Gastrointestinal Flashcards
organs of the right upper quadrant
liver (right lobe), gallbladder, duodenum, pancreas (head), right kidney (upper pole), right adrenal gland, hepatic flexure of colon, ascending colon, traverse colon and stomach (pylorus)
organs of the left upper quadrant
stomach, liver (left lobe), spleen, pancrease (body), latter adrenal gland, left kidney (upper pole), splenic flexure of colon, transverse colon, descending colon
organs of the right lower quadrant
right kidney, cecum, appendix, ascending colon, right ovary, right fallopian tube, right ureter, right spermatic cord
organs of the left lower quadrant
left kidney, descending colon, sigmoid colon, left ovary, left fallopian tube, uterus (if enlarged), left ureter, left spermatic cord
components of the large intestine
ascending, transverse, descending colon, the rectum and the anal canal
pain of appendicitis
perimubilical or epigastric pain, starts colicky then localizes to RLQ
pain of cholecystitis
sever epigastric or RUQ pain that refers to the shoulder
pain of diverticulitis
epigastric pain radiates to the left side of the abdomen especially after eating
pain of intestinal obstruction
sever, abrupt, spasm-like pain that refers to umbilicus and epigastrium (described as gripping)
pain of leaking abdominal aneurysm
steady, throbbing, midline, pain over aneurysm that may radiate to back or flank (described as tearing)
pain of pancreatitis
acute, excruciating, LUQ umbilical or epigastric pain that may be referred to the flank and left shoulder. pain may be so severe that fainting occurs.
pain of perforated gastric or duodenal ulcer
abrupt, RLQ pan that may refer to shoulder, described as burning
pain of rupture of abdominal organ
pain is felt all, no localization
pain of biliary stones
intense pain in the RUQ described as cramping
pain of GERD
occurs 30-60 minutes after a meal
important associated symptoms
projectile vomiting (head injury, cranial lesion, pyloric obstruction), fever (viral syndrome, appendicitis), diaphoresis, dizziness, chest pain (MI), vomiting followed by eagerness to eat again and weight loss (pyloric stenosis)
nausea without vomiting
common in patients with hepatocellular disease, pregnancy and metastatic disease
quality of vomitus
stomach contents - acute gastritis
greenish-yellow - biliary conditions
billious fecal smelling - obstruction
GI conditions associated with stomach resection
dumping syndrome, anemia, delayed emptying, malabsorption
GI conditions associated with esophageal resection
fat malabsorption, abnormal swallowing and obstruction
GI conditions associated with small bowel resection
steatorrhea, fat malabsorption, anemia (vit B12 malabsorption), and short bowel syndrome
GI conditions associated with pancreatic resection
insufficient insulin secretion, glucagon, and pancreatic enzymes
inspection of the abdomen
inspect for striae, scars, veins, ecchymoses, hernia, inflmmation of ubilicus, blugling flakns, suprapublic bulges, tumores, peristaltic waves, pulsations
auscultation of the abdomen
in all 4 quadrants for bowel sounds, bruits over the renal artery, iliac arteries, femoral arteries, and aorta, for friction rubs of liver tumor or splenic infarct, venous hum in the epigastric and umbilical area to the right of the midline (indicate increased collateral circulation between the portal and venous system)
percussion of the abdomen
percuss for patterns of tympany and dullness, looking for ascites, go obstruction, pregnant uterus, ovarian tumor, purcuss for size of liver and spleen
palpate the abdomen
lightly and then deeply for masses or tenderness, tumors, distention, rebound tenderness
normal liver spans
4-8 cm at the midsternal line and 6-12 cm in right midclavicular line
sounds of the abdomen on percussion
hyperresonnance around umbilicus, tyranny over stomach and small intestines, dullness over liver and spleen
rebound tenderness
pain that increases when deep palpation ends, usually indicating peritoneal irritation. If presen int eh RLQ (McBurne’s point) it suggests appendicities
murphy’s sign
when palpating deeply ask the patient to take a deep breath, if they stop mid-inspiration due to pain, this is a positive murphy’s sign
obturator test
to assess for ruptured append or plevic infection, place patient in supine position with right left flexed at hip and kneed. place a hand just above the patient’s knee with your other hand at the ankle rotate the patients leg internally and externally, if the patient feels pain in the hypogastric area, the appendix may be ruptured or the patient has pelvic infection
additional exam for complaint of abdominal pain
pelvic exam, rectal exam
choleycystitis/choleylithiasis
pain in the epigastrium or RUQ, radiating to the high scapular region or back, severe, dull, boring or constant in nature, develops hours after a meal and occurs frequently at night, with associated symptoms of nausea , vomiting, pleuritic pain and fever. On exam, fever, epigastric or RUQ tenderness, fullness in RUQ, murphy’s sign, guarding during palpation, jaundice (20%), sepsis
peptic ulcer disease
abdominal pain in the epigastrium to LUQ, buying, might radiate to tieback, occurs 1-5 hours after eating, relieved by food, antacids (duodenal), or vomiting (gastric), following a daily pattern specific to the patient.
on exam mild epigastric tenderness, normal bolwel sounds, and sign of peritonitis or GI bleeding (fever and pain)
pancreatitis
pain in the epigastrium or URQ, may radiate to the back, recent surgeries and invasive procedures, family history of hypertriglycerieds, history of biliary colic and binge ETOH consumption, N/V
On exam fever, tachdrdia, tachypnea, hypotension, abd. tenderness, distention, guarding on palpation, rigidity, mild jaundice, dim or absent blowl sounds, asilar rals on lung ascultation, Grety-Turners’s sign and cullen’s sign
Grey-Turner’s sign
bluish discoloration of the flanks in pancreatitis
Cullen’s sign
bluish discoloration of the periumbilical area
the four F’s
common characteristics of a choleycystitis patient - female, over forty years old, fair comlextion, fat
