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Physical Assessment > Chapter 3, Module 7; Abdominal Pain > Flashcards

Chapter 3, Module 7; Abdominal Pain Flashcards

1
Q

Age 10-20 yr, although it can occur at any age; patient reports sudden onset of colicky pain that progresses to constant pain; pain can begin in epigastrium or periumbilicus and then later localizes in RLQ; pain worsens with movement or coughing; vomiting after onset of pain is sometimes present

A

Appendicitis

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2
Q

Patient lying still; involuntary guarding; tenderness in RLQ; other tests for peritoneal irritation positive; rebound tenderness; variation in presentation common, particularly with infants, children, and elderly

A

Appendicitis

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3
Q

DIAGNOSTIC STUDIES FOR Appendicitis?

A

CBC with differential, ultrasonography, CT, laparoscopy

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4
Q

Women of childbearing age; sudden onset of spotting and persistent cramping in lower quadrant that begins shortly after missed period

A

Ectopic pregnancy

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5
Q

Signs of hemorrhage, shock, and lower abdominal peritoneal irritation that can be lateralized; enlarged uterus; CMT; tender adnexal mass

A

Ectopic pregnancy

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6
Q

DIAGNOSTIC STUDIES FOR Ectopic pregnancy?

A

Positive hCG, ultrasound; ruptured ectopic pregnancy is surgical emergency

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7
Q

Sudden onset of severe in¬ tense, steady epigastric pain that radiates to sides, back, or right shoulder; history of burning, gnawing pain that worsens with empty stomach

A

Peptic ulcer perforation

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8
Q

Patient lying still; epigastric tenderness; rebound tenderness; abdominal muscles rigid; bowel sounds can be absent

A

Peptic ulcer perforation

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9
Q

DIAGNOSTIC STUDIES FOR peptic ulcer perforation?

A

Diagnosis confirmed by upright or lateral decubitus radiograph showing air under diaphragm or in peritoneal cavity; perforation is surgical emergency

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10
Q

Most frequent in elderly, especially if hypertensive; sudden onset of excruciating pain that can be felt in chest or abdomen and can radiate to legs and back

A

Dissection of aortic aneurysm

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11
Q

Patient lying still; epigastric tenderness; rebound tenderness; abdominal muscles rigid; bowel sounds can be absent Patient appears shocky, vital signs reflect impending shock; deficit or difference in femoral pulses

A

Dissection of aortic aneurysm

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12
Q

DIAGNOSTIC STUDIES FOR Dissection of aortic aneurysm?

A

CT or MRI; additional tests include ECG and cardiac enzymes; surgical emergency

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13
Q

Upper or diffuse abdominal pain; can be accompanied by nausea, vomiting, dyspepsia

A

Myocardial infarction

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14
Q

Hypertension or hypotension, cardiac arrhythmia, paradoxical S2

A

Myocardial infarction

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15
Q

DIAGNOSTIC STUDIES FOR Myocardial infarction?

A

Serial ECGs, serial cardiac enzymes

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16
Q

Occurs more often in elderly; sudden onset of severe pain that is diffuse and worsens with movement or coughing

A

Peritonitis

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17
Q

Guarding; rebound tenderness; bowel sounds decreased or absent

A

Peritonitis

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18
Q

DIAGNOSTIC STUDIES FOR Peritonitis?

A

CBC with differential, abdominal radiographs

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19
Q

History of cholelithiasis or excessive alcohol use; pain is steady and boring in quality and is unrelieved by change of position; located in LUQ and radiates to back; nausea, vomiting, and diaphoresis

A

Acute pancreatitis

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20
Q

Patient appears acutely ill; abdominal distention, decreased bowel sounds, diffuse rebound tenderness; upper abdomen can show muscle rigidity; can have limited diaphragmatic excursion of lungs

A

Acute pancreatitis

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21
Q

DIAGNOSTIC STUDIES FOR Acute pancreatitis?

