GI Flashcards
1
Q
PSHx
A
- EtOH increases risk for esophageal cancer and liver cirrhosis
- Diet: if someone has unexpected weight gain or loss ⇒ know # and quality of calorie intake
- Anxiety, depression, stress affects GI tract
- Sexual Hx: # of partners, gender(s) involved, protection
- If female of child bearing age and have abdominal pain ⇒ have to think abt pregnancy
- If men and women have abdominal pain in general ⇒ think of STIs
2
Q
Abdominal Inspection of…
A
- Pt position & appearance
- Position: can pt lie down and keep legs straight?
- If they have inflammation of peritonitis ⇒ can’t keep leg flat and want to lie on side or bent
- contour: is abdomen contour concave or convex?
- color: Pink-purple striae ⇒ found in Cushing syndrome
- distention: 7 Fs that may explain it…
- fat, fetus, fluid, flatulence, feces, fibroid tumor, fatal tumor
- movement:
- Peristalsis should be happening 24/7 in abdomen unless something is wrong w/ colon, small intestines, etc.
- Shouldn’t be able to see peristalsis though
- Pulsations of abdominal aorta can be seen if lying down and can see slight pulsation
- Bounding pulse abnormal
- Peristalsis should be happening 24/7 in abdomen unless something is wrong w/ colon, small intestines, etc.
- urine, stool, emesis (vomit)
3
Q
Abdominal Auscultation
A
- Norm: gurgling sound
- Abnormal: hearing bruits
- Auscultation points…
- aorta, right renal artery, left renal artery, vena cava, right iliac artery, left iliac artery, right femoral artery, left femoral artery
- Bowel sound interpretations…
- Norm: high-pitched gurgles or clicks every 5-15 sec
- Hypoactive/Absent: ↓ of norm sounds
- Norm during sleep
- Causes: paralytic ileus, peritonitis, bowel obstruction, constipation
- Hyperactive (Borborygmi): ↑ of norm sounds
- Norm during postprandial (after dinner/lunch)
- Causes: gastroenteritis or diarrhea
4
Q
Abdominal Percussion
A
- Norm sound over belly: tympany (hollow sound bc there’s more air under there)
- Norm sound over organ: dullness
- Tympany: over-filled viscera (most of abdomen)
- Hyperresonance: base of left lung
- Dullness: solid organs, full bladder
5
Q
Hepatic Percussion
A
- Goal: get liver size
- Norm adults: 6 - 12 cm
- Steps: down from lungs resonance until you hear dullness (mark) + up from from bottom of abdomen’s tympany sound until you hear dullness (mark) + measure distance between those marks
6
Q
Spleen Percussion
A
- Steps:
- Percuss on left lateral side bc that’s where spleen is
- You’ll hear usual abdominal tympany sound
- Ask pt to take deep breath → sound should go to dullness ⇒ suggests splenic enlargement (normal)
- If there’s abnormal splenic enlargement and the percussion sound is still the same dullness that’s normal
- Causes: mononucleosis or lymphoma
7
Q
Indirect Kidneys Percussion
A
- CVA Tenderness Test
- Steps:
- Put one hand where kidney is on back
- Take other fist and pound fist over back of your placed hand
- If pt feels tenderness ⇒ pyelonephritis or musculoskeletal issue
- Pyelonephritis can be narrowed if pt has fever + urine dip test shows UTI
- Pyelonephritis can present w/ flank pain that this indirect percussion can detect
- Causes of enlarged kidneys: hydronephrosis, cysts, or tumors
- Left flank mass ⇒ may represent enlarged left kidney or splenomegaly
- Suspect enlarged kidney if ⇒
- Normal tympany in LUQ
- Can probe w/ fingers between mass and costal margin but not deep to its medial and lower border - Bilateral enlargement suggests ⇒ polycystic kidney disease
8
Q
Abdominal Palpation (Goal, Light, Deep, Norm)
A
- Goal: looking for tenderness and associated signs
- Going from least (light) to most (deep) invasive palpations
- Light palpation: general vague pressing of hand over abdominal area
- Deep palpation: pressing firmer and deeper
- look at pt’s facial expressions while doing both
- norm: pt isn’t in any pain and you feel no abnormalities
9
Q
Liver Palpation (Norm, Abnormal, Steps, etc.)
