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Pt Assess II Final > Chapter 14 - Abdominal > Flashcards

Chapter 14 - Abdominal Flashcards

1
Q

Which race has the highest incidence of colorectal cancer?

A

African Americans

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2
Q

Which race has the lowest incidence of colorectal cancer?

A

Native Americans

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3
Q

The lifetime risk of colonic cancer is 100% for patients with ____

A

Polyposis coli

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4
Q

What kind of diet puts a person at higher risk for colonic cancer?

A

Low fiber

High fat

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5
Q

What is the MC type of liver cancer?

A

Hepatocellular carcinoma

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6
Q

The incidence of liver cancer has been _____

A

Increasing

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7
Q

Rates of liver cancer are highest in which races?

A

Asians, Pacific islanders, Hispanics

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8
Q

MC causes of liver cancer in US/western countries

A

Alcohol-related cirrhosis and fatty liver disease from obesity

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9
Q

MC causes of liver cancer worldwide (outside of US)?

A

HBV and HCV

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10
Q

What increases the risk of pancreatic cancer?

A

Smoke and smokeless tobacco

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11
Q

Which organs are located posteriorly in the abdomen (so unlikely to be palpated)?

A

Kidneys
Duodenum
Pancreas

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12
Q

Why can a child’s kidneys be palpated?

A

Less developed abdominal muscles

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13
Q

What is dysphagia?

A

Difficulty swallowing

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14
Q

What is chyme?

A

Semifluid creamy material produced by gastric digestion of food

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15
Q

Emptying of the stomach is normally complete within:

A

6 hours of eating

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16
Q

When is the flow of pancreatic juice maximal?

A

Approx. 2 hours after a meal

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17
Q

What are the 3 enzymes of chyme?

A

Lipase (fats)
Amylase (starches)
Trypsin (proteins)

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18
Q

Where are bile acids and Vit B12 absorbed?

A

Ileum

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19
Q

What is the dark color of stool caused by?

A

Presence of stercobilin (a metabolite of bilirubin)

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20
Q

What are acholic stools?

A
  • No bile

- Pale brown to gray

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21
Q

Most abdominal disease manifests itself with:

A

Pain!

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22
Q

Abdominal pain can result from:

A
  • Mucosal irritation
  • Smooth muscle spasm
  • Peritoneal irritation
  • Capsular swelling
  • Direct nerve stimulation
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23
Q

3 categories of abdominal pain

A
  1. Visceral
  2. Parietal
  3. Referred
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24
Q

When does visceral pain develop?

A

Hollow abdominal organs contract forcefully or their walls are stretched

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25
Q

How is visceral pain usually described by the patient?

A

Gnawing, burning, aching

Difficult for pt to locate specifically

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26
Q

How does parietal pain develop?

A

Inflammation of peritoneum

  • Extremely severe, patient can locate over a specific organ usually
  • Movement exacerbates the pain
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27
Q

How does pain vary between gastric and duodenal ulcers?

A
  • Gastric: pain 30 mins to 1 hr after a meal

- Duodenal: pain 2-3 hours after eating or before next meal

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28
Q

Nocturnal pain is a symptom of what abdominal condition?

A

Duodenal peptic ulcer

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29
Q

What triad of symptoms are found in abdominal angina?

A

Postprandial pain
Anorexia
Weight loss

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30
Q

What does abdominal angina result from?

A

Obstructive vascular disease in celiac axis or superior mesenteric artery

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31
Q

Cystitis vs. ureteral pain

A
  • Cystitis: dull pressure a/w burning during urination

- Ureteral: extremely severe and colicky

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32
Q

Vomiting resulting from perforation is commonly ____

A

NOT massive

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33
Q

Vomiting resulting from obstruction is:

A

Episodic and at the height of pain

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34
Q

What generally causes persistent vomiting?

A

Toxins

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35
Q

In acute appendicitis, how do pain and vomiting usually present?

A

Pain precedes vomiting usually by a few hours

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36
Q

What is feculent vomitus usually caused by?

A

Intestinal obstruction

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37
Q

_____ is a disease of the colon that produces bloody diarrhea

A

Shigellosis

-Amebiasis is also a/w bloody diarrhea

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38
Q

Describe diarrhea/constipation in patients with colon cancer or diverticulitis

A

Diarrhea and constipation frequently alternate

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39
Q

_____ stools may result from malabsorption syndromes

A

Floating

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40
Q

How does diarrhea classically present in IBS?

A

More in the morning

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41
Q

“Pencil” diameter stools may result from:

A

Anal or distal rectal carcinoma

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42
Q

What are black feces a/w?