A

CBC with differential, serum amylase and lipase levels, triglyceride level, calcium level, and liver chemistries; ultrasonography; CT

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22
Q

Fever, pain in RLQ, other symptoms suggestive of appendicitis

A

Mesenteric adenitis

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23
Q

Pain on palpation in RLQ; there can be pharyngitis, cervical adenopathy

A

Mesenteric adenitis

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24
Q

DIAGNOSTIC STUDIES FOR Mesenteric adenitis?

A

CBC with differential; adenovirus found in tissue of surgical specimen

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25
Q

Appears in adults more than in children, females more than males; colicky pain with progression to constant pain; pain in RUQ that can radiate to right scapular area; pain of cholelithiasis is constant, progressively rising to plateau and falling gradually; nausea, vomiting, history of dark urine and/or light stools; may be aggravated by certain foods

A

Cholecystitis/ lithiasis

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26
Q

Tender to palpation or percussion in RUQ; gallbladder palpable in about half cases of cholecystitis; positive Murphy sign

A

Cholecystitis/ lithiasis

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27
Q

DIAGNOSTIC STUDIES FOR Cholecystitis/ lithiasis?

A

CBC with differential, ultrasonography, radiographs, serum amylase and lipase levels

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28
Q

Sudden onset, excruciating intermittent colicky pain that can progress to constant pain; pain in lower abdomen and flank and radiates to groin; nausea, vomiting, abdominal distention, chills, and fever; increased frequency of urination

A

Ureterolithiasis

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29
Q

CVA tenderness; increased sensitivity in lumbar and groin areas; hematuria

A

Ureterolithiasis

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30
Q

DIAGNOSTIC STUDIES FOR Ureterolithiasis?

A

U/A, noncontrast-enhanced helical CT

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31
Q

Urinary symptoms with UTI, back pain with pyelonephritis; infants present with fever, failure to thrive, irritability; toddlers report pain in abdomen; may not report dysuria or frequency

A

Urinary tract infection (UTI)/pyelonephritis

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32
Q

Altered voiding pattern, malodorous urine, fever

A

Urinary tract infection (UTI)/pyelonephritis

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33
Q

DIAGNOSTIC STUDIES FOR Urinary tract infection (UTI)/pyelonephritis?

A

U/A andculture

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34
Q

Lower abdominal pain that becomes progressively more severe; can have irregular bleeding, vaginal discharge, and vomiting; most common in sexually active women

A

Pelvic inflammatory disease (PID)

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35
Q

Abdominal tenderness, CMT and adnexal tenderness (usually bilateral); with peritonitis can also have guarding and rebound tenderness; fever and vaginal discharge common

A

Pelvicinflammatory disease (PID)

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36
Q

DIAGNOSTIC STUDIES FOR Pelvic inflammatory disease (PID)?

A

WBC and ESR usually elevated; DNA testing, cultures and Gram staining for STIs

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37
Q

Sudden onset of crampy pain usually in umbilical area of epigastrium; vomiting occurs early with small intestinal obstruction and late with large bowel obstruction; obstipation or diarrhea

A

Obstruction

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38
Q

Hyperactive, high-pitched bowel sounds; fecal mass can be palpated; abdominal distention; empty rectum on digital examination

A

Obstruction

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39
Q

DIAGNOSTIC STUDIES FOR Obstruction?

A

Diagnosis confirmed with CT, abdominal radiographs

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40
Q

Abdominal distention, vomiting, obstipation, and cramps

A

Ileus

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41
Q

Minimal or absent peristalsis on auscultation

A

Ileus

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42
Q

DIAGNOSTIC STUDIES FOR Ileus?

A

Gaseous distention of isolated segments of both small and large intestines shown on radiographs

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43
Q

Sudden-onset pain in infant; occurs with sudden relief, then pain again

A

Intussusception

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44
Q

Fever, vomiting, currant jelly stools

A

Intussusception

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45
Q

DIAGNOSTIC STUDIES FOR Intussusception?

