GI/Abdomen - Bates Flashcards
Epigastric = \_\_\_ Umbilical = \_\_\_ Suprapubic/Hypogastric = \_\_\_
upper abdomen
middle abdomen
lower abdomen
The ___ lies lateral to and behind the stomach.
spleen
The bladder accommodates about ___ ml. Rising pressure in the bladder triggers what?
300
The urge to void
Increased ___ pressure can overcome rising pressures in the bladder and prevent ___ from occurring.
intraurethral, incontinence
Voluntary control of the bladder depends on higher centers in the ___ and on ___ and ___ pathways btwn the brain and the reflex arcs of the sacral spinal cord.
brain, motor, sensory
The kidneys are ___ organs. The ___ ___, formed by the lower border of the 12th rib and the transverse processes of the upper lumbar vertebrae, defines where to examine for kidney tenderness.
posterior, costovertebral angle
Abdominal pain, heartburn, n/v, difficulty or pain w/swallowing, vomiting of stomach contents or blood, loss of appetite, and jaundice are all r/t ___ GI symptoms.
upper
Diarrhea, constipation, change in bowel habits, and blood in the stool are all r/t ___ GI symptoms.
lower
___ pain occurs when hollow abdominal organs such as the intestine or biliary tree contract unusually forcefully or are distended or stretched.
Visceral
___ pain is difficult to localize. It is typically palpable near the midline at levels that vary according to the structure involved.
Visceral
___ pain varies in quality and may be gnawing, burning, cramping, or aching.
Visceral
Ischemia stimulates ___ pain fibers.
visceral
___ pain originates from inflammation in the parietal peritoneum.
Parietal
___ pain is a steady, aching pain that is usually more severe than visceral pain and more precisely localized over the involved structure.
Parietal
___ pain is typically aggravated by movement or coughing.
Parietal
Pt’s w/___ pain prefer to lie still.
parietal
___ pain is felt in more distant sites, which are innervated at approximately the same spinal levels as the disordered structures.
Referred
___ pain often develops as the initial pain becomes more intense and seems to radiate or travel from the initial site.
Referred
___ pain may be felt superficially or deeply but is usually localized.
Referred
Visceral periumbilical pain may signify early ___ ___.
acute appendicitis
Doubling over w/cramping colicky pain indicates ___ ___.
renal stone
Sudden knifelike epigastric pain occurs in ___ ___.
gallstone pancreatitis
Pay special attn to any assoc of ___ w/meals, alcohol, meds, stress, body position, and use of antacids.
pain
Chronic or recurrent discomfort or pain centered in the upper abdomen is ___.
dyspepsia
Dys = \_\_\_ pepsia = \_\_\_
bad
digestion
A negative feeling that is nonpainful is ___.
discomfort
What 3 GI symptoms can occur alone and can also be seen in other disorders?
bloating, nausea, belching
Bloating may occur w/___ ___ disease.
inflam bowel
___/___ dyspepsia is a 3-month hx of nonspecific upper abd discomfort or nausea not attributable to structural abnormalities or peptic ulcer disease.
Functional/nonulcer
Pt’s w/chronic upper abd discomfort c/o what 3 things?
heartburn, acid reflux, regurgitation
If pt’s report heartburn, acid reflux, or regurgitation more than once a week, they are likely to have ___.
GERD
Risk factors for ___ include reduce salivary flow (prolongs acid clearance), delayed gastric emptying, certain meds, and hiatal hernia.
GERD
___ is a rising retrosternal burning pain occurring wkly or more often.
Heartburn
___ is aggravated by food such as alcohol, chocolate, citrus fruits, coffee, onions, and pepperment, or positions like bending over, exercising, lifting, or lying supine.
