General diagnosis - abdominal exam Flashcards
1
Q
Abdominal aorta aneurysm
A
vascular surgeon
- often asymptomatic
- symptomatic: LBP, pulsating mid-line mass, in abdomen above umbilicus, bruit in region
- saccular or fusiform dilation o aorta below renal aa. caused by atherosclerosis
- abdominal xray: curvilinear lines of calcification adj to Lx vertebra
- US confirms Dx and size
2
Q
Acute pancratitis
A
urgent referral
- sever epigastric pain that radiates through the back
- acute inflammation of pancreas caused by: alcohol abuse, stone in ampulla of vater, viral infection (mumps virus)
- labs: marked elevation of serum amylase and lipase
- CT shows swollen pancreas
- Cullen and Grey Turner’s signs may be present in small % of pts
3
Q
Appendicitis
A
urgent referral (CT confirm Dx)
- periumbilical pain followed by n/v, fever, then pain radiates to right iliac fossa,
- Rovsing’s, psoas or obturator signs may be present
- acute inflammation of appendix (often in kids)
- caused by: fecalith obstructing the orifice of the appendix, viral infection
4
Q
Celiac disease
A
Co-manage with gastroenterologist (recomment gluten-free diet)
- weight loss, fatigue, diarrhea, steatorrhea in adults, failure to thrive in kids
- may have: chronic papular vesicular skin rash-dermatitis herpetiformis
- Gluten hypersensitivity causing chronic disease of the SI.
- MC: iron deficiency anemia, less common: folic acid, B12 deficiency
- labs: elevated antigliadin (IgA) and IgG antibodies: mucosal biopsy confirms Dx
5
Q
Cholecystitis
A
urgent referral
- RUQ pain that can radiate to the rigth infrascapular region, fever, n/v and Murphy’s sign
- common: fair, fat, fertile females in 40’s, 95% associated w/ gallstones
- acute inflammation of the GB (MC E. coli)
- US shows stones in GB better than xray of the abdomen
6
Q
Cirrhosis
A
Co-manage with gastroenterologist
- fatigue, jaundice, palmer erythema, enlarged non-tender liver, gynnecomastia, caput mdusa, esophageal varices and internal hemorrhoids, signs of portal HTN like ascites
- liver condition d/t chronic damage (alcohol abuse, hepatitis C infection)
- Liver function test: elevated liver enzymes (AST, ALT, alkaline phosphatase), bilirubin; liver biopsy confirm Dx
7
Q
crohn’s disase
A
Co-manage with gastroenterologist
- recurrent RLQ pain, diarrhea, fatigue
- characterized by: cobblestone appearance of the mucosa of terminal ileum, skip lesions, non-caseous granulomas
- chronic inflammatory bowel disease (idiopathic)
- Lab: CBC (macrocytic normochromic anemia, Vitamin B12 deficiency)
- endoscopy and biopsy confirm Dx
8
Q
Diabetic ketoacidosis
A
urgent referral
- shortness of breath, acetone smell, polyuria, polydypsia, polyphagia, Kussmaul’s brathin (deep rapid=air hunger) present, 50% pts have abdominal pain
- characterized by: excess ketone production from beta oxidation of fats
- poorly controlled diabetes mellitus (especially Type 1)
- raised Fasting Blood Glucose level, hyperkalemia and ketonuria
9
Q
Diverticulitis
A
urgent referral if bright red rectal bleeding
- lower left sided abdominal pain with blood in stool, low grade fever
- acute inflammation of diverticula in LI (associated w/: lack of iber, after 70yo)
- barium enema or colonoscopy will confirm Dx
10
Q
Ectopic pregnancy
A
urgent referral, 911 if pts BP <90/60
- 6-8wks of amenorrhea followed by lower abdominal pain, vaginal spotting, Kehr’s (left shoulder pain) may be present
- pregnacy developing in uterus (MC in fallopian tube)
- associated w/: previous gonorrhea or chlamydia infection
- abdominal US confirm Dx
11
Q
Epididymo-orhitis
A
hospital referral
- pain in scrotum and periumbilical region, history of dysuria, urinary frequency
- Prehn’s test (reduction of pain w/ elevation of scrotum) may be +
- infection of epididymis and testis (Neisseria infection)
12
Q
Femoral hernia
A
general surgeon referral
- irreducible swelling I. and lateral to pubic tubercle
- defect in femoral canal (MC females)
13
Q
Generalized peritonitis
A
urgent referral
- sever generalized abdominal pain, guarding, fever, ABSENT bowl sounds
- Blumberg’s sign (rebound tenderness)
- acute inflammation of peritoneum d/t rupture of the bowel or ruptured ectopic pregnancy
- xray: distended loops of bowel with multipule air-fluid levels
14
Q
Hepatitis
A
gastroenterologist referral
- fever, n/v, jaundice, tender swollen liver
- acute/chronic inflammation of liver d/t viral infections (hep A, B, C or E0
- Hep A, E are spread vi orofecal route; Hep B, C by sex or contaminated blood
