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PAR3011 - MEDICAL > WEEK 10 > Flashcards

WEEK 10 Flashcards

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USMLE® Step 1 flashcards
1
Q

what are the boundaries of the abdomen

A
  • Diaphragm - top
  • Anterior abdominal wall - front
  • Pelvic skeletal structures - bottom
  • Vertebral column - back
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2
Q

WHat are the areas of the assessment of abdomen for paramedics?

A

Right upper quandrant - Left upper quandrant

Right lower quadrant - Left Lower quadrant

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3
Q

WHat are the areas of the assessment of abdomen rule of 9?

A

right hyperchondriac region - epigastric - L hyperchondriac
R Lumbar - umbillical - L lumbar
R illiac - Hypogastric - L illiac

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4
Q

What is the Mesentery

A

a new organ discovered…

connects all elements of the gastrointestinal tract

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5
Q

what are the abdominal and pelvic cavities?

A

retroperitoneal
peritoneal
pelvic

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6
Q

What are the solid organs of the GIT?

A

Liver
Spleen
Pancreas

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7
Q

What are the hollow organs of the GIT

A 
Stomach
Gallbladder
Duodenum
Small Intestines
– Jejunum
– Ileum
Cecum 
Colon
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8
Q

what are the layers of the GIT Wall?

A

Serosa - connectiv tissue layer
Submucosa
Mucosa
Muscularis- circular muscular layer

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9
Q

what are the types of perforation and ulceration caused by ingesting foreign bodies?

A
  • pressure necrosis (coins)
  • perforation (pins/bones)
  • chemical irritation (batteries/pills)
  • obstruction (hair) -> repunzel syndrome
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10
Q

what are the s&s of GORD/Oesophagitis/Hiatus Hernia?

A
  • Burning sensation in chest
  • Sour taste
  • Difficulty in swallowing
  • Dry cough
  • Sore throat
  • Regurgitation of food/liquid
  • “lump” in throat
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11
Q

what does GORD stand for?

A

gastro oesophageal reflux disease

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12
Q

what are the s&s of oesophageal spasm?

A
  • Similar to cardiac chest pain
  • Difficulty in swallowing
  • Object “stuck in throat”
  • Regurgitation
  • Pain may subside after several minutes
  • Normally have a Hx
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13
Q

What is a a Mallory-Weiss tear?

A

Oesophageal bleeding caused by excessive vomiting

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14
Q

What causes oesophageal varacis?

A

hypertension of the venous portal vein

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15
Q

What are the types of blood seen in Oesophageal bleeding?

A

– Frank – bright red blood
• Non‐digested blood

– Coffee grounds – brown/black with “lumps”
• Digested blood

–> Estimate amount
• Number of towels etc.

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16
Q

What are some key gastric/stomach conditions?

A
  • Hiatus hernia
  • Upper GI bleed
  • Peptic ulcer disease
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17
Q

What is a hiatus hernia?

A

• Protrusion of part of the stomach through

diaphragmatic hiatus into thoracic cavity

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18
Q

What causes hiatus hernias?

A

Higher pressure in abdominal cavity compared to thoracic cavity; obesity, age, heredity

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19
Q

WHat is the presentation of a hiayus hernia?

A 
• Very few patients experience significant symptoms
– epigastric burning,
– nausea,
– regurgitation,
– difficulty in swallowing
Hiatus
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20
Q

What is Upper GIT Bleeding?

A

Bleeding originating proximal to ligament of Treitz

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21
Q

What are some causes of upper GIT bleeding?

A
  • Peptic ulcer disease
  • Erosive gastritis and oesophagitis
  • Esophageal varices (chronic liver disease, portal hypertension)
  • Mallory‐Weiss tear
  • Tumors
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22
Q

What is peptic ulcer disease?

A

• Chronic illness manifested by recurrent
ulcerations in the stomach and proximal
duodenum

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23
Q

What causes peptic ulcer disease?

A

– Bacteria

– Excessive acid secretion

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24
Q

how does peptic ulcer disease usually present?

A

as GIT bleeding

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25
Q

what are some lower GIT conditions?

A
  • Bowel obstruction
  • Ischaemic bowel
  • Diverticular disease
  • Diarrhoea
26
Q

What is a bowel obstruction?