Heartburn
Some pt’s w/GERD may also present w/___ or ___ symptoms. These symptoms include:
respiratory, pharyngeal
coughing, wheezing, aspiration pneumonia, hoarseness, sore throat, laryngitis
___ is difficulty swallowing.
dysphagia
___ is pain w/swallowing.
odynophagia
Some pt’s may have “___ ___”, such as difficulty swallowing, pain w/swallowing, recurrent vomiting, evidence of GI blding, wt loss, anemia, risk factors for gastric CA, palpable mass, or jaundice.
“alarm symptoms”
Pt’s w/uncomplicated GERD who do not respond to empiric therapy, pt’s older than 55, and those w/”alarm symptoms” warrant ___ to detect esophagitis, peptic strictures, or Barrett’s esophagus.
endoscopy
RLQ pain or pain that migrates from the periumbilical region is most likely ___.
appendicitis
In women experiencing acute lower abd pain, consider ___, ___ ___ ___, and ___ ___.
PID, ruptured ovarian follicle, ectopic pregnancy
LLQ pain w/a palpable mass may be ___.
diverticulitis
Diffuse abd pain w/absent BS and firmness, guarding, or rebound on palpation is seen in ___ or ___ ___ ___.
small or large bowel obstruction
Change in bowel habits w/mass lesions indicates ___ ___.
colon CA
Intermittent pain for 12 wks of the preceding 12 months w/relief from defecation, change in frequency of BM’s, or change in form of stool (formed/hard, soft/loose), w/out structural or biochemical abnormalities are symptoms of ___.
IBS
___ is often described as “feeling sick to my stomach.”
nausea
___ is involuntary spasm of the stomach, diaphragm, and esophagus that precedes and culminates ___, which is the forceful expulsion of gastric contents out of the mouth.
Retching, vomiting
Induced vomiting w/out nausea is indicative of ___.
bulimia
Fecal odor occurs w/___.
SBO
___ is coffee-grounds emesis or red blood
hematemesis
Symptoms of blood loss such as lightheadedness or syncope are rare until blood loss exceeds ___ ml.
500
___ is loss or lack of appetite.
Anorexia
Pt’s w/___ may c/o unpleasant abd fullness after eating, and early satiety (inability to eat a full meal).
anorexia
Foods that stick, hesitate, or “don’t go down right” suggest ___ disorders.
motility
Indications of ___ ___ include drooling, nasopharyngeal regurgitation, and cough from aspiration. These may occur in pt’s w/___ or ___.
oropharyngeal dysphagia
stroke, parkinson’s
Regurgitation of undigested food occur in structural conditions like ___ ___.
Zenker’s diverticulum
Difficulty w/solid foods = ___
Difficulty w/solid and liquids = ___.
structural
motility
Flatus is normally about ___ ml/day.
600
Increased water content of the stool results in ___, or stool volume > 200g in 24 hrs.
diarrhea
Lasts up to 2 wks = ___ diarrhea
Lasting 4 wks or more = ___ diarrhea
acute
chronic
Acute diarrhea is usually caused by ___, whereas chronic diarrhea is seen in ___ or ___ ___.
infection, Crohn’s, ulcerative colitis
___ is the constant urge to defecate.
Tenesmus
Oily residue, sometimes frothy, or floating occurs w/___ from malabsorption.
steatorrhea
What meds can cause diarrhea?
PCN, macrolides, magnesium-based antacids, metformin, and herbal/alternative meds
___ should be present for at least 12 wks of the prior 6 months w/at least 2 of the following: fewer than 3 BM’s/wk, 25% of BM’s w/either straining or sensation of incomplete evacuation, lumpy/hard stools, ormanual facilitation.
Constipation
Thin, pencil-like stool occurs in an obstructing “apple-core” ___ of the sigmoid colon.
lesion
___ is black tarry stools
Melena
___ is red/maroon-colored stools
Hematochezia
Melena may appear w/as little as 100ml of bld from ___ GI blding, whereas hematochezia is more than 1000ml of bld from the ___ GI tract.
upper, lower
___ is a yellowish discoloration of the skin and sclerae from increased levels of ___, a bile pigment derived from the breakdown of ___.
