Chapter 29 Flashcards
1
Q
What is melena?
A
Black tarry stool, caused by upper GI bleed
2
Q
Visceral Pain
A
Organ pain from stimulation of autonomic nerve fibers that surround an organ.
Diffused pain, varies with intensity
Tachycardia, diaphoresis, nausea, vomiting
3
Q
Causes of visceral pain
A
Early appendicitis, pancreatitis, cholecystitis, and intestinal obstruction
4
Q
Somatic Pain
A
Produced by bacterial or chemical irritation of nerve fibers in the peritoneum
Constant pain, specific area, sharp or stabbing
Hesitant to move, involuntary guarding
5
Q
Causes of Somatic pain
A
Appendicitis, inflamed or perforated viscus (ulcer, gallbladder, large or small intestine)
6
Q
Referred Pain
A
Pain in a part of the body considerably removed from the tissues that cause the pain
7
Q
Signs and symptoms associated with acute abdominal pain (5)
A
Nausea, vomiting, anorexia Diarrhea Constipation Change in stool color Chills and fever
8
Q
Causes of Nausea, vomiting, and anorexia with acute abdominal pain (5)
A
Appendicitis Biliary Tract Disease Gastritis High Intestinal obstruction Pancreatitis
9
Q
Causes of diarrhea with acute abdominal pain
A
inflammatory process
10
Q
Causes of constipation with acute abdominal pain (3)
A
Dehydration
Obstruction
Medication-induced decreased intestinal motility
11
Q
Causes of stool color change with acute abdominal pain
A
Biliary tract obstruction (clay colored stools)
Lower GI bleeds (bright red)
Upper GI bleeds (black tarry stools)
12
Q
Causes of chills and fever with acute abdominal pain (4)
A
Appendicitis
Bacterial infection
Cholecystitis
Pyelonephritis
13
Q
Murphy’s sign
A
Cessation of inspiration during examination of the RUQ
14
Q
May indicate acute cholecystitis
A
Murphy’s sign
15
Q
McBurney’s sign
A
Tenderness midway between the anterior-superior iliac spine and the umbilicus
16
Q
May indicate acute appendicitis
A
McBurney’s sign
17
Q
Cullen’s sign
A
Periumbilical bluish discoloration
18
Q
May indicate retroperitoneal hemorrhage, pancreatic hemorrhage or rupture of an AAA
A
Cullen’s Sign and Grey Turner’s sign
19
Q
Grey Turner’s Sign
A
Bluish discoloration of flanks
20
Q
Kehr’s sign
A
Severe left shoulder pain
21
Q
May indicate splenic rupture or rupture of ectopic pregnancy
A
Kehr’s sign
22
Q
Obturator Sign
A
Pain with flexed right hip rotation
23
Q
May indicate appendicitis
A
Obturator sign
24
Q
Psoas Sign
A
Pain when raising a straight leg against resistance
25
May indicate appendicitis, right side AAA
Psoas Sign
26
Ascities
An abnormal accumulation of fluid in the space between the tissues lining the abdomen and the abdominal organs
Caused by hypertension in liver blood vessels and low albumin levels, severe liver disease
27
Orthostatic Positive is what?
From recumbent position to sitting or standing, fall in systolic of 10-15mmHg and rise in the pulse of 10-15 beats a min
Indications significant volume depletion and a decrease in perfusion status
28
Auscultation of bowel sounds
2 minutes in each quadrant, precede palpation and percussion
A significant decrease or lack of may indicate peritonitis or ileus
29
Absent bowel sounds is indicative of what?
Complete GI obstruction
30
Hepatitis A
Spread by fecal-oral route
31
Hepatitis B
Spread by infectious blood
32
Hepatitis C
Spread by infectious blood
33
Pain associated with appendicitis
Initially periumbilical or epigastric, colicky
| Later becomes localize to RLQ, often at McBurney's point
34
Associated findings with appendicitis
```
Guarding tenderness
Positive iliopsoas and obturator signs.