A

• Inability of intestinal tract to allow for regular passage of food and bowel contents
(Mechanical or paralytic)

27
Q

how does bowel obstruction present?

A 
– Abdomen distention
– “bloated”
– Abdomen pain
– Constipation
– Diarrhoea
– vomiting
28
Q

What are some complications of Diverticular Disease?

A

– Older patients at higher risk of free
perforation of colon, which is often fatal.

– Diverticular bleeding usually painless and
results from erosion into the penetrating
artery of the diverticulum

29
Q

what is diverticular disease?

A

break down of colon lining with age

30
Q

what is diverticulitis?

A

• Acute inflammation of the wall of a
diverticulum and surrounding tissue

– Caused by micro or macro perforation
– Common disorder of industralised nations
– 1/3 population acquired by age 50
– 2/3 population acquired by age 85
– Occurs in 10‐25 % of patients with diverticulosis

31
Q

What are some types of liver disease?

A
  • Cirrhosis
  • Viral hepatitis
  • Hepatic failure
32
Q

What are S&S of liver inflammation?

A
  • Malaise, weakness, anorexia
  • Intermittent nausea and vomiting
  • Dull right upper quadrant pain
  • Jaundice, dark urine within 1 week
  • Yellow “white” of eyes
33
Q

What is Liver Cirrhosis

A

– Scar tissue replaces healthy tissue causing
• decrease in liver function
• increased portal hypertension

34
Q

What are the causes of pancreatitis?

A

– 80% of acute pancreatitis cases in US caused
by alcohol or cholelithiasis
– Primary inflammatory (alcohol)
– Secondary obstructive (usually biliary)
– Other: drugs, infection, inflammation, trauma,
metabolic disturbances

35
Q

What are the S&S of pancreatitis?

A 
– Mid‐epigastric/ LUQ pain
– Pain and tenderness can include upper
abdomen only or generalised (thought
to be related to absence of capsule
that might otherwise contain the
inflammation)
– N&V, abdominal bloating
– Cullen's sign (peri‐ umbilical)
– Turner’s sign (flank)
36
Q

What would you see with haemorrhagic pancreatitis

A

Cullens sign

Turners sign

37
Q

What is the most commonly diagnosed GIT disease in ED patients over 50?

A

Biliary tract disease (Gallstones)

38
Q

What can be caused by Biliary calculi (Gall stones)?

A

– Cholecystitis,
– “biliary colic” – symptomatic cholelithiasis
– common duct obstruction
– Gallstone pancreatitis

39
Q

What is Cholelithiasis

A

– Stone migration from gallbladder into biliary tract and eventual obstruction
– Pain, N&V
– If obstruction persists, acute cholecystitis
may develop

40
Q

what is Cholecystitis

A

– Inflammation of gall bladder
– Mechanical, chemical, infectious factors
– Risk factors:
– Pregnancy, elderly, familial tendency, Asian descent, chronic liver disease

41
Q

What is the presentation of cholecytisis

A

– RUQ or epigastric pain most common, with
• back/ shoulder radiation in 1/3
• N&V in ½ of patients;
• 10‐30% jaundiced
– Pain usually persistent, not colicky
• Intermittent and changing from visceral to parietal, with signs of systemic toxicity (tachycardia and fever) with progression

42
Q

What is appendicitis?

A

Acute inflammation of the vermiform
appendix, located in right iliac region

• Inflammation occurs when obstruction
(food matter, adhesions, lymphoid
hyperplasia) occurs leading to infection
• Arterial stasis, oedema leads to tissue
infarction
• Perforation and spillage of infected
appendiceal contents into peritoneum
43
Q

What are the S&S of appendicitis?

A

– Initial pain at umbilicus (visceral)
– Pain moves to Mc Burney’s point (somatic)
– Anorexia, N&V, ? constipation
– Fever is a relatively late physical finding
– Perforation → peritonitis

44
Q

What are the relevant assessment techniques and referred pain locations of the key abdominal pain issues?

A 
Kehrs sign - splenic rupture
McBurneys point - appendicitis
Murphys sign - Gallbladder/Liver
Obturator sign - appendicitis
Psoas sign - appendicitis
45
Q

what is constipation?

A
  • Most common digestive complaint in US

* The presence of hard stools that are difficult/unable to pass

46
Q

What factors impact constipation?