A
  • Meds like Pepto Bismol, dietary iron supplements

- Foods like black licorice or blueberries

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43
Q

What is hematochezia and what is it a/w?

A
  • Bright red blood per rectum (BRBPR)

- Can occur from colonic tumors, diverticular disease, ulcerative colitis

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44
Q

What is tenesmus?

A
  • Painful ineffective straining at stool

- Caused by inflammation or a space-occupying lesion (e.g. tumor)

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45
Q

What is a common cause of hematochezia?

A

Hemorrhoidal bleeding

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46
Q

What is melena?

A

-Black, tarry stool-Results from bleeding above the first section of duodenum w/partial digestion of hemoglobin

47
Q

Silver-colored stools

A
  • RARE
  • Pathognomonic of acholic stools with melena
  • Strongly suggestive of cancer of ampulla of Vater in the duodenum
48
Q

Presence of icterus or jaundice results from:

A

Decreased excretion of conjugated bilirubin into the bile

49
Q

Medical jaundice results from:

A

Intrahepatic biliary obstruction

50
Q

Surgical jaundice results from:

A

Extrahepatic biliary obstruction

51
Q

What condition can be linked to ingestion of raw shellfish?

A

Hepatitis A

52
Q

Viral hepatitis is a/w

A

N/V
Loss of appetite
Aversion to smoking (if in the habit)

53
Q

What is the MC chronic blood-borne infection in the US?

A

HCV

54
Q

What is the MC indication for liver transplantation?

A

End stage liver disease secondary to HCV infection

55
Q

How does obstructive jaundice present?

A

Slowly developing accompanied by pale stools and cola-colored urine

56
Q

What is suspected if jaundice accompanied by fever and chills?

A

Cholangitis

57
Q

Cholangitis may result from:

A
  • Stasis of bile in bile duct (gallstone)

- Cancer of pancreas head

58
Q

What are the MC occupational exposures known to cause liver disease?

A
  • Carbon tetrachloride

- Vinyl chloride

59
Q

Abdominal distention may be related to:

A
  • Increased gas in GI tract

- Presence of ascites

60
Q

What can cause increased gas in the GI tract?

A
  • Malabsorption
  • Irritable colon
  • Aerophagia
61
Q

What can cause ascites?

A
  • Cirrhosis
  • CHF
  • Portal HTN
  • Peritonitis
  • Neoplasia
62
Q

What could an abdominal mass be?

A
  • Neoplasm

- Hernia

63
Q

What is the MC complaint of an abdominal hernia?

A

Swelling (may or may not be painful)

64
Q

When is a hernia termed “reducible”?

A

When it can be emptied of its contents by pressure or a change in posture

65
Q

What does a pulsatile abdominal mass indicate?

A

Possible aortic aneurysm!

66
Q

What is pruritus ani?

A

Localized itching of anal skin

*Cleanliness is almost never a factor

67
Q

How are bowel movements characterized in IBD?

A

10-30 watery or blood BMs a day

68
Q

What do patients develop from IBD due to malabsorption?

A

Osteopenia/osteoporosis

69
Q

What is the most reported characteristic of patients with IBD?

A

Dependency

also obsessive-compulsive

70
Q

Is denial an issue with IBD patients?

A

No - typically they are obsessed with the details of their condition

71
Q

How does sexual activity present in patients with IBD?

A
  • Low level
  • Many prefer to be fondled like a child
  • Many reject any genital contact
  • Many view sex as “dirty”, “unclean”
72
Q

What may be the basis of depression in IBD patients?

A

Fear of cancer

73
Q

What is an unappreciated major complication of IBD?

A

Substance abuse

74
Q

Which side should the examiner stand on for abdominal examination?

A

Patient’s right side

75
Q

How should you examine abdominal pain?

A

Examine that area last! Otherwise, abdominal muscles will tighten

76
Q

How do patients present in renal/biliary colic vs. peritonitis?

A
  • Renal/biliary colic writhe in bed, can’t find comfortable position
  • Peritonitis have intense pain on movement so they lay very still in bed
77
Q

How should you evaluate for jaundice?

A

In natural light if possible

78
Q

When does jaundice become apparent?

A

When serum bilirubin exceeds 2.5 mg/dL in adults (above 6 mg/dL in neonates)

79
Q

What can spider angiomas indicate?

