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PCM II Midterm > Approach to Abdominal Exam 2 > Flashcards

Approach to Abdominal Exam 2 Flashcards

1
Q

What is the sound on percussion of the abdomen?

A

tympanic (for air)

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2
Q

What is a Murphy sign?

A

gall bladder disease

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3
Q

What is McBurney’s point?

A

a location

tenderness over point for apendicitis

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4
Q

What is a Rovsing sign?

A

press over LLQ & ask where it hurts

if pt has apendicitis, will feel pain in RLQ

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5
Q

What is the order of examination for the abdomen?

A

Inspection
Auscultation
Percussion
Palpation

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6
Q

Where do you expose the abdomen from during exam?

A

from xiphoid process to ASIS

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7
Q

What are normal findings on abdomen exam?

A 
flat 
non-distended
normoactive bowel sounds
tympanic throughout
soft
no masses
non-tender
no hepatomegaly/splenomegaly
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8
Q

What are abnormal findings on abdomen exam?

A 
distended
round
obese
scaphoid
tenderness to palpation
rebound
guarding
rigid
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9
Q

What are some common GI issues in primary care?

A

Constipation
Gastoenteritis
Irritable Bowel Syndrome

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10
Q

What is constipation?

A

a SYMPTOM, not a disease

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11
Q

What is the Rome criteria?

A

tool to categorize constipation

need to have 2 symptoms over 3 months:

fewer than 3 bowel movements/week

straining

lumpy or hard stools

sensation of incomplete defecation
manual maneuvering required to defecate

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12
Q

What is considered abnormal about bowel movements?

A

if less than 1 bowel movement each week

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13
Q

What is the Bristol

stool scale?

A

describes look & feel of feces & passage of fecal material

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14
Q

What is considered normal on the Bristol stool scale?

A

types 3 to 4 are considered normal (formed & easy to pass)

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15
Q

What is considered constipation on Bristol stool scale?

A

type 1 & 2

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16
Q

What symptoms are associated with constipation?

A 
abdominal bloating
low back pain
tenesmus (contracted anal sphincter)
pain on defecation
rectal bleeding
abdominal pain
inability to pass flatus
vomiting
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17
Q

What are the most urgent symptoms assoc w/ constipation?

A

rectal bleeding
abdominal pain
inability to pass flatus
vomiting

18
Q

What do you want to ask about in history for cc of constipation?

A

normal pattern of defecation

frequency

hardness of stools?

whether pt strains to defecate

time spent on toilet

what have tried to help

duration of problem

relation to any changes in diet, water intake or exercise

19
Q

What do you include in PE for constipation complaint?

A

abdomen exam

pelvic exam for females (fissure between rectum & vagina)

anorectal exam

20
Q

What does a distension or mass indicate on abdomen exam?

A

colonic stools or tumors (in LLQ)

21
Q

What do you look for on anorectal exam?

A 
perianaal excoriation
skin tags/hemorrhoids
anal fissure
prolapse during straining
masses
tone of internal sphincter
gross blood
fecal impaction
22
Q

What are some lifestyle modifications for constipation?

A 
increase fiber in diet
increase water in diet
use bathroom when have urge
increase exercise
uninterrupted time
23
Q

What is the purpose of the squatty potty?

A

proper positioning of body for a bowel movement

24
Q

What is diarrhea?

A

a component of gastroenteritis

25
Q

What is gastroenteritis?

A

stomach flu

primary manifestation is diarrhea but can also have nasea, vomiting, ab pain

26
Q

What tends to cause gastroenteritis?

A

infectious agents (usually viral)

food-borne

drug associated

27
Q

What are the 2 major viral gastroenteritis?

A

Norovirus & rotavirus

28
Q

Norovirus

A

starts w/ sudden onset of uncontrolled vomiting for 12-48 hrs

usually more vomiting

think outbreak on cruise-ship or casino

29
Q

Rotavirus

A

very contagious

can be immunized against

30
Q

What are 3 bacterial gastroenteritis?

A

salmonella
C difficile
E coli

31
Q

What is the major parasitic gastroenteritis?

A

Giardia (causes diarrhea, bloating, ab cramping)

often get in infected water

32
Q

What drugs are associated w/ diarrhea?

A 
antibiotics
laxatives
Colchicin
Quinidine
Sorbitol
PPIs
33
Q

What is IBS?

A

functional GI disorder

altered bowel habits
abdominal pain
ab bloating/distension

34
Q

What questions should you ask a pt who presents w/ diarrhea?

A 
nausea 
vomiting
ab cramping
ab bloating
fever
35
Q

What questions do you ask about stools w/ diarrhea complaint?

A

frequency, amot, color, consistency

36
Q

What does a white/bulk stool indicate?

A

small bowel pathology (malabsorption)

37
Q

What are large stools associated with?

A

enteric infection

38
Q

What are small stools associated with?

A

colonic infection

39
Q

What does stool from cholera infection look like?

A

copious rice water diarrhea

40
Q

What are important historical clues for diarrhea?

A

travel
recent change in meds
recent hiking/camping

41
Q

What are some osteopathic treatments for pts presenting w/ constipation?

A

Mesenteric release (lympathic treatment)

42
Q

What is an osteopathic treatment for diarrhea?

A

ganglion inhibition (want to inhibit bowel movement)

PCM II Midterm (15 decks)

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