Jaundice, bilirubin, Hgb
Impaired excretion of conjugated bilirubin is seen in viral ___, ___, primary ___ ___, and ___-___ cholestasis.
hepatitis, cirrhosis, biliary cirrhosis, drug-induced
___ jaundice can be hepatocellular, from damage to the hepatocytes, or cholestatic from impaired excretion as a result of damaged hepatocytes or intrahepatic bile ducts.
Intrahepatic
___ jaundice arises from obstruction of the extrahepatic bile ducts, most commonly the cystic and common bile ducts.
Extrahepatic
___ or ___ ___ are things that may obstruct the common bile duct.
Gallstones, pancreatic carcinoma
Dark urine indicates impaired excretion of ___ into the GI tract.
bilirubin
Hepatitis, alcoholic cirrhosis, toxic liver damage, GB disease, hereditary disorders are all risk factors for what?
Liver disease
Stress incontinence arises from decreased ___ pressure.
intraurethral
Pain of sudden overdistention accompanies acute ___ ___.
urinary retention
In men, difficulty starting the stream, needing to stand closer to the toilet, straining to void, change in force of stream, and dribbling afterwards are commonly seen in what cases?
partial bladder outlet obstruction
benign prostatic hyperplasia
urethral stricture
___ is an unusually intense and immediate desire to void. This symptoms indicates ___.
Urgency, UTI
___ is pain/burning on urination (sometimes also referred to as difficulty voiding). This symptoms suggests ___.
dysuria, UTI
___ is significant increase of volume of urine in 24-hr period, often exceeding 3L.
Polyuria.
___ is urinary frequency at night.
Nocturia
___ ___ is an involuntary loss of urine that may become socially embarrassing or cause problems w/hygiene.
Urinary incontinence
When increased abd pressure causes bladder pressure to exceed urethral resistance d/t poor urethral sphincter tone or poor support of bladder neck, this results in ___ ___.
stress incontinence
When urgency is followed by immediate involuntary leakage d/t uncontrolled detrusor contractions that overcome urethral resistances, this results in ___ ___.
urge incontinence
When neurologic disorder or anatomic obstruction from pelvic organs or the prostate limits bladder emptying until the bladder is overdistended, this results in ___ ___.
overflow incontinence
___ ___ may arise from impaired cognition, musculoskeletal problems, or immobility.
Functional incontinence
___ is blood in the urine. Must test w/a dipstick and microscopic exam before you dx.
Hematuria
___ pain is typically ex[erienced at or below the posterior costal margin near the CVA.
flank pain
Kidney pain, fever, and chills occur in acute ___.
pyelonephritis
___ pain is a visceral pain, usually produced by distention of the renal capsule and typically dull, aching, and steady.
Kidney
___ pain is usually severe and colicky, originating at the CVA and radiating around the trunk into the lower quad of the abdomen, or possibly into the upper thight and testicle or labium.
Ureteral
___ pain results from sudden distention of the ureter and assoc. distention of the renal pelvis.
Ureteral
Spider angiomas, palmar erythema, peripheral edema, hepatosplenomegaly, and ascites are all symptoms that can be seen in pt’s w/___ ___.
alcohol abuse
Max drinks for women = ___/day or ___/wk
Max drinks for men = ___/day or ___/wk
3, 7
4, 14
Transmission of Hepatisis ___ is fecal/oral route.
A
Groups at increased risk for Hepatitis ___ include travelers to endemic areas, male/male partners, injection/illicit drug users, persons w/chronic liver dis.
A
Hepatitis ___ is spread by sexual contact.
B
Groups at increased risk for Hepatitis ___ include sexual contacts, ppl w/percutaneous or mucosal exposure to bld, adults in occupational exposure settings.
B
Hepatitis ___ is transmitted by repeated percutaneous exposure to infect bld.
