Test 3 (Unit 11) Abdominal, Male GU, and Rectal

Question 1

Abdominal Pain

Answer 1

Can be related to the heart - ESP, if the person is diabetic

Question 2

Acute abdominal pain

Answer 2

Take BP, pulse (in indication of whether they are deteriorating)

Question 3

Peritonitis

Answer 3

Inflammation of the peritoneum, the thin tissue that lines the inner wall of the abdomen.

Question 4

S/S of Peritonitis

Answer 4

Rigid, board-like abdomen
Severe rebound
Involuntary guarding

Question 5

Onset and Progression

Answer 5

Acute surgical abdomen: pain progressing to vomiting.

With medical problem, vomiting birth and pain later.

Question 6

Inspect First

Answer 6

Tangential light. Get down, and look across the plane.

Question 7

Listen next

Answer 7

5 minutes to determine “no bowel sounds”

Question 8

The smaller the opening in the wall…

Answer 8

The more likely the ‘strangulation’

Question 9

Labs to consider

Answer 9

Complete metabolic panal, CBC with differential.

Looking for “shift to the left” on CBC - immature neutrophils are mounting an infection, but total WBC has not risen yet

Question 10

Labs to consider (continued)

Answer 10

Amylase, Lipase (if you think the liver is involved)

UA - ALWAYS. Women of childbearing age must do pregnancy

STDs - gonorrhea, chlamydia… ascending infection. They go “up” from the vagina

Always do hemocult

Question 11

EKG

Answer 11

EKG on ANYONE with acute abdominal pain (50+) and/or CAD risk (diabetes)

Abdominal pain could be Agina!

Question 12

High fever, lethargy, chills

Answer 12

Think shock or peritonitis

Question 13

Pain exaggerated by movement

Answer 13

Think peritonitis

Question 14

Restless, writhing patient

Answer 14

Think renal or binary colic (it is soothing to be rocking)

Question 15

Peritonitis patients are super still

Answer 15

When things move around and hit the gut, it will hurt!!

Question 16

X-rays

Answer 16

Only diagnostic 50% of the time in abdomen

Only for renal stones, bowel or gas patterns

Question 17

Cancer

Answer 17

Is a common cause of abdominal pain in elderly patients

Question 18

1 cause of blood in stool for adults

Answer 18

Is Diverticulitis

Question 19

With belly pain…

Answer 19

Sometimes it is just your clinical judgement - which can make us new providers nervous

Question 20

MSK pain in ribs, reproducible, between ribs

Answer 20

Constacondritis

Question 21

Timing is important

Answer 21

With reflux, GERD… eating a big meal causes the pain vs. peptic or duodenal ulcer, when eating can actually soothe the pain because the acid has something to complete with. It isn’t simply gnawing away at the ulcerated tissue.

Question 22

Diverticulitis

Answer 22

An inflammation or infection in one or more small pouches in the digestive tract. Commonly causes left lower quadrant pain. #1 cause of blood in stool (diverticulitis)

Question 23

REBOUND TENDERNESS

Answer 23

Look at diagram

Front: liver, gallbladder, duodenum. upper right shoulder

From back: pancreas. upper left shoulder

Question 24

Palpation

Answer 24

Always start away from the pain

Question 25

ROS with physical exam

Answer 25

“If you review it, you have to touch it”

Question 26

Dyspnonia

Answer 26

Pain with talking. Pretty significant finding. Will need a scope.

Question 27

Odynophagia

Answer 27

Pain with eating. Pretty significant finding. Will need a scope.

Question 28

Hematuria

Answer 28

Blood in urine. In men, must assume it is cancer until you can rule it out.

Question 29

Rapid weight loss…

Answer 29

Can lead to gallbladder disease

Question 30

Bowel sounds

Answer 30

Hyper-active vs. Hypo-active

Question 31

Palpation

Answer 31

Always do light first, always start away from the pain. Be mindful of “creepy” touch

Question 32

Hernia

Answer 32

Try to replace the hernia by pushing it back in

Question 33

Lipomas

Answer 33

Little fatty tissue

Question 34

Obese vs. Ascites

Answer 34

Ascites - accumulation of fluid. Fluid is dull!

Question 35

Indurated

Answer 35

Hard, raised, red, warm

Question 36

Imaging

Answer 36

Ultrasound vs. CT scan

Abdominal tumor - need CT scan with and without contrast

Ascites - ultrasound (they can see free-fluid in the belly with ultrasound)

Question 37

1 hand, 2 hand

Answer 37

1 hand = general landscape

2 hands = where you get the information

Question 38

Palpate liver

Answer 38

Have patient breath in, and as they breathe out push in!

Question 39

Percusssion

Answer 39

Palpate liver should be DULL (solid organ)

Expected sounds: hyper resonance (air filled), tympany, resonance

Question 40

Rebound tenderness

Answer 40

Sign of peritoneal irritation

Question 41

Markle sign (“heel jar”)

Answer 41

Stand on tiptoes, jar down will cause pain to localized where the problem is.

Sign of appendicitis, peritoneal irritation

Question 42

McBurney’s sign

Answer 42

Rebound tenderness at McBurney’s point is appendicitis

Question 43

Murphy Sign

Answer 43

Respiratory cessation at costal margin –> Gallbladder.

**A positive Murphy’s sign is NOT pain with palpation, it is the gasp (the respiratory cessation)

Question 44

Rovsing sign

Answer 44

Palpate left and increased pain on the right

Question 45

Alarming features requiring endoscopy

Answer 45

> 55 yo new onset upper GI pain (sign something is wrong. ppl will have it before then)

Weight loss

Iron deficiency anemia (esp. if male)

All patients with GERD, not controlled on meds, needs endoscopy

Question 46

Colonoscopy

Answer 46

Q 10 years age 50-75

Consider risk and family history for 20+