A
- Norm liver edge: smooth, rounded
- Abnormal liver edge: hard, nodules
- In chronic liver disease ⇒ enlarged palpable liver edge roughly doubles likelihood of cirrhosis
- Steps: Place one hand behind rib cage and other on belly → Tell pt to take deep breath in and exhale → On exhale → you’re trying to get fingers under rib cage and seeing if you can feel edge of liver → Assess for tenderness, size, and feel of overall liver
10
Q
Spleen Palpation (Norm, Left Flank Mass Meaning, Steps)
A
- Norm: no pain or tenderness
- Left flank mass ⇒ may represent splenomegaly or enlarged left kidney
- Suspect splenomegaly if ⇒
- Palpable notch on medial border
- Edge extends beyond midline
- Percussion dull
- Fingers can probe deep to medial and lateral borders
- No probing between mass and costal margin
- Suspect splenomegaly if ⇒
- Steps:
- Two hands w/ opposing pressure to feel for spleen → Ask pt to take deep breath in and out → Inspect pt’s facials for pain/tenderness
11
Q
Ascites
A
- What: excess fluid in peritoneal cavity
- Ascitic fluid in lowest point of abdomen ⇒ produces building flanks
- Sound percussed: dull
- Inspection: Percuss and tap on belly a little ⇒ if wave like movement occurs ⇒ ascites
- Turn pt to side to detect shift in position of fluid lvl (shifting dullness)
- Fluid can appear to be either from fat or ascites →
- If excess mass forms rolls ⇒ abdominal fat
- If excess mass shifts dullness + pt has abdominal muscle pain + mass had rapid size growth + abdomen skin feels tight ⇒ ascites
- S&S:
- Abdominal pain (can also be from fat)
- Tight abdominal skin
- Feels like a full balloon
- Rapid mass size growth over days
- Tx: tap and drain but underlying cause needs to be treated otherwise fluid returns
12
Q
Peritonitis (What + S&S)
A
- What: inflammation of parietal peritoneum
- S&S:
- Guarding: voluntary contraction of abdominal wall, accompanied by grimace that may go away if pt is distracted
- Rigidity: involuntary reflex contraction of abdominal wall from peritoneal inflammation that persists over several exams
- Rebound tenderness: pain expressed by pt after examiner presses down on area of tenderness and suddenly removes hand
- Positive cough test
- Percussion tenderness
13
Q
What are the Specific Intestine Diseases
A
- Diverticulitis
- Small Bowel Obstruction (SBO)
- Paralytic Ileus
- Irritable Bowel Syndrome (IBS)
- Inflammatory Bowel Disease (IBD): Crohn’s Disease and Ulcerative Colitis
- Pancreatitis: Acute and Chronic
- Hepatitis
- Abdominal Aortic Aneurysm (AAA)
14
Q
Diverticulitis
A
- What: something got stuck in diverticula pouch ⇒ causes inflammation and infection of diverticulum
- Usually in LLQ
- Can have pieces of stool gets caught in diverticula pouch
- Diagnose w/: CT (computer tomography scan)
- S&S: LLQ tenderness, Abdominal distention, Pain, Decreased appetite, NV, Fever/Chills
- Management: Hydration, More Fiber, Avoiding nuts and seeds (easier to get stuck), avoiding constipation
- Causes: EtOH, inactivity, low fiber, obesity, smoking
- Common in: > 60 yo adults
15
Q
Small Bowel Obstruction (SBO)
A
- Leads to: dilation of proximal intestine
- Causes:
- Adhesions: scar tissues that develop bc of surgery can cause obstruction
- Malignancy: tumor can cause obstruction
- IBD
- Hernias: bulge that occurs when internal organ or tissue pushes through weakness in abdominal wall or other surrounding tissue
- S&S:
- Abdominal pain and distention
- ↓ bowel sounds (high-pitched → absent)
- ↓ flatulence
- NVD bc you can’t get things down thru system and can’t get things out either
- Diarrhea bc it might mean that they have rlly small area where liquidy stool can get by even w/ large obstruction - Constipation
- Dehydration
- Prognosis: 100% mortality rate if undetected