A

Sensitive for alcoholic cirrhosis but non-specific (can occur in pregnancy and collagen vascular disorders)

80
Q

Pyoderma gangrenosum

A
  • Tender ulcerations commonly on lower extremities

- A/w IBD, especially ulcerative colitis

81
Q

Half and half nails can indicate:

A

Cirrhosis

Lindsay’s nails

82
Q

Peutz-Jeghers syndrome

A
  • Melanin deposition around and in oral cavity
  • Genetic disorder causing GI and mucocutaneous pigmentation
  • Benign polyps in jejunum (rarely become malignant)
83
Q

Osler-Weber-Rendu syndrome

A
  • Multiple telangiectases of lips, tongue, GI tract

- May bleed insidiously causing anemia

84
Q

How does Cushing’s syndrome present in the abdominal/GI system?

A

Obesity (90% pts)

85
Q

Scaphoid abdomen and what it can be a/w

A
  • Concave

- May be a/w cachexia

86
Q

Protuberant abdomen may result from:

A
  • Gaseous distention of intestines
  • Ascites
  • Massive splenomegaly
  • Obesity
87
Q

When a patient with ascites lays supine:

A

Fluid bulges in the flanks

88
Q

What are silver striae vs. pinkish-purple striae?

A
  • Silver are consistent with weight loss

- Purple are a/w Cushing’s

89
Q

What does an everted umbilicus often indicate?

A

Increased abdominal pressure usually from ascites or a large mass

90
Q

What is Grey Turner’s sign?

A
  • Massive ecchymoses on abdomen or flanks (SC purpura)

- Result of hemorrhagic pancreatitis or strangulated bowel

91
Q

What is Cullen’s sign?

A

Bluish discoloration of the umbilicus resulting from hemoperitoneum of any cause

92
Q

What is caput medusae?

A
  • Dilated veins that appear to radiate from the umbilicus

- Seen in pts with portal HTN

93
Q

What are borborygmi and what are they a/w?

A
  • Low pitched rumbling bowel sounds
  • A/w hyperperistalsis
  • Common in early acute intestinal obstruction
94
Q

When could a peritoneal friction rub be heard?

A

Hepatic or splenic inflammation

95
Q

What is the MC percussion note in the abdomen?

A

Tympany

  • Caused by presence of gas in stomach, SI, colon
  • Suprapubic area may sound dull if bladder is distended or a woman’s uterus enlarged
96
Q

Percussion note over the liver

A

Dull until colon (tympanic)

97
Q

What is Traube’s space?

A
  • Where spleen is found in normal individuals

- Within rib cage against posterolateral wall

98
Q

What is the most sensitive sign for ascites?

A

Shifting dullness

99
Q

What is the most specific sign for ascites?

A

Prominent fluid wave

100
Q

With patients who are ticklish, what may be useful to assist in palpation of the abdomen?

A

Sandwich their hand between your hands

101
Q

Describe rigidity vs. guarding in abdominal exam

A
  • Rigidity is involuntary spasm of abdominal muscles

- Guarding is voluntary spasm of abdominal muscles

102
Q

Murphy’s sign

A
  • Pain is elicited in LUQ on inspiration

- Suggestive of acute cholecystitis

103
Q

What is Sims’ position?

A
  • Left lateral prone

- Used for DRE in pts who are weak and confined to bed

104
Q

What is a sessile polyp?

A

Attached by a base

105
Q

What is a pedunculated polyp?

A

Attached by a stalk

106
Q

What is Blumer’s shelf?

A

Shelflike structure that projects into rectum as a result of infiltration of Douglas’ pouch with neoplastic cells

107
Q

What do the guaiac or benzidine tests assess?

A

Occult blood in the stool

108
Q

What are tests that find colorectal polyps and cancer?

A
  • Flexible sigmoidoscopy every 5 years
  • Colonoscopy every 10 years
  • Double contrast barium enema every 5 years
  • CT colonography every 5 years
109
Q

What are tests that primarily find colorectal cancer?

A
  • FOBT (fecal occult blood test) yearly

- Fecal immunochemical test yearly

110
Q

Anal cancer is ____ in both men and women _____

A

Increasing

worldwide

111
Q

Which populations have higher risk for anal cancer?

A
  • MSM
  • HIV positive
  • Transplant recipients
  • Women with cervical neoplasia
112
Q

What is the leading cancer diagnosed among men in the US?

A

Prostate

113
Q

What population has the highest rates of prostate cancer in the world?

A

African Americans in the US

114
Q

Describe PSA

A
  • Produced by prostate
  • Mostly found in semen, but also blood
  • When cancer develops, PSA rises
  • Many false positives for cancer

Pt Assess II Final (17 decks)

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