The Abdomen Flashcards
0
Q
Visceral periumbilical pain may signify what?
A
Early acute appendicitis from distention of an inflamed appendix
1
Q
Visceral pain in the RUQ may result from what?
A
liver distention against its capsule in alcoholic hepatitis
2
Q
Pain of duodenal or pancreatic origin may be referred where?
A
to the back
3
Q
Pain from the biliary tree may be referred where?
A
to the right shoulder or the right posterior chest
4
Q
Pain from the pleurisy or inferior wall myocardial infarction may be referred to where?
A
the epigastric area
5
Q
Studies suggest neuropeptides such as 5-hydroxytryptophan and substance P, mediate interconnected symptoms of what?
A
pain, bowel dysfunction, stress
6
Q
In emergency rooms, 40-45% of patients have nonspecific pain, but 15-30% need surgery, usually for what?
A
appendicitis, intestinal obstruction, or cholecystitis
7
Q
Doubling over with cramping colicky pain indicates what?
A
renal stone
8
Q
Sudden knifelike epigastric pain occurs in patients with what condition?
A
gallstone pancreatitis
9
Q
Epigastric pain occurs with what two conditions?
A
gastritis and GERD
10
Q
Right upper quadrant and upper abdominal pain are common in what condition?
A
cholecystitis
11
Q
Note that angina from inferior wall coronary artery disease may present as indigestion, but is precipitated by what are relieved by what?
A
precipitated by exertion and relieved by rest
12
Q
Bloating may occur from what three things?
A
Inflammatory bowel disease, belching from aerophagia, or swallowing air
13
Q
Patients with upper abdominal discomfort or pain will have functional dyspepsia, which can be caused by multifactorial causes including what 4 things?
A
delayed gastric emptying, gastritis from H. pylori, peptic ulcer disease, and psychosocial factors
14
Q
What are the risk factors for GERD?
A
reduced salivary flow, delayed gastric emptying, selected medications, and hiatal hernia
15
Q
Note that angina from inferior wall coronary ischemia along the diaphragm may present as what?
A
Heartburn
16
Q
30-90% of patients with asthma and 10% with specialty referral for throat conditions have symptoms like what condition?
A
GERD-like symptoms
17
Q
Patients with uncomplicated GERD who do not respond to empiric therapy, patients older than 55, and those with alarm symptoms warrant endoscopy to detect what?
A
esophagitis, peptic strictures, or Barrett’s esophagus
18
Q
Approximately what percent of GERD patients will have no disease on endoscopy?
A
50%
19
Q
RLQ pain or pain that migrates from the periumbilical region, combined with abdominal wall rigidity on palpation, is most likely to predict appendicitis. However, in women consider what three other conditions?
A
pelvic inflammatory disease, ruptured ovarian follicle, and ectopic pregnancy
20
Q
cramping pain radiating to the right or left lower quadrant may be what?
A
a renal stone
21
Q
Left lower quadrant pain with a palpable mass may be what?
A
diverticulitis
22
Q
Diffuse abdominal pain with absent bowel sounds and firmed, guarding, or rebound on palpation is seen in what condition?
A
small or large bowel obstruction
23
Q
Change in bowel habits with mass lesion indicates what?
A
colon cancer
24
Intermittent pain for 12 weeks of the preceding 12 months with relief from defecation, change in frequency of bowel movements, or change in form of stool without structural or biochemical abnormalities are symptoms of what condition?
irritable bowel syndrome
25
Anorexia, nausea, and vomiting accompany many GI disorders including what?
diabetic ketoacidosis, adrenal insufficiency, hypercalcemia, uremia, liver disease, emotional states, adverse drug reactions, and other conditions
26
Induced vomiting without nausea is indicative of what?
anorexia/bulimia
27
Regurgitation occurs in what three conditions?
GERD, esophageal stricture, esophageal cancer
28
Vomiting and pain indicate what?
small bowel obstruction
29
Fecal odors occur with what conditions?
small bowel obstruction or gastrocolic fistula
30
Hematemesis may accompany what conditions?
esophageal or gastric varices, gastritis, or peptic ulcer disese
31
Symptoms of blood loss such as lightheadedness or syncope depend on what?
The rate and volume of bleeding and are rare until blood loss exceeds 500 mL
32
If a patient complains of abdominal fullness after light or moderate meals or early satiety, what should you consider?
diabetic gastroparesis, anticholinergic medications, gastric outlet obstruction, gastric cancer, early satiety in hepatitis
33
Indicators of oropharyngeal dysphagia include what?
drooling, nasopharyngeal regurgitation, and cough from aspiration in neuromuscular disorders affecting motility such as stroke or Parkinson's disease
34
Gurgling or regurgitation of undigested food occur in structural conditions like what?
