PC Exam II Flashcards
pleuritic/MI pain can be referred to where?
upper abd
where can gallbladder pain be referred to?
right shoulder
right posterior chest
where can duodenum/pancreas pain be referred to?
back
when pain is located in the RUQ, what organs can be affected?
lung liver gallbladder stomach bowel R kidney ureter cholecystitis/lithiasis duodenal ulcer
when pain is located in the LUQ, what organs can be affected?
lung heart spleen pancreas L kidney ureter pancreatitis
when pain is located in the RLQ, what organs can be affected?
appendix bowel R ureter ovary/tube/uterus bladder
when pain is located in the LLQ, what organs can be affected?
bowel L ureter ovary/tube/uterus bladder *diverticulitis most common
typical presentation for acute appendicitis:
vague initial symptoms (indigestion, anorexia)
pain: initially poorly localized, mild but constant & increasing (peaks 4-6 hrs, localizes to RLQ)
N/V/D
fever
pain w/cough
can often POINT to location of pain
tenderness at McBurney’s
peritoneal signs (guarding, rebound, obturator, psoas, Rovsing’s)
what is obturator sign?
pain with rotation of R leg w/patient supine and R hip/knee flexed
what is posts sign?
pain w/raised straight leg against resistance
what is Rovsing’s sign?
RLQ pain with palpation of LLQ
what are the diagnostics used to dx acute appendicitis?
CBC w/dff U/A Hcg pelvic exam US (young)/CT (adult)
what are the risk factors for a ruptured AAA?
atherosclerosis HTN PVD smoking male advanced age
what does the USPSTF recommend for AAA screening?
one time men 65-75 who smoke or who have ever smoked
symptoms of a ruptured AAA?
back pain sudden onset severe abd pain pain worse in recumbent position syncope/shock chest pain
who is at highest risk of cholelithiasis/cystitis?
female obese rapid weight loss pregnant/recent pregnancy 40+ comorbidities: DM, IBD, ETOH
s/s associated with cholelithiasis
biliary colic (intermittent or steady RUQ and/or epigastric pain)
often radiates to R should
often follows eating (fatty foods)
mild to severe commonly associated with N/V- lasts 1-6 hrs
s/s associated with acute cholelithiasis
biliary colic that doesn’t go away
fever, chills
what is chariot’s triad?
RUQ pain
fever
jaundice
what is calculus cholecystitis?
critically ill on presentation
what is the PE for cholelithiasis?
RUQ tendernes
+ Murphy’s sign (inability to take a deep breath w/palpation at R costal margin)
fever
jaundice
what diagnostics are used for dx of cholelithiasis?
CBC LFTs Hcg U/A US HIDA
s/s of diverticulitis?
mild to moderate aching abd pain usually LLQ colicky or steady fever \+/- constipation or diarrhea N/V
what is the PE for diverticulitis?
tenderness of suprapubic area/LLQ of varying degrees
possible peritoneal signs (guarding/rebound)
+/- fever
rectal exam
pelvic exam
what diagnostics are used for dx of diverticulitis?
CBC w/diff Hcg U/A stool OB CT-WWO contrast
management of diverticulitis?
cipro + metronidazole close f/u (24-48 hrs) clear liquids- advance to low residue when asymptomatic, increase fiber GI f/u to exclude carcinoma
when should diverticulitis pts be hospitalized?
more severe presentation
peritoneal signs
marked leukocytosis
fever >101
risks of pancreatitis?
ETOH gallstones/obstruction hypertriglyceridemia pregnancy HIV blunt trauma
presentation of pancreatitis?
variable
constant knife-like pain in epigastric/LUQ area or periumbilical
increasing intensity/excrutiating
may radiate to chest/back/L shoulder/flank/LLQ
pain worse supine
rocking motion
N/V
what is the PE for pancreatitis?
epigastric, LUQ tenderness fever hypotension tachycardia hemodynamic instability CV collapse Cullen's sign (bluish hue periumbilicus) ecchymotic discoloration in flank area (Grey Turner's sign) distension decreased/absent bowel sounds
what diagnostics are used for dx of pancreatitis?
CBC w/diff
hCG
U/A
serum chem (including LFTs, BS)
amylase (2-12 hrs after onset of symptoms- not always elevated (drinkers); return to normal after 2-3 days)
lipase (elevated several days AFTER attack, elevated in drinkers and non-drinkers)
what is the ROME III criteria?
recurrent abd pain or discomfort at least 3 days per month in the last 3 months associated with 2 or more of the following:
improvement w/defecation
onset associated with a change in frequency of stool
onset associated with a change in appearance of stool