RLQ skin hyperethesia
Anorexia, nausea, vomiting after onset of pain
Low grade fever
```
35
Pain Characteristics with peritonitis
Sudden or gradual onset, generalized or localized, dull or severe and unrelenting, guarding, PAIN ON DEEP INSPIRATION
36
Associated findings with peritonitis
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Shallow respirations
positive Blumberg, Markle, and Balance signs
reduced or absent bowel sounds
nausea and vomiting
positive obturator and iliopsoas tests
```
37
Pain associated with cholecystitis
Severe, unrelenting RUQ or epigastric pain, may be referred to right subscapular area
Caused by inflammation of the gallbladder, mostly from gallstones
38
Associated findings with cholecystitis
RUQ tenderness and rigidity, positive Murphy sign, palpable gallbladder, anorexia, vomiting, fever, possible jaundice
39
Pain with pancreatitis
Dramatic, sudden, excruciating LUQ, epigastric, or umbilical pain, may be present in one or both flanks, may be referred to left shoulder
40
Associated findings with pancreatitis
Epigastric tenderness, vomiting, fever, shock, positive grey turner and Cullen sign, both occur 2-3 days after onset
41
Salpingitis Pain characteristics
lower quadrant, worse on left
42
Associated findings with salpingitis
Nausea, vomiting, fever, suprapubic tenderness, rigid abdomen, pain on pelvic exam
43
Pelvic Inflammatory disease pain
Lower quadrant, increase with activity
44
Associated findings with PID
tender adnexa and cervix, cervical discharge, dyspareunia
45
Diverticulitis Pain
Epigastric, radiating down left side of abdomen, especially after eating, may be referred to back
46
Associated finds with diverticulitis
Flatulence, borborygmus, diarrhea, dysuria, tenderness on palpatation
47
Perforated gastric or duodenal ulcer pain
Abrupt onset in RUQ, may be referred to shoulders
48
Associated findings of a perforated gastric or duodenal ulcer
Abdominal free air and distention with increased resonance over liver, tenderness in epigastrium or RUQ, rigid abdominal wall, rebound tenderness
49
Intestinal obstruction pain
abrupt, severe, spasmodic, referred to epigastrium, umbilicus
50
Associated findings of intestinal obstruction
Distention, minimal rebound tenderness, vomiting, loacalized tenderness, visible peristalsis, bowel sounds absent (paralytic obstruction) or hyperactive high pitched (mechanical obstruction)
51
Volvulus pain
referred to hypogastrium and umbilicus
52
Associated findings of volvulus
Distention, nausea, vomiting, guarding, sigmoid loop volvulus may be palpable
53
Leaking Abdominal aneurysm pain
Steady throbbing midline over aneurysm, may radiate to back, flank
54
Associated findings of leaking abdominal aneurysm
nausea, vomiting, abdominal mass, bruit
55
Biliary stones, colic pain
Episodic, severe, RUQ, or epigastrium last 15 min to several hours, may be referred to subscapular area, especially right
56
Associated findings of biliary stones
RUQ tenderness, soft abdominal wall, anorexia, vomiting, jaundice, subnormal temperature
57
Renal Calculi Pain
Intense, flank, extending to groin and genitals, may be episodic
58
Associated findings of Renal Calculi
Fever, hematuria, positive Kehr's sign
59
Ectopic Pregnancy pain
Lower quadrant, referred to shoulder, agonizing with rupture
60
Associated findings with ectopic pregnancy
hypogastric tenderness, symptoms of pregnancy, spotting, irregular masses, soft abdominal wall, mass on bimanual pelvic examination, ruptured: shock, rigid abdominal wall, distention; positive Kehr and Cullen signs
61
Ruptured Ovarian cyst pain
Lower quadrant, steady, increase with cough or motion
62
Associated findings with ruptured ovarian cyst
vomiting, low grade fever, anorexia, tenderness on pelvic examination
63
Splenic Rupture pain
intense LUQ radiating to left shoulder
64
Bloody vomitus
Hematemesis
65
Hematochezia
Bright red blood from the rectum, usually signifies a bleeding source close to the rectal opening
66
Lower GI bleeding Causes
Diverticulosis, most common
| Others: colon cancers, colon polyps, and IBDs such as ulcerative colitis and Crohn's disease
67
Lower GI bleed complaints
Cramping, abdominal pain, diarrhea (could be bloddy) nausea, vomiting, changes in stool and bowel habits
68
Upper GI Bleed causes
Most common: ulcer disease and variceal rupture
| Other causes: Mallory-Weiss syndome, tumors or cancers of the esophagus or stomach
69
Mallory-Weiss Syndrome
Characterized by massive bleeding after a tear in the mucous membrane at the junction of the esophagus and stomach. Caused by excessive vomiting.