Zenker's diverticulum
35
Pointing to below the sternoclavicular notch indicates what?
esophageal dysphagia
36
If solid foods cause dysphagia, consider what conditions?
esophageal stricture, web or schatzki's ring, neoplasm
37
If solids and liquids cause dysphagia, consider what TYPE of disorder?
motility
38
If there is odynophagia, what conditions should you consider?
esophageal ulceration from radiation, caustic ingestion, or infection from Candida, cytomegalovirus, herpes simplex, or HIV
39
For patients who complain about flatus, what should you consider?
aerophagia, legumes or other gas-producing foods, intestinal lactase deficiency or irritable bowel syndrome
40
Acute diarrhea, especially food borne, is usually cause by what?
infection
41
Chronic diarrhea is typically noninfectious in origin, as in what two conditions?
Crohn's disease and ulcerative colitis
42
High-volume, frequent watery stools usually from where?
the small intestine
43
small volume stools with tenesmus, or diarrhea with mucus, pus, or blood occur in what conditions?
rectal inflammatory conditions
44
Oily residue, sometimes frothy or floating, occurs with what conditions?
steatorrhea (fatty diarrheal stools), malabsorption in celiac sprue, pancreatic insufficiency, and small bowel bacterial overgrowth
45
diarrhea is common with the use of what medications?
penicillins and macrolides, magnesium-based antacids, metformin, and herbal and alternative medicines
46
Mechanisms of constipation include what?
slow transit and outlet delay from impaired expulsion
47
Thin, pencil-like stool occurs in what?
An obstructing "apple core" lesion of the sigmoid colon
48
What medications promote constipation?
anti-cholinergic agents, calcium-channel blockers, iron supplements, and opiates
49
Constipation occurs with what conditions?
diabetes, hyperthyroidism, hypercalcemia, multiple sclerosis, Parkinson's disease, and systemic sclerosis
50
Obstipation signifies what?
intestinal obstruction
51
Melena may appear with as little as 100 mL of blood from what (where)?
upper gastro-intestinal bleeding
52
Hematochezia if more than 1000 mL of blood, is usually from where?
lower gastrointestinal bleeding
53
Blood on the surface or toilet paper may occur with what condition?
hemorrhoids
54
Predominantly unconjugated bilirubin occurs from what three mechanisms?
increased production of bilirubin, decreased uptake of bilirubin by the hepatocytes, and decreased ability of the liver to conjugate bilirubin
55
Predominantly unconjugated bilirubin occurs in what conditions?
hemolytic anemia and Gilbert's syndrome
56
Impaired excretion of conjugated bilirubin is seen in what conditions?
viral hepatitis, cirrhosis, primary biliary cirrhosis, and drug-induced cholestasis, as from oral contraceptives, methyl testosterone, and chlorpromazine
57
What two conditions may obstruct the common bile duct?
gallstones or pancreatic carcinoma
58
Dark urine from bilirubin indicated what?
impaired excretion of bilirubin into the gastrointestinal tract
59
Acholic stools may occur briefly in what condition? What condition are they common in?
viral hepatitis, obstructive jaundice
60
Itching occurs in what two conditions?
cholestatic or obstructive jaundice
61
Itching with associated pain may signify what?
Distended liver capsule, biliary colic, or pancreatic cancer
62
Involuntary voiding or lack of awareness suggests what?
cognitive or neurosensory deficits
63
Stress incontinence arises from what?
decreased intraurethral pressure
64
Changes in stream, or hesitating or stopping in the middle of voiding are some problems common in men with either urethral stricture or partial bladder outlet obstruction from what?
benign prostatic hyperplasia
65
Pain of sudden overdistention accompanies what?
acute urinary retention
66
Painful urination accompanies what?
cystitis or urethritis and urinary tract infections
67
If dysuria, what should you consider?
bladder stones, foreign bodies, tumors, acute prostatitis
68
In women, internal burning during urination occurs in what condition?
urethritis
69
In women, external burning during urination occurs with what condition?
vulvovaginitis
70
Urgency suggests what?
bladder infection or irritation
71
In men, painful urination without frequency or urgency suggests what?
urethritis
72
Abnormally high renal production of urine suggests what condition?
polyuria
73
Frequency without polyuria during the day or night suggests what?