- Labs: elevated liver enzymes (AST, ALT and alkaline phsphatase) and bilirubin
- serology confirms type of virus
15
Q
Inguinal hernia
A
general surgeon referral
- reducible mass in inguinoscrotal region
- congenital defect or traumatic (MC hernia type, M > F)
16
Q
Intestinal obstruciton
A
urgent referral
- cramping abdominal pain, abdominal distention with hyperactive vowel sounds
- blockage of small/large bowel d/t mass or adhesions form previous surgery obstructing bowel from the outside
- abdominal xray: distended loops of bowel with multiple air-fluid levels
17
Q
Irritable bowel syndrome
A
Co-manage with gastroenterologist
- bouts of abdominal pain relieved by defecation, diarrhea, constipation
- closed eye sign may be present; NO confirmatory test
- chronic functional gut disorder (idiopathic)
18
Q
Mesenteric Vascular Occlusion
A
urgent referral (angiography to confirm)
- sever abdominal out of proportion to findings (mild tenderness early), blood in stool, shock (late stage)
- sudden blockage of mesenteric artery/vein
- associated w/: atherosclerosis
19
Q
Nephrotic Syndrome
A
hospital referral
- fatigue, BL ankle swelling, ascites, Muehrcke’s lines (curved transverse lines on the nails), frothy/foamy urine
- chronic disease of kidney affecting basement membrane, associated w/ diabetes mellitus and SLE
- UA: massive proteniuria > 3.5g/d, hypoproteinemia, hypercholesterolemia
- renal biopsy confirms Dx
20
Q
Pelvic Inflammatory disease (PID)
A
hospital referral
- fever, lower abdominal pain, cervical motion tenderness and mucopurulent discharge
- inflammatory disease of the uterus, Fallopian tubes and surrounding pelvic connective tissue (Neisseria gonorrhea or Chlamydia trachomatis)
21
Q
Peptic Ulcer Disease
A
Co-manage with gastroenterologist (stress reduction + dietary modification)
- epigastric pain: worse with food (gastric ulcer) or beter with food (duodenal ulcer), might have melena (black tarry stools) if ulcer bleeds
- ulceration of stomach/duodenum associated w/; helicobacter pylori infection (NSAIDS, smoking or alcohol)
- gastroscopy and biopsy confirm Dx
22
Q
Portal HTN
A
gastroenterologist referral
- fatigue, caput medusae, esophageal varices and internal hemorrhoids, ascites
- cirrhosis complication: blood flow from portal vein to liver is obstructed d/t increase fibrosis
23
Q
Prostatisis
A
urologist referral
- suprapubic/perineal discomfort, dysuria, frequency of urination, tender soft boggy prostate on digital rectal examination
- acute/chronic inflammation of the prostate
- associated w/: E. coli, chlamydia infection
24
Q
Pyelonephritis
A
hospital referral
- chills, fever, n/v, flank pain with costovertebral angle tenderness, + Murphy’s punch
- acute/chronic inflammation of pelvis of kidney and ureter d/t ascending infection from bladder (E. coli MC)
- UA: numerous WBC, WBC casts and bacteria
25
Q
Tertiary Syphilis
A
neurologist referral
- lightning pains in the abdomen (idiopathic) and/or chronic non-healing ulcers with undetermined edges (gumma)
- Romberg’s sign might be present, Argyll Robertson pupils in neurosyphilis
- 3rd stage syphilis caused by Treponema pallidum (can take 3-15y to develop after exposure)
26
Q
Testicular cancer
A
urologist referral
- dull ache in scrotum with enlarged irregular testis and possible gynecomastia (some leydig cells testicualr aners produce estrogen)
- uncommon malignancy in testis (MC type is seminoma)
- spreads to para-aortic lymph nodes
- US confirms the ECHOdensity of the mass and biopsy will confirm Dx
27
Q
Torsion of the testis
A
urgent referral (confirm and surgery)
- sudden onset of testicular or scrotal pain (in periumbilical region), n/v
- (-) Prehn’s sign, affected testis is higher than the other
- uncommon twisting of testis d/t a long mesorchium (testicular mesentery)
28
Q
Ulcerative colitis
A
Co-manage with gastroenterologist
- left sided abdominal pain, fatigue, anemia, recurrent bloody diarrhea
- chronic inflammatory bowel disorder (idiopathic)
- characterized by: superficial ulcerations of the descending and sigmoid colon
- Lab: microcytic and hypochromic anemia (iron deficiency) d/t blood loss
- colonoscopy and biopsy confirm Dx
29
Q
Volvulus
A
urgent referral
- sever abdominal pain, distension with hyperactive bowel sounds
- acute twisting of the bowel on itself (MC in sigmoid colon)
- abdominal xray: classic coffee-bean (inverted U) sign
30
Q
abdominal bruit in midline of epigastrum
A
AAA
31
Q
abdominal bruit left of midline epigastrium
A
unilateral renal artery stenosis