C
Groups at high risk for Hepatitis ___ include injection drug users, pt’s transfused w/clotting factors before 1987, bld transfusion or organ transplant before 1992, hemodialysis, HIV inf, birth from a hep-C + mom.
C
When adenomas are detected during colon screening, intervals generally narrow to ___-___ yrs, instead of ___.
3-5, 10
___ is considered the highest standard for colon screening.
Colonoscopy
Diets high in fat and low in calcium, folate, fiber, and fruits and veggies are at higher risk for ___ ___.
colorectal CA
ASA, NSAIDS, estrogen-progesterone therapy reduce the incidence of ___ ___.
colorectal CA
Asymmetry of the abdomen suggests an ___ ___ or a ___.
enlged organ, mass
May see increased peristaltic waves w/___ ___.
intestinal obstruction
The normal aortic pulsation is visible in the ___.
epigastrium
Normal frequency of BS is btwn ___-___ sounds per min.
5-34
___ is prolonged gurgles of hyperperistalsis.
Borborygmi
Tympany is usually heard over areas of ___ or ___. It is a higher, bell-like pitch that is resonant.
gas, air
Dullness is typically heard over ___ or may suggest a ___. It is a blunt, lower-pitched sound that does not resonate.
organs, mass
Deep palpation is usually required to delineate abdominal ___.
masses
A + cough test, guarding, rigidity, rebound tenderness, and percussion tenderness are signs of ___. Before palpating, ask the pt to cough and identify where the cough produces pain.
peritonitis
___ is a voluntary contraction of the abd wall, often accompanied by a grimace.
Guarding
___ is an involuntary reflex contraction of the abd wall that persists over several exams.
Rigidity
Assess for ___ ___ by pressing in and letting go. The maneuver is + if withdrawal produces pain.
rebound tenderness
Liver dullness may be displaced downward by the low diaphragm of ___.
COPD
Normal liver span should be ___-__ cm in rt midclavicular line and ___-___ cm in midsternal line.
6-12
4-8
On inspiration, the liver is palpable about ___ cm below the RCM in the midclavicular line.
3
When spleen size is normal. the percussion note is usually ___.
tympanic
A change in percussion note from tympany to dullness on inspiration suggests splenic ___.
enlgment
The spleen tip is located deep to the ___.
LCM
___ are not usually palpable. ___ is lower than the ___.
Kidneys, right, left
A left flank mass may represent ___ or an ___ ___ ___. Indications of an enlged kidney rather than spleen is ability to probe w/fingers btwn the mass and the costal margin.
splenomegaly, enlged left kidney
Pain elicited on the CVA suggests ___.
pyelonephritis
Bladder volume must be btwn ___-___ before dullness appears.
400-600
Risk factors for ___ are age 65 and older, hx of smoking, male, and first-degree relative w/hx of.
AAA
A periumbilical or upper abd mass w/expansile pulsations that is ___ cm or more wide suggests ___.
3, AAA
A protuberant abd w/bulging flanks may indicate ___.
ascites
___ occurs in increased hydrostatic pressure in cirrhosis, heart failure, constrictive pericarditis, or inferior vena cava or hepatic vein obstruction.
Ascites
After percussing the border of tympany and dullness w/the pt supine, ask the pt to turn onto one side, while percussing again. This is testing for ___ ___.
shifting dullness
In ___, dullness shifts to the more dependent side, whereas tympany shifts to the top.
ascites
To test for a ___ ___, ask the pt or an assistant to press the edges of both hands firmly down the midline of the abd. While you tap on one flank sharply w/your fingers, feel on the opposite flank for an impulse transmitted thru the fluid.
fluid wave
A + fluid wave, shifting dullness, and peripheral edema make the dx of ___ very likely.
ascites
The technique of ___ is where you straighten and stiffen the fingers of one hand together and make a brief jabbing mvment toward the anticipated structure.
ballotte
The pain of ___ classically begins near the umbilicus, then shifts to the RLQ, and ___ or ___ may increase it.
appendicitis, coughing, mvmnt