bladder disorder or impairment to flow at or below the bladder neck
74
Define stress incontinence
when increased abdominal pressure causes bladder pressure to exceed urethral resistance due to poor urethral spincter tone or poor support of bladder neck
75
Define urge incontinence.
when urgency is followed by immediate involuntary leakage due to uncontrolled detrusor contractions that overcome urethral resistance
76
Define overflow incontinence
when neurologic disorder or anatomic obstruction from pelvic organs or the prostate limits bladder emptying until the bladder is over-distended
77
Functional incontinence may arise from what?
impaired cognition, musculo-skeletal problems, or immobility
78
Kidney pain, fever, and chills occur in what?
acute pyelonephritis
79
Sudden obstruction of a ureter (for example, from renal or urinary stones or blood clots) causes what?
renal or ureteral colic
80
What are three classical abdominal findings that indicate alcohol abuse?
spider angiomas, palmar erythema, and peripheral edema
81
While doing a physical exam of the abdomen, have the patient lay flat - an arched back will do what to the abdominal muscles?
thrusts the abdomen forward and tightens the abdominal muscles
82
Pink-purple striae on the skin of the abdomen indicates what?
Cushing's syndrome
83
Dilated veins on the abdomen can be indicative of what?
hepatic cirrhosis or inferior vena cava obstruction
84
Ecchymosis of the abdominal wall is seen with what conditions?
intraperitoneal or retroperitoneal hemorrhage
85
When observing the contour of the abdomen, what specifically are you looking for?
observe for bulging flanks or ascites, suprapubic bulge of a distended bladder or pregnant uterus, hernias
86
Observing asymmetry when inspecting the contour of the abdomen suggests what?
an enlarged organ or mass
87
When inspecting the contour of the abdomen and observing a lower abdominal mass in a female patient, what should you consider?
ovarian or a uterine cancer
88
Increased peristaltic waves suggests what?
intestinal obstruction
89
Increased pulsation of the aortic pulsation can be significant of what?
an aortic aneurysm or increased pulse pressure
90
Bruits suggests what?
vascular occlusive disease
91
Bowel sounds may be altered in what conditions?
diarrhea, intestinal obstruction, paralytic ileus, or peritonitis
92
A bruit in the epigastrium or each upper quadrant that has both systolic and diastolic components strongly suggests what?
renal artery stenosis as the cause of hypertension
93
What percent of healthy individuals have abdominal bruits?
4-20%
94
Bruits with both systolic and diastolic components suggest what?
turbulent flow from athero-sclerotic arterial disease
95
Friction rubs over the spleen or liver are indicative of what?
hepatoma, gonococcal infection around the liver, splenic infarction, and pancreatic carcinoma
96
A protuberant abdomen that is tympanitic throughout suggests what?
intestinal obstruction
97
Dull areas while percussing the abdomen can indicate what?
a pregnant uterus, an ovarian tumor, a distended bladder, or a large liver or spleen
98
Dullness in both flanks prompts further assessment for what condition?
ascites
99
In what rare condition are the organs reversed - air bubble on the right, liver dullness on the left?
situs inversus
100
Involuntary rigidity (muscular spasm) typically persists despite palpation maneuvers of the abdomen suggests what?
peritoneal inflammation
101
Abdominal masses may be categorized in what 5 ways?
Physiologic (pregnant uterus)
inflammatory (diverticulitis of the colon)
vascular (an abdominal aortic aneurysm)
neoplastic (colon cancer)
obstructive (distended bladder or dilated loop of bowel)
102
What are the signs of peritonitis?
positive cough test, guarding, rigidity, rebound tenderness, percussion tenderness
103
What are the possible causes of peritonitis?
appendicitis, cholecystitis, and a perforation of the bowel wall
104
Estimated liver span by percussion is relatively accurate with a what percent correlation with actual span?
60-70%
105
The span of liver dullness is decreased under what conditions?
when the liver is small, when free air is present below the diaphragm (as in a perforated hollow viscus)
106
Serial observations of decreased liver dullness may show a decreasing span of dullness with resolution of what?
hepatitis, heart failure, or with progression of fulminant hepatitis
107
Liver dullness may be displaced downward by the low diaphragm of what disease?