A

Abdominal films, ultrasound

46
Q

Seen in infants up to 1 mo old; irritability, pain

A

Malrotation/volvulus

47
Q

Bilious emesis, abdominal distention

A

Malrotation/volvulus

48
Q

DIAGNOSTIC STUDIES FOR Malrotation/volvulus?

A

Abdominal films

49
Q

Seen in children age 2-8 yr

A

Henoch-Schonlein purpura

50
Q

Rash on lower extremities/ buttocks; arthralgias; hematuria

A

Henoch-Schonlein purpura

51
Q

DIAGNOSTIC STUDIES FOR Henoch-Schonlein purpura ?

A

CBC, ESR, serum IgA

52
Q

More common in elderly; constant severe pain in RLQ or LLQ that worsens with coughing or straining

A

Incarcerated hernia

53
Q

Hernia or mass that is nonreducible

A

Incarcerated hernia

54
Q

DIAGNOSTIC STUDIES FOR Incarcerated hernia?

A

MRI, CT, ultrasound

55
Q

Children age 2-5 yr can present with only abdominal pain and fever

A

Pneumonia

56
Q

Tachypnea, retractions, pallor, nasal flaring, crackles

A

Pneumonia

57
Q

DIAGNOSTIC STUDIES FOR Pneumonia?

A

CBC, chest radiograph demonstrating infiltrations

58
Q

Begins in adolescence or as young adult; hypogastric pain; crampy, variable infrequent duration; associated with bowel function; associated with gas, bloating, distention; relief with passage of flatus, feces

A

Irritable bowel syndrome (IBS)

59
Q

Normal examination; heme-negative stool

A

Irritable bowel syndrome (IBS)

60
Q

DIAGNOSTIC STUDIES FOR Irritable bowel syndrome (IBS) ?

A

Proctosigmoidoscopy, colonoscopy if onset at middle age/older, stool positive for blood, family history of colorectal cancer or polyps, failure to improve after 6-8 wk of therapy

61
Q

Abdominal pain with chronic bloody diarrhea

A

Crohn disease

62
Q

Abdominal tenderness; weight loss

A

Crohn disease

63
Q

Crampy pain after eating milk or milk products

A

Lactose intolerance

64
Q

Negative physical examination

A

Lactose intolerance

65
Q

DIAGNOSTIC STUDIES FOR Lactose intolerance?

A

Trial elimination of offending foods

66
Q

Localized pain, usually LLQ; older patient

A

Diverticular disease

67
Q

Abdominal tenderness; fever

A

Diverticular disease

68
Q

DIAGNOSTIC STUDIES FOR Diverticular disease?

A

CT, contrast enema, cystography, ultrasound, colonoscopy sometimes useful but not used during acute attack

69
Q

Colicky or dull and steady pain that does not progress and worsen

A

Simple constipation

70
Q

Fecal mass palpable, stool in rectum

A

Simple constipation

71
Q

DIAGNOSTIC STUDIES FOR Simple constipation?

A

None

72
Q

Lifelong history; younger patient

A

Habitual constipation

73
Q

Normal examination; heme-negative stool

A

Habitual constipation

74
Q

DIAGNOSTIC STUDIES FOR Habitual constipation?

A

Sigmoidoscopy, anorectal manometry, colonoscopy if symptoms are alarming

75
Q

Typical premenstrual pain onset soon after menarche, gradually diminishing with age

A

Dysmenorrhea

76
Q

Normal pelvic examination

A

Dysmenorrhea

77
Q

DIAGNOSTIC STUDIES FOR Dysmenorrhea?

A

Gynecology consult; pelvic ultrasound if secondary dysmenorrhea, increasing disability, or abnormal pelvic examination

78
Q

Pain related to menses, intercourse

A

Uterine fibroids

79
Q

Palpable myomas; no suspicion of other pelvic disorder

A

Uterine fibroids

80
Q

DIAGNOSTIC STUDIES FOR Uterine fibroids?