A 
Factors: dietary intake,
fluid intake, exercise,
medical conditions, and
medications affect gut
motility
Constipation
47
Q

what is gastroenteritis?

A

Syndrome consists of diarrhoea,
abdominal cramping or pain, N&V,
lethargy, malaise and fever

• May last for 1/7 – 3/52

• Infection of the GIT mostly transmitted
through faecal‐oral route
– Viruses
– Bacteria
– Protozoa
48
Q

Define diarrhoea?

A

– Diarrhoea is the passage of 3 or more loose or liquid stools per day, or more
frequently than is normal for the individual.

– Diarrhoeal disease kills 1.5 million children every year.
– Globally, there are about two billion cases of diarrhoeal disease every year.

49
Q

What are the 4 basic mechanisms of diarrhoea?

A
  • Increased intestinal secretion
  • Decreased intestinal absorption
  • Increased osmotic load
  • Abnormal intestinal motility
50
Q

Define vomiting?

A

Forceful emptying of the stomach (and intestinal) contents through the mouth
– Differentiate from regurgitation

51
Q

what are the 4 ways in which vomiting centre in medulla is excited?

A
  • Vagal & sympathetic nerves from peritoneum, GI, biliary and genitourinary tracts; pelvic organs, heart, pharynx, head, vestibular apparatus
  • Impulses converging at necleus tractus solitarius in medulla
  • Chemoreceptor trigger zone – 4th ventricle
  • Vestibular or vestibulocerebellar system
52
Q

What is Crohn’s disease

A

– Chronic inflammatory disease
– Can involve any part of GI tract from mouth to anus
– Chronic abdominal pain, anorexia, weight loss, persistent diarrhoea/constipation, painful defecation, fever

53
Q

What is ulcerative colitis?

A

Ulcerative Colitis
• Inflammatory bowel disease
• Ulcerated intestinal mucosa
• Often between 15‐30 y/o

54
Q

What are the S&S of ulcerative colitis?

A 
– Chronic abdominal pain,
– anorexia,
– weight loss,
– persistent diarrhoea/constipation,
– painful defecation,
– fever,
– rectal bleeding
55
Q

What is Acute abdomen?

A

A syndrome characterised by pain,
shock and rigid abdomen, which
constitutes an acute surgical
emergency.

56
Q

What are the vascular casues of acute abdomen?

A 
Mesenteric ischaemia
• Occlusive:
• thrombotic (AF, hypercoagulable state)
• Embolic
• Nonocclusive ‐ low flow state (typically low
flow state due to cardiac disease)

Ischaemic Colitis
• Predominantly older patients, presenting
with diffuse or lower abdo visceral pain,
diarrohea

57
Q

What are some other causes of abdo pain?

A 
• Acute coronary syndromes (and "angina equivalents")
• Pneumonia (especially basilar)
• Spontaneous pneumothorax
• Pulmonary embolus (rare cause)
• Pericarditis
• Diabetic ketoacidosis (DKA)
• Hyperlipidemia (often with
pancreatitis)
• Acute prophyrias
• Sickle cell crisis (sequestration in spleen
or liver, or vaso‐occlusive)
58
Q

What is the difference between Visceral and Somatic pain?

A

– Visceral:
• Deep‐seated, dull pain from hollow viscera or capsule of solid organs
• Poorly localised, falls along midline

– Somatic (Parietal):
• Pain becomes localised over time
• Localises over organ involved
• Pain sharper in intensity and constant
• guarding, rigidity, legs raised, decreased movement
59
Q

What is the difference between Local and Generalised peritonitis

A

– Local:
• Pain over affected organ with palpitation or stretching

– Generalised:
• Blood, gastric contents or pus in peritoneal cavity causes generalised pain with any movement or palpation
– Diaphragmatic irritation → ipsilateral supraclavicular/shoulder pain
– Biliary tract disease → right infrascapular pain

60
Q

What is the pre-hospital test for peritoneal irritation?

A

– Ask patient to cough

• DO NOT USE REBOUND TENDERNESS

61
Q

What are some mimics of acute abdomen?

A 
– DKA
– Food poisoning
– Pneumonia
– PID (pelvic inflammatory disease)
– AAA
62
Q

What are the 4 key steps to abdo assessment?

A
  • Inspection
  • Auscultation
  • Percussion
  • Palpation

PAR3011 - MEDICAL (32 decks)

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