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PCM III - Exam 2 > Approach to the Patient with an Abdominal Complaint - SRS > Flashcards

Approach to the Patient with an Abdominal Complaint - SRS Flashcards

1
Q

If I say: •medical jargon that refers to any acute condition within the abdomen that requires immediate medical or surgical attention.

You say?

A

Acute abdomen

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2
Q

Riddle me some common symptoms of abdominal disease.

A
  1. –Pain
  2. –Nausea and vomiting
  3. –Change in bowel habits (constipation & diarrhea)
  4. –Rectal bleeding
  5. –Jaundice
  6. –Abdominal distention
  7. –Abdominal mass
  8. –Anorexia
  9. –Dysphagia
  10. –Indigestion
  11. –Hematemesis
  12. –Melena
  13. –Change in stool size
  14. –Weight loss
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3
Q

What are the three types of abdominal pain?

A
  1. Visceral pain (colic pain)
  2. Parietal Pain
  3. Referred pain
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4
Q

Describe the source and character of colic pain.

A

Usually from a hollow organ being distended or stretched.

Comes and goes, crescendo/decrescendo pattern with poorly localized cramping.

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5
Q

Describe the cause and character of parietal pain.

A

Inflammation of the peritoneum.

Steady aching pain that is usually well localized.

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6
Q

What are 7 causes of RUQ pain?

A
  1. Acute cholecystitis
  2. duodenal ulcer
  3. hepatitis
  4. congestive hepatomegaly
  5. pyelonephritis
  6. appendicitis
  7. pneumonia (right sided)
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7
Q

What are four causes of epigastric pain?

A

MI

Peptic ulcer

Acute cholecystitis

Perf. esophagus

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8
Q

What does ERCP stand for?

A

Endoscopic retrogrades cholangiopancreatography

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9
Q

What is melena?

Where is it typically from?

A

–Black tarry stools

–50-60 ml of blood in the stomach can produce melena

–Above the “Ligament of Treitz” (very general rule)

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10
Q

Hematochezia is what?

From where?

What if blood is mixed into stool? Outside stool?

A

–Blood unchanged by passage through the gut usually at the level of the colon or lower

–Blood mixed with stool suggests upper colon, blood outside the stool suggests sigmoid or rectum.

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11
Q

What are five signs/symptoms of jaundice? (three bold)

A

–Yellow skin

–Scleral yellowing

–Pruritus

–Urine color – darken urine from conjugated

–Acholic feces – malodorous, gray to light colored stools

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12
Q

What are five possible etiologies for Unconjugated hyperbilirubinemia?

A
  1. •Hemolysis
  2. •Red cell defects – sickle cell
  3. •Ineffective erythropoiesis
  4. •Deficient hepatic uptake
  5. •Deficient hepatic conjugation – hepatitis
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13
Q

What causes conjugated hyperbilirubinemia?

A

–Impaired excretion of conjugated bilirubin from hepatocytes in the bile canaliculi or obstruction of biliary flow.

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14
Q

What will be seen on the liver function testing that indicates conjugated hyperbilirubinemia?

A

–Serum alkaline phosphatase is elevated out of proportion to the transaminases.

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15
Q

If you see painless jaundice, that is indicative of what?

A

pancreatic cancer.

(apparently very important to know)

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16
Q

What are two general mechanisms of conjugated hyperbilirubinemia?

A

–Intrahepatic cholestasis – hepatocellular disease, drugs, sepsis, primary biliary cirrhosis

–Extrahepatic obstruction – gallstones, biliary carcinoma, sclerosing cholangitis, parasites, pancreatic cancer, pancreatitis

17
Q

What are the four signs of free fluid? (ascites)

A
  1. –Bulging flanks
  2. –Tympany at the top of the abdomen
  3. –Fluid wave
  4. –Shifting dullness
18
Q

What are the nine regions of the abdomen?

A

Right hypochondrium

epigastrium

left hypochondrium

right lumbar

umbilical

left lumbar

right inguinal

suprapubic

left inguinal

19
Q

On auscultation of the abdomen you hear: –high pitched “tinkle” about every 3-5 seconds.

What is this?

A

Normal bowel sounds

20
Q

What is Borborygmi?

A

–Increased, hyperactive bowel sounds,

–Low pitched rumbling

–Hyperperistalsis

21
Q

What are the common locations for abdominal bruits?

A

Aorta

Renal arteries

Iliac Arteries

Femoral Arteries

22
Q

How should the lungs, liver and intestine sound to percussion?

A

–Resonant (lungs) to dull (liver) to tympanic (intestine)

23
Q

You have hepatomegaly if your liver is greater than what in size?

A

10 cm

24
Q

What are the important tests for liver health?

A

Enzymes

  • ALT
  • AST
  • ALP

Function

  • Bilirubin
  • Albumin
  • PT
25
Q

If AST and ALT are significantly elevated, where is the problem likely to be?>

A

Intrahepatic

26
Q

If Alk phos is super high, where is the problem?

A

Likely extrahepatic

27
Q

What are some possibilities for the DDX of CVA tenderness?

A
  1. •Nephrolithiasis
  2. •Pyelonephritis
  3. •Renal cell carcinoma
  4. •DJD
  5. •Pneumonia – lower lobe
  6. •SLE
  7. •Perinephric abscess
  8. •AAA
  9. •Glomerulonephritis
28
Q

What is the most important component of the rectal exam?

A

Inform the patient what is going on. No surprises.

29
Q

What are four components of the appendicitis history to pick up on?

A
  1. –Pain starts peri-umbilical then shifts to the right lower quadrant.
  2. –Nausea and vomiting
  3. –Anorexia
  4. –Fever
30
Q

What is described here?

–place the right leg in a “figure 4”. Press on the right knee while holding down the left iliac crest.

A

Obturator sign

31
Q

What is described here?

–turn patient on left side and extend the right leg to check for psoas muscle inflammation.

A

Psoas sign

32
Q

What are the F’s of acute cholecystitis?

A

–The 5 “f’s” – female, fat, fertile, fair, flatulent.

33
Q

What are some elements of history that should point to acute cholecystitis?

A

–RUQ postprandial pain. Biliary colic pain.

–Pain radiating to the right shoulder.

–Nausea and vomiting.

–Anorexia

–Obesity

–Fever

–The 5 “f’s” – female, fat, fertile, fair, flatulent.

34
Q

What is the diagnostic triad for acute cholecystitis?

A

–RUQ pain, fever and leukocytosis.

35
Q

What are the big causes of acute pancreatitis?

A

–Alcohol use

–Obstruction – gallstones, cancer

–Hyperlipidemia

–Drugs and medications

–Infection

36
Q

What are some common history elements for acute pancreatitis?

A

–Acute onset

–Nausea/vomiting

–Pain radiating to the back

–Constant pain

37
Q

In acute pancreatitis, you may see…

–Low grade fever

–Hypotension

–Decreased or absent bowel sounds

–Epigastric tenderness

–Turner’s sign

–Cullen’s sign

What are the last two things? What are they due to?

A

–Turner’s sign – discoloration around the flanks

–Cullen’s sign – discoloration around the umbilicus

• D/T Hemorrhagic pancreatitis

38
Q
A

PCM III - Exam 2 (3 decks)

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