70
Esophageal varices
Veins at the lower end of the esophagus that become enlarged and swollen as a result of portal hypertension
Usually associated with chronic liver disease
71
Diverticulosis definition
The presence of pouchlike herniations (diverticula) through the muscular layer of the colon
72
What is Diverticulitis? What are S/S?
When one or more diverticula become obstructed with fecal matter and they become inflamed
Irregular bowel habits, fever, and LOWER left quadrant pain
Can lead to perforation of the bowel
73
What is Chronic Gastroenteritis? Causes?
Inflammation of the stomach and intestines usually due to microbial infection, hyperacidity, or chronic use of alcohol, NSAIDS and aspirin. May be contracted thru fecal-oral transmission or contaminated food and water
Commonly results from helicobacter pylori
74
Chronic Gastroenteritis S/S?
Epigastric pain, nausea, vomiting, fever, anorexia, mucosal bleeding and epigastric tenderness on palpation. Severe cases can lead to hypovolemia and shock.
75
What is Ulcerative colitis? S/S?
Known as colitis or proctitis. Inflammatory condition of the large intestine caused by ulceration of the mucosa of the intestine. Classified as an IBD. Results in diarrhea.
S/S: fatigue, weight loss, anorexia, rectal bleeding, and loss of body fluids and nutrients.
Occurs equally in men and women
76
What causes Appendicitis? S/S?
Inflammation of the appendix. Occurs when the passage way between the appendix and the cecum is obstructed by fecal matter.
S/S: abdominal pain, cramping, nausea, vomiting, chills, low-grade fever, and anorexia. At first pain is periumbilical and diffuse. Later it becomes intense and localized to LRQ McBurney's point.
If pain diminishes appendix may have ruptured
77
Bowel obstruction Causes
An occlusion of the intestinal lumen.
From an ileus or more commonly: mechanical obstruction such as adhesions, hernias, fecal impaction, polyps, and tumors. Other causes: volvulus, ingested foreign bodies and foreign bodies from anus, more common in kids is intussuception (telescoping)
78
Bowel Obstruction S/S? Issues?
Nausea, Vomiting, abdominal pain, diarrhea, constipation (late finding) and abdominal distention
Greatest danger is perforation of the bowel.
Stool in vomit
79
Zollinger-Ellison syndrome
Increased circulatory gastrin from gastrin-secreting tumors. Results in peptic Ulcers
80
Trace a drop of food
Mouth, Pharynx, Epiglottis, Esophagus, Cardiac Sphincter, Stomach, Pyloric Sphincter, Duodenum, Jejunum, Ileum, Ileocecal sphincter, Cecum, Ascending Colon, Transverse colon, descending colon, sigmoid colon, Rectum, Anal canal, Anus
81
Steps for checking genitalia
Not part of a regular exam, cover and comfortable as possible
82
Peptic Ulcer Disease Causes
High acid and peptic content, irritation, Poor Blood supply, Poor secretion of mucus, Infection H. Pylon
More common in men than women
83
Peptic Ulcer S/S
Occur before meals, during stressful periods. Burning or gnawing discomfort in epigastric region or LUQ
Antacids or vomit may help
84
Pancreatitis Causes
Acute pancreatitis usually results from obstruction by gallstones in the bile duct or by alcohol abuse
Chronic pancreatitis begins as acute but becomes chronic when the pancreas becomes scarred usually from long term and excessive alcohol abuse
85
Jaundice is caused by?
Excess bilirubin, gives yellow coloring
86
Crohn's Disease
Chronic inflammatory bowel disease that affects the ileum, the colon or both. thought to be autoimmune in origin
Characterized by frequent attacks of diarrhea, severe abdominal pain, nausea, fever, chills, weakness, anorexia, and weight loss.
High level of suspicion with history of rectal fistulae or abscesses
87
Acute gastroenteritis bacteria
E. coli and salmonella