COPD (note that the span remains normal)
108
Dullness of a right pleural effusion or consolidated lung, if adjacent to liver dullness may falsely do what to the estimate of liver size?
increase the estimate
109
Gas in the colon may produce what?
tympany in the RUQ, obscure liver dullness, and falsely decrease the estimate of liver size
110
Only about half of livers with an edge below the right costal margin are palpable, but when the edge is palpable, the likelihood of what condition roughly doubles?
hepatomegaly
111
What suggests abnormality of the liver in a physical exam?
firmness or hardness of the liver, bluntness or rounding of its edge, and irregularity of its contour
112
An obstructed, distended gallbladder may form an oval mass below the edge of the liver and merge with it. How will the merged area sound during percussion?
dull
113
The edge of an enlarged liver may be missed by making what mistake in palpation?
starting too high in the abdomen
114
Tenderness over the liver suggests what?
inflammation as in hepatitis, or congestion as in heart failure
115
If percussion dullness is present, palpation correctly detects presence or absence of what more than 80% of the time?
splenomegaly
116
Fluid or solids in the stomach or colon may also cause dullness in what location?
Traube's space
117
A change in percussion note from tympany to dullness on inspiration suggests what? Note that this is a positive splenic percussion sign
splenic enlargement
118
Splenomegaly is eight times more likely when the spleen is palpable. What are some causes of this?
portal hypertension, hematologic malignancies, HIV infection, and splenic infarct or hematoma
119
The spleen tip is just palpable where?
deep to the left costal margin
120
A left flank mass may represent what?
marked splenomegaly or an enlarged left kidney
121
If a notch is palpated on medial border, the edge extends beyond the midline, percussion is dull, and your fingers can probe deep into the medial and lateral borders but not between the mass and costal margin, what should you suspect?
splenomegaly
122
Attributes indicating an enlarged kidney rather than an enlarged spleen include what?
preservation of normal tympany in the LUQ, and the ability to probe with your fingers between the mass and the costal margin, but not deep to its medial and lower borders
123
What are the causes of kidney enlargement?
hydronephrosis, cysts, and tumors
124
Bilateral kidney enlargement suggests what?
polycystic kidney disease
125
Pain with pressure or fist percussion suggests what? Note that this may also have a musculoskeletal cause.
pyelonephritis
126
Bladder distention from outlet obstruction may be due to what?
urethral stricture, prostatic hyperplasia, or from medications and neurologic disorders such as stoke or multiple sclerosis
127
Suprapubic tenderness is common in what condition?
bladder infection
128
Risk factors for abdominal aortic aneurysm (AAA) are what?
age 65 or older, history of smoking, male gender, and first-degree relative with a history of AAA repair
129
A periumbilical or upper abdominal mass with expansile pulsations that is 3cm or more wide suggests what?
an AAA
130
Ascites occurs in what conditions?
increased hydrostatic pressure in cirrhosis, heart failure, constrictive pericarditis, or inferior vena cava or hepatic vein obstruction, and may signal decreased osmotic pressure in nephrotic syndrome and malnutrition, or ovarian cancer
131
In ascites, where does dullness shift and where does tympany shift?
tympany shifts to the top, and dullness shifts to the more dependent side
132
An easily palpable impulse, a positive fluid wave, shifting dullness, and peripheral edema suggest what?
ascites
133
Appendicitis is twice as likely in the presence of what? Three times more likely?
twice in guarding, Rosving's sign, and the psoas sign, three times more likely if rigidity and McBurney's point tenderness
134
The pain of appendicitis classically begins near the ________ , shifts to the ___________ , where _______ increases it.
umbilical, RLQ, coughing
135
Localized tenderness anywhere in the RLQ, even in the right flank, may indicate what?
appendicitis
136
Early voluntary guarding may be replaced by involuntary muscular rigidity and signs of what?
peritoneal inflammation
137
Pain in the right lower quadrant during left-sided pressure is a positive what?
Rovsing's sign
138
Increased abdominal pain on either maneuver constitutes what?, suggesting irritation of the psoas muscle by an inflamed appendix
psoas sign
139
Right hypogastric pain constitutes a positive sign for what, from irritation of the obturator muscle by an inflamed appendix?
obturator sign
140
Right-sided rectal tenderness may also be caused by what?
an inflamed adnexa or an inflamed seminal vesicle
141
A sharp increase in tenderness with a sudden stop in inspiratory effort constitutes what sign?
A positive Murphy's sign of acute colecystitis
142
The buldge of a hernia will usually appear with what action?
ask the patient to raise both head and shoulders off the table
143
The cause of intestinal obstruction or peritonitis may be missed by overlooking what?
a strangulated femoral hernia
144
A mass in the abdominal wall remains palpable, but an intra-abdominal mass is obscured by what?
muscular contraction
