Approach to Abdominal Exam 2

Question 1

What is the sound on percussion of the abdomen?

Answer 1

tympanic (for air)

Question 2

What is a Murphy sign?

Answer 2

gall bladder disease

Question 3

What is McBurney’s point?

Answer 3

a location

tenderness over point for apendicitis

Question 4

What is a Rovsing sign?

Answer 4

press over LLQ & ask where it hurts

if pt has apendicitis, will feel pain in RLQ

Question 5

What is the order of examination for the abdomen?

Answer 5

Inspection
Auscultation
Percussion
Palpation

Question 6

Where do you expose the abdomen from during exam?

Answer 6

from xiphoid process to ASIS

Question 7

What are normal findings on abdomen exam?

Answer 7

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

Question 8

What are abnormal findings on abdomen exam?

Answer 8

distended
round
obese
scaphoid
tenderness to palpation
rebound
guarding
rigid

Question 9

What are some common GI issues in primary care?

Answer 9

Constipation
Gastoenteritis
Irritable Bowel Syndrome

Question 10

What is constipation?

Answer 10

a SYMPTOM, not a disease

Question 11

What is the Rome criteria?

Answer 11

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

Question 12

What is considered abnormal about bowel movements?

Answer 12

if less than 1 bowel movement each week

Question 13

What is the Bristol

stool scale?

Answer 13

describes look & feel of feces & passage of fecal material

Question 14

What is considered normal on the Bristol stool scale?

Answer 14

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

Question 15

What is considered constipation on Bristol stool scale?

Answer 15

type 1 & 2

Question 16

What symptoms are associated with constipation?

Answer 16

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

Question 17

What are the most urgent symptoms assoc w/ constipation?

Answer 17

rectal bleeding
abdominal pain
inability to pass flatus
vomiting

Question 18

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

Answer 18

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

Question 19

What do you include in PE for constipation complaint?

Answer 19

abdomen exam

pelvic exam for females (fissure between rectum & vagina)

anorectal exam

Question 20

What does a distension or mass indicate on abdomen exam?

Answer 20

colonic stools or tumors (in LLQ)

Question 21

What do you look for on anorectal exam?

Answer 21

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

Question 22

What are some lifestyle modifications for constipation?

Answer 22

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

Question 23

What is the purpose of the squatty potty?

Answer 23

proper positioning of body for a bowel movement

Question 24

What is diarrhea?

Answer 24

a component of gastroenteritis

Question 25

What is gastroenteritis?

Answer 25

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

Question 26

What tends to cause gastroenteritis?

Answer 26

infectious agents (usually viral) food-borne drug associated

Question 27

What are the 2 major viral gastroenteritis?

Answer 27

Norovirus & rotavirus

Question 28

Norovirus

Answer 28

starts w/ sudden onset of uncontrolled vomiting for 12-48 hrs usually more vomiting think outbreak on cruise-ship or casino

Question 29

Rotavirus

Answer 29

very contagious can be immunized against

Question 30

What are 3 bacterial gastroenteritis?

Answer 30

salmonella C difficile E coli

Question 31

What is the major parasitic gastroenteritis?

Answer 31

Giardia (causes diarrhea, bloating, ab cramping) often get in infected water

Question 32

What drugs are associated w/ diarrhea?

Answer 32

``` antibiotics laxatives Colchicin Quinidine Sorbitol PPIs ```

Question 33

What is IBS?

Answer 33

functional GI disorder altered bowel habits abdominal pain ab bloating/distension

Question 34

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

Answer 34

``` nausea vomiting ab cramping ab bloating fever ```

Question 35

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

Answer 35

frequency, amot, color, consistency

Question 36

What does a white/bulk stool indicate?

Answer 36

small bowel pathology (malabsorption)

Question 37

What are large stools associated with?

Answer 37

enteric infection

Question 38

What are small stools associated with?

Answer 38

colonic infection

Question 39

What does stool from cholera infection look like?

Answer 39

copious rice water diarrhea

Question 40

What are important historical clues for diarrhea?

Answer 40

travel recent change in meds recent hiking/camping

Question 41

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

Answer 41

Mesenteric release (lympathic treatment)

Question 42

What is an osteopathic treatment for diarrhea?

Answer 42

ganglion inhibition (want to inhibit bowel movement)