PE of abdomen and rectum- Stasio 12/1 Flashcards
common Sx abdominal disease
pain, nausea, change in bowel habits
what is visceral pain
colic pain
hollow organ from distention or stretching
comes and goes, crescendo/decrescendo
what is parietal pain
inflammation of peritoneum
steady pain
referred pain
from distant site
gall bladder- R shoulder
pancreas- back
spleen - L shoulder
epigastric pain ddx?
MI
peptic ulcer
acute cholecystitis
perforated oesophagus
what is melena
black tarry stools
above ligament of treitz
what is hematochezia
red blood usually at level of colon or lower
blood outside of stool suggests what
bleeding in anus
congenital ddx for GI bleed
telangiectasias, hemophilia, meckel diverticulum, A-V malformations
inflammatory immune causes GI bleed
ulcerative colitis, crohns disease, PUD
neoplastic causes GI bleed
polyps, cancer, zollinger ellison syndrome
metabolic/toxic causes GI bleeed
NSAID, Vit K deficiency, anticoagulants
mechanical/trauma causes GI bleed
mallory weiss tear, impaction, intussusception
currant jelly stool, most likely?
intussusception
signs Sx jaundice
yellow, scleral yellowing
pruritis
urine color is dark
acholic feces- malodorous gray-light colored stools
etiologies of increased unconj hyperbilirubinemia
hemolysis sickle cell ineffective erythropoiesis deficient hepatic uptake deficient hepatic conjugation- hepatitis
what other value is elevated in conjugated hyeprbilirubinemia
serum alkaline phosphatase
what can cause conjugated hyperbilirubinemia
intracellular: hepatocellular disease, drugs, sepsis, primary biliary cirrhosis
extrahepatic: gallstone, biliary carcinoma, sclerosing cholangitis, parasites, pancreatic cancer, pancreatitis
painless jaundice is what until proven otherwise
pancreatic cancer
4 signs of ascietes
bulging flanks
tympany at top of abdomen
fluid wave
shifting dullness
Ddx ascites
cirrhosis (80-85%) malignancy (10%) CHF (5%) Tuberculous peritonitis dialysis nephrotic syndrome bile or pancreatic ascites lymphatic tear
Portal HTN triad
hemorrhoids
caput medusa
esophageal varices
what is an ileus
no peristalsis
when can you report a bowel as absent sounds
after 2 minutes
normal liver size
<10cm
MCL
Ddx peritonitis
spontaneous bacterial secondary bacterial pancreatic ascites PID ectopic pregnancy Fitz-Hugh-Curtis syndrome
fitz hugh curtis syndrome
disseminated gonorrhea or chlamydia
out of uterus out of fallopian tubes
liver palpation where
11th 12th rib
ddx hepatomegaly
hepatitis fatty liver cirrhosis CHF carcinoma or metastatic cancer leukemia or lymphoma autoimmune infiltrative sickle cell glycogen storage disease
What liver function levels test for function
bilirubin, albumin and PT
what enzymes are included in liver panel
ALT
AST
ALP
released d/t inflammation, tissue damage or obstruction
what is anasarca
generalized edema
if all liver enzymes elevated but ALP is really really high
extra hepatic
Ddx splenomegaly
infections leukemia/lymphoma EMH CHF polycythemia vera/thrombocytosis SLE RA- feltys syndrome metastatic disease amyloidosis
ddx CVA tenderness
nephrolithiasis
pyelonephritis
renal cell carcinoma
DJD degenerative joint disease
condylotmata cuminata
HPV
condylomata lata
syphilis
procidentia
complete rectal prolapse