A

Pelvic ultrasound if ovarian or uterine neoplasm cannot be excluded; gynecology consult if abnormal bleeding or severe symptoms

81
Q

Localized pain that increases with exertion or lifting

A

Hernia

82
Q

Physical examination documents hernia

A

Hernia

83
Q

DIAGNOSTIC STUDIES FOR Hernia?

A

MRI, CT, ultrasound, BE if suspect strangulation or bowel obstruction

84
Q

Young woman

A

Ovarian cyst(s)

85
Q

Adnexal pain and palpable ovarian cysts, especially in late cycle (corpus luteum)

A

Ovarian cyst(s)

86
Q

DIAGNOSTIC STUDIES FOR Ovarian cyst(s)?

A

Pelvic ultrasound

87
Q

History of trauma

A

Abdominal wall disorder

88
Q

Visible ecchymosis or swelling; palpable hernia pain with rectus muscle stress; no Gl/genitourinary symptoms

A

Abdominal wall disorder

89
Q

DIAGNOSTIC STUDIES FOR Abdominal wall disorder?

A

CT if internal disease cannot be excluded

90
Q

Burning, gnawing pain in midepigastrium that worsens with recumbency; water brash; pain occurs after eating and can be relieved with antacids; in infant: failure to thrive, irritability, postprandial spitting and vomiting

A

Esophagitis/GERD

91
Q

Physical examination negative; in infants: weight loss, in some cases aspiration pneumonia

A

Esophagitis/GERD

92
Q

DIAGNOSTIC STUDIES FOR Esophagitis/GERD?

A

Endoscopy if symptoms are severe or do not respond to therapy; manometry, pH monitoring

93
Q

Burning or gnawing pain; soreness, empty feeling, or hunger; occurs most often with empty stomach, stress, and alcohol, and relieved by food intake; pain steady, mild, or severe and located in epigastrium; can be atypical in children and minimal in elderly

A

Peptic ulcer

94
Q

Can be epigastric tenderness on palpation

A

Pepticulcer

95
Q

DIAGNOSTIC STUDIES FOR Pepticulcer?

A

H. pylori testing; endoscopy if no response to therapy

96
Q

Constant burning pain in epigastric area that can be accompanied by nausea, vomiting, diarrhea, or fever; alcohol, NSAIDs, and salicylates make pain worse

A

Gastritis

97
Q

Physical examination negative

A

Gastritis

98
Q

DIAGNOSTIC STUDIES FOR Gastritis?

A

No diagnostic testing necessary if patient responds to therapy

99
Q

Occurs at any age and produces diffuse crampy pain accompanied by nausea, vomiting, diarrhea, and fever; can have history of recent travel, family members ill

A

Gastroenteritis

100
Q

Hyperactive bowel sounds will be heard on auscultation; dehydration if severe

A

Gastroenteritis

101
Q

DIAGNOSTIC STUDIES FOR Gastroenteritis?

A

No diagnostic testing needed

102
Q

Vague reports of indigestion, heartburn, gassiness, or fullness; belching, abdominal distention, and occasionally nausea

A

Functional dyspepsia

103
Q

Physical examination negative

A

Functional dyspepsia

104
Q

DIAGNOSTIC STUDIES FOR Functional dyspepsia?

A

H. pylori testing; consider endoscopy if no response to empiric treatment; CBC, FOBT, or FIT

105
Q

Females age 7-10 yr; episodic periumbilical pain lasting more than 1 hr accompanied by nausea, photophobia, headache, and vomiting; family history of migraines

A

Abdominal migraine

106
Q

Physical examination negative

A

Abdominal migraine

107
Q

DIAGNOSTIC STUDIES FOR Abdominal migraine?

A

Rule out other causes of episodic pain

108
Q

Children age 5-10 yr; history of environmental or psychological stress

A

Recurrent abdominal pain (RAP)

109
Q

Physical examination negative

A

Recurrent abdominal pain (RAP)

110
Q

DIAGNOSTIC STUDIES FOR Recurrent abdominal pain (RAP)?

A

CBC, U/A, ESR, FOBT, or FIT, stool for O&P

Physical Assessment (27 decks)

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