Clinical Exam Considerations Right Abdomen

Question 1

What would a HPI look like in a person with Hepatitis A?

Answer 1

• Anorexia
• N/V
• Malaise
• Mild and constant mid epigastric to RUQ pain
• Upper respiratory sx
• Worse in adults than kids

Question 2

What would a PE look like in a person with Hepatitis A?

Answer 2

• Fever
• Enlarged liver (50% cases)
• Splenomegaly (15% cases)
• Jaundice
• Cervical adenopathy

Question 3

What would a HPI look like in a person with Hepatitis B?

Answer 3

Symptoms range from asx to liver failure

• anorexia
• n/v
• Malaise
• abdomen pain constant in the mid epigastric to RUQ region

Question 4

What would a PE look like in a person with Hepatitis B?

Answer 4

• Low grade fever
• Enlargd liver
• Jaundice
• Lasts 2-3 weeks

Question 5

What form of Hepatitis is deccreased due to vaccinations?

Answer 5

Hep B

Question 6

What would a HPI look like in a person with Hepatitis C?

Answer 6

Mild usually asx

• anorexia
• n/v
• Malaise
• abdomen pain constant in the mid epigastric to RUQ region

Question 7

what would a PE look like in a person with Hep C?

Answer 7

• Fever
• enlarged liver
• jaundice

Question 8

What is Cholelithiasis?

Answer 8

• Stones in the gallbladder

Question 9

What Signs and physical exam findings may be present with Cholelithiasis?

Answer 9

• +/- N/V
• no jaundice
• +/- murphy sign
• +/- recurring attacks

Question 10

What is acute cholecystitis?

Answer 10

• Inflammation proximal to the stone causing colicky abdominal pain
• Assoc. with fatty or spicy foods

Question 11

What signs and physical exam findings are assoc with cholecystitis?

Answer 11

• • N/V
• +/- jaundice
• • murphys sign
• • recurring attacks

Question 12

What is Choledocholithiasis?

Answer 12

• Stone in the common bild duct usually coming from the gallbladder, but occassionally spontaneously from the liver
• Double the risk with juxtapapillary duodenal diverticulum

Question 13

Describe Charcot’s Triad seen in Choledocholithiasis.

Answer 13

• Frequent recurring attacks that are severe & last hours
• Chills and fever assoc. with the pain
• Jaundice with abdomen pain

Question 14

Describe Reynold’s Pentad seen in Choledocholithiasis?

Answer 14

Charcot’s triad

• Frequent recurring attacks that are severe & last hours
• Chills and fever assoc. with the pain
• Jaundice with abdomen pain

Plus:

• Hypotension
• Mental status change

Question 15

What are the physical exam findings and signs assoc. with Choledocholithiasis?

Answer 15

• • N/V
• • jaundice
• • murphy
• • recurring attacks

Question 16

when does IBS start?

Answer 16

late teens early 20s

Question 17

What is ROME criteria for IBS?

Answer 17

• abdominal pain
  
  • related to defecation
  • assoc. with change in stool frequency
  • assoc. with change in stool form or appearance

Question 18

What contributes to IBS?

Answer 18

• Abnormal motilityi
• Intestinal inflammation
• Visceral hypersensitivity
• Psychosocial abnormalities
  
  • >50% with IBS have depression anxiety or somatization

Question 19

What is the history for appendicitis?

Answer 19

• Periumbilical pain for ~12 hrs leading to RLQ pain
• N/V after pain starts
• Sensne of constipation
• Low grade fever

Question 20

What are the PE findings for appendicitis?

Answer 20

• Rebound tenderness
• Guarding
• Rovsings sign- palpate left side and get pain on right
• Psoas sign- ext of hip
• OBturator sign- flex and int rotation of hip

Question 21

What are the atypical presentations of appendicitis?

Answer 21

• Pregnancy: uterine displacement of appendix moves pain superiorly
• Elderly: diagnosed later due to vague or mild sx
• Retrocecal appendicitis: less pain and poorly localized, may be left sided, may be flank pain
• Pelvic appendicitis: pelvic pain, urge to urinate/defecate, tenderness on rectal/pelvic exam