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Year 1: 2020 PCM II Midterm > Lecture 6: Abdominal Pain I > Flashcards

Lecture 6: Abdominal Pain I Flashcards

1
Q

What are the types of abdominal pain?

A

Visceral Pain
Parietal Pain
Referred Pain

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2
Q

Describe visceral pain.

A

Stimulation of visceral pain fibers

  • distension or stretching of hollow organs
  • not localized
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3
Q

Describe parietal pain.

A

Stimulation of somatic pain fibers

  • inflammation in parietal pleura
  • localized, sharp
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4
Q

Describe referred pain.

A

Pain that originates within abdomen but felt other places

-example: duodenal and pancreatic pain felt in back

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5
Q

What are the more important OLDCAAARTS to focus on for patients presenting with abdominal pain?

A

Location: what quadrant

Aggravating/Alleviating Factors: food

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6
Q

What GI ROS questions should you ask a patient with abdominal pain?

A 
Nausea
Vomiting 
Diarrhea
Black stools
Blood in stools
Blood in vomit
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7
Q

What GU ROS questions should you ask a patient with abdominal pain?

A

Dysuria
Polyuria
Hematuria
Flank or CVA pain

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8
Q

What GYN ROS questions should you ask a patient with abdominal pain?

A

Vaginal Bleeding
Vaginal Discharge
Last Menstrual Period
Possibility of pregnancy

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9
Q

What are some specific GI cases to pay attention to in a patient’s history?

A 
Hepatitis
GERD
IBD
Chronic abdominal pain
Constipation 
Liver issues
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10
Q

What are some specific GI surgical cases to pay attention to in a patient’s history?

A

Abdominal: cholecystectomy, appendectomy
GYN: hysterectomy, tubal ligation, c-section, ovarian cyst

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11
Q

In what order should the physical exam be performed?

A

Inspection
Auscultation
Percussion
Palpation

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12
Q

What are some important landmarks to inspect for?

A

Xiphoid process
Costal margins
Umbilicus
ASIS

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13
Q

What main organs are found in the RUQ?

A

Liver

Gallbladder

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14
Q

What main organs are found in the RLQ?

A

Appendix

Ovary

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15
Q

What main organs are found in the LUQ?

A

Stomach

Spleen

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16
Q

What main organs are found in the LLQ?

A

Colon

Ovary

17
Q

What main organs are found in the epigastric area?

A

Pancreas

18
Q

What are some things to inspect for on the abdominal surface?

A 
Skin color
Surgical scars
Striae (stretch marks)
Dilated veins
Rash
Ecchymoses 
Hernias
19
Q

To listen for bruits, what do you use?

A

Bell of stethoscope

20
Q

What can absent bowel sounds indicate?

A

Long-lasting intestinal obstruction
Intestinal perforation
Mesenteric ischemia

21
Q

What can decreased bowel sounds indicate?

A

Post-surgical ileus

Peritonitis

22
Q

What can increased bowel sounds indicate?

A

Diarrhea

Early Bowel Obstruction

23
Q

What can high pitched bowel sounds indicate?

A

Early intestinal obstruction

24
Q

What can bruits indicate?

A

Vascular obstruction

25
Q

What can friction rub indicate?

A

Inflammation of peritoneal surface of an organ

26
Q

What can venus hum indicate?

A

Increased collateral circulation b/t portal and systemic venous systems

27
Q

When percussing the abdomen, what type of percussion predominates?

A

Tympany: high-pitched and air filled

28
Q

If the spleen is enlarged, what does it do?

A

Expands anteriorly, downward, and medially

29
Q

If the vertical span of the liver is increased, what can that indicate?

A 
Cirrhosis
Lymphoma
Hepatitis
Right-sided heart failure
Amyloidosis
Hemochromatosis 
RIght pleural effusion
30
Q

If the vertical span of the liver is decreased, what can that indicate?

A

Cirrhosis

31
Q

If irregular edges or nodules are palpated on the liver, what can that indicate?

A

Hepatocellular carcinoma

32
Q

If firmness or hardness are palpated on the liver, what can that indicate?

A

Cirrhosis
Hemochromatosis
Amyloidosis
Lymphoma

33
Q

If dullness is percussed at the midaxillary line, what can that indicate?

A

Splenomegaly

34
Q

What is a systematic approach to developing a broad differential diagnosis for GI issues?

A

VINDICATE

  • Vascular
  • Infection/Inflammatory
  • Neoplasm
  • Drugs/Degenerative
  • Iatrogenic/Idiopathic
  • Congenital
  • Autoimmune/allergic/anatomic
  • Trauma
  • Endocrine/environment
35
Q

What are some symptoms of bilary colic secondary to choelithiasis?

A

RUQ Pain

  • Pain can feel sharp, crampy, or like a constant dull ache. –Colic after eating a heavy meal
  • Bilious vomiting
  • Positive Murphy’s sign
36
Q

What are some symptoms of pancreatitis?

A

Epigastric abdominal pain

  • bilious vomiting
  • abdominal pain that radiates to your back.
  • abdominal pain that feels worse after eating.
  • tenderness when touching the abdomen.
37
Q

What are some symptoms of ureterolithiasis?

A

Severe pain in the side and back, below the ribs.

  • pain that radiates to the lower abdomen and groin.
  • pain that comes in waves and fluctuates in intensity.
  • pain on urination.
  • pink, red or brown urine.
  • Cloudy or foul-smelling urine.
  • nausea and vomiting
  • persistent need to urinate.
38
Q

What are some symptoms of appendicitis?

A

RLQ Abdominal Pain

  • pain starts in belly button move to RLQ
  • low grade fever and chills
  • nausea and vomiting
  • loss of appetite.
  • constipation or diarrhea
  • inability to pass gas
  • stomach swelling

Year 1: 2020 PCM II Midterm (14 decks)

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