those that have these disorders have pain?
Acute cholecystitis
Biliary colic
Acute hepatitis
Duodenal ulcer
Right lower lobe pneumonia
myocardial infarction
A

Right upper quadrant associated pain

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11
Q 
What region could be in pain if someone had these disorders?
Splenic pathology
Gastritis
GERD
AAA
Left lower lobe pneumonia
A

Upper left quadrant pain

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12
Q 
What region could be in pain if someone had these disorders?
Appendicitis (early)
Gastritis
GERD
AAA (abdominal aortic aneurism) 
Pancreatitis
A

Periumbilical Pain

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13
Q

What are these a sign of, and what is the treatment?
Irregular bleeding
Adnexal pelvic pain
Kehr’s sign (left shoulder/supraclavivular pain)

A

Ectopic pregnancy, treat with surgery or methotrexate if stable

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14
Q

What are these a sign of, and what is the treatment?
Mimics GERD
Presents differently in females
Can be “same belly pain I get all the time.”

A

Myocardial Infarction - ER!

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15
Q

What are these a sign of, and what is the treatment?
Pain or cramps
Chronic constipation or diarrhea, with change in stool appearance

A

Irritable bowel syndrome
Pain often relieved with bowel movement
Treat with antispasmodics, anti-constipation agents, SSRI’s, and even placebos “reassurance”

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16
Q

What are these a sign of, and what is the treatment?
Over 60
Fiber-deficient diet
High fat/red meat diet. Hard stools contribute
Diverticulosis (swelling in the colon, very common, 10% of those over 40 have)
Diverticulitis (serious)

A

Diverticular disease

Diagnose with CBC, treat with antibiotics

17
Q

What are these a sign of, and what is the treatment?
Periumbilical pain, migrates
Nausea, vomiting, anorexia, diarrhea, obstipation, fever
Cutaneous hyperesthesia (hypersensitive to touch)

A 
Appendicitis
Psoas and obturator signs
Rovsing's, Markle signs
McBurney's sign 
Diagnose with CBC, MRI, CAT scan
Treat with surgery or antibiotics. Complicated with perforation.
18
Q

What is the point hallway between the belly button and the hip called?

A

McBurney’s point

19
Q

What sign do you test for when you punch the bottom of a foot to test for appendicitis?

A

Markle’s or Rovsing’s sign

20
Q 
What are these a sign of, and what is the treatment?
5 F's (common in cholecystitis)
Murphy's sign
Cholelithiasis
Cancer/tumor
gallstone pancreatitis
Biliary tract obstruction
A

-Gallbladder disease
-Murphy’s sign: ultrasound positive sonograph of Murphy’s (CVAT over kidney) - sensitive to pressure
-May resolve if they lose weight, or never work right again
Treatment: Medical or surgical

21
Q

What are the 5 F’s, and what are they common in?

A 
Female 
Fertile
Forty
Flatulence
Fat
Common in cholecystitis (inflammation of the gallbladder)
22
Q 
What are these a sign of, and what is the treatment?
Suprapubic pain
Dysuria (pain with urination)
Hematuria
Fever
A

Urinary system disorders: Cystitis (UTI in the lower section - bladder infection)
Diagnosis: Urinalysis
Treatment: Antibiotics, fluids
(Not usually in males 5-80: most likely STD or something else)

23
Q

What are these a sign of, and what is the treatment?
CVA tenderness
fever
hematuria

A

Urinary system disorders: pyelonephritis (kidney infection)
Diagnosis: Urinalysis
Treatment: Antibiotics, possibly IV

24
Q

What are these a sign of, and what is the treatment? What do the differences in size mean?
Flank pain, hematuria, CVA tenderness

A

Renal calculi/nephrolithiasis (kidney stones)
Treatment: <5mm stone: flomax and pain/nausea control - to pass
>5mm stone: surgery (SWL, PCNL, stenting, uretoscopy)

25
Q 
What are these a sign of, and what is the treatment? Causes?
Nausea
Vomiting
Anorexia
malaise
fever
jaundice
white stool
(What else might you check for?)
A

Hepatitis
Can check for liver tenderness, hepatomegaly, caput medusa (appearance of veins)
Causes include viral, EtOH, drugs, autoimmune, toxins
Treatment: remove offending agent, treat viral types if possible.
If hepatic encephalopathy (slurring speech, white stool, asctece): paracentesis (draining of fluid), diuretics
If 65 or older, screen for Hep C

26
Q

What are these a sign of, and what is the treatment?
Bouts of fever
RLQ pain
Diarrhea
perianal access, fistulas
Extra-colonic manifestations (such as skin, eyes, joints)

A

Inflammatory Bowel Diseases: Crohn’s
Treatment: diet, 5-ASA, steroids, anti-TNF drugs
Extends from mouth to anus

27
Q

What are these a sign of, and what is the treatment?
Bloody diarrhea
fecal urgency

A

Inflammatory bowel disease: ulcerative colitis
Treatment: 5-ASA, steroids, surgery
Increased risk of colon cancer
Up to 1/3 of people need to have colon removed (can affect absorption, nutrition)

28
Q

What should you do if you see abdominal pain, but cannot link it to anything physical?

A

There might be an underlying psychosocial issue, such as depression, anxiety, somatization disorders, malingering. Address the underlying cause, but never ignore the abdominal symptoms.

29
Q

What kind of ulcer do you have if it is relieved with intake of food?

A

A duodenal ulcer

30
Q

What kind of ulcer do you have if it is worse with food?

A

probably a gastric ulcer

31
Q 
What are these a sign of, and what is the treatment?
Nausea
vomiting
cramping
fever
A

Gastritis
Caused by GI irritants, infection, stress
Usually benign and self-limiting with proper approach.
Treatment: clear fluids for 24-48 hours, then BRAT (no food at first - will just prolong it)

32
Q 
What are these a sign of, and what is the treatment?
Cullen's sign
Grey-Turner's sign
Tender LUQ
N/V/fevers/chills
A

Pancreatitis
(Grey-Turner’s sign is dark on hip/flank)
(Cullen’s sign is around belly button)
Treatment is IV fluids, NPO
Would get pancreatic enzymes (lipase and amylase levels)
Often caused by EtOH abuse, or fatty meals

33
Q

What are these a sign of, and what is the treatment?
Problems with LES (lower esophageal sphincter) and caffeine, EtOH, chocolate, mint, tomato sauce, lying flat
Sour brash, retrosternal pain, cough, voice changes

A

GERD
Treat with H2 blockers, PPI’s, diet changes
Weight loss is very important
Nissen fundoplication

34
Q

What is pancreatitis a predisposition for?

A

Pancreatic cancer, which has a 100% fatality rate.

35
Q

What are these a sign of, and what is the treatment?
Cullen’s sign
Prominent aortic pulsation
Severe pain and hypotension with rupture, increased abdomen size

A 
Abdominal aortic aneurysm
Associated with pancreatitis
Diagnosed with ultrasound
Treatment: surgical
Risk factors: genetics, high BP, aneurysms in corners of brain, family history of atherosclerosis, people with valve structural defects
Life-threatening if bursts

Pharmacy Practice V (4 decks)

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