Week 2 Abdomen Flashcards
Common or concerning symptoms of GI disorders
Indigestion
Nausea
Vomiting
Hematemesis
Abdominal pain
Dysphasia
Odynophobia
Change in bowel functions
Constipation
Diarrhea
Jaundice
Ask the patient about bowel movements
Frequency of BMs
Consistency
Pain with BM
blood, black/tarry stool
Color
Jaundice
History taking of problems of the abdomen
Prior medical problems related to abdomen
Surgeries of abdomen
Any foreign travel and occupational hazards
Use of tobacco, alcohol, illegal drugs
Med history
Hereditary disorders
Regurgitation
Vomiting
History taking of problems of abdomen: urinary tract
Frequency
Urgency
Pain
Color and smell
Difficulty starting
Leakage
Back pain
Visceral (somatic or nociceptive) pain
Forceful contraction or distention of hollow organs (stomach, colon). Solid organs (liver, spleen) can also generate this type of pain when they swell against their capsules
Gnawing cramping colicky aching
Parietal pain (inflammatory)
Inflammation from the hollow or solid organs that affect the parietal peritoneum. Parietal pain is more severe and is usually easily localized (ex appendicitis)
Referred pain
Originates at different sites but shares innovation from the same spinal level
Abdominal exam rubric
Inspect
Auscultation
Percuss
Light palpate
Deep palpate
Palpate other organs
Tympany
High pitched musical sound that indicates a hollow space filled by air or gas in stomach/intestines
Dullness
Suggests fluid or underlying organs like spleen or liver
Signs of acute abdomen
Abdominal pain with coughing
Rigidity
Guarding
Rebound tenderness
Percussion tenderness
Costovertebral angle (CVA)
Ulnar side of first lightly tap to note tenderness
Obturator sign
+ pain with inward rotation of hip with knee bent
Flip on left side, bring leg into flexion
Psoas sign
+pain with hand on thigh, ask patient to raise in opposition; contracts psoas muscle and produces pain in RLQ
Rovsings sign
+rebound tenderness of RLQ on palpitation of LLQ
3 techniques to determine appendicitis
Obturator sign
Psoas sign
Rovsings sign
Inspection of Abdomen
contour
pulsations or peristalsis visible
scars, ecchymoses, rashes
umbilicus
Ausculatation of Abdomen
all 4 quadrants
note quality and frequency of sounds
normal- 5-34 /min
Borborygmi
stomach growling
hyperperistalsis
can hear without stethoscope
mcburney’s point
appendicitis
Murphy’s sign
cholecystitis
+ pain on palpation RUQ, just under ribs
Grey Turner’s sign
pancreatitis
discoloration of left flank
rare
Cullen’s sign
pancreatitis
discoloration surrounding umbilicus
Somatic/visceral/tension pain
caused by an increased forcefulness of peristaltic contraction–> acute stretching of an organ capsule
inflammatory pain
caused by inflammation of peritoneum
starts generalized, later localizes to location of organ
deep, intense pain worsening with movement or coughing
examples of possible diagnoses for somatic/visceral/tension abdominal pain
bowel obstruction, gastroenteritis, food-related
examples of possible diagnoses for inflammatory abdominal pain
appendicitis, cholecystitis, pancreatitis
ischemic abdominall pain
caused by inceased O2 demand and decreased O2 supply in the gut
deep intense continuous pain worsening with actiivities that increase O2 demand such s eating
examples of possible diagnoses for ischemic abdominal pain
ischemic bowel, mesenteric artery, ischemia/infarct
warning signs of “surgical abdomen”
intractable pain
acute, progressive pain over time
pain causing syncope or disturbing sleep
old surgical scars on the abdomen
localized pain
cholecystitis definition
inflammation of gallblader
subjefctive findings of cholecystitis
acute pain in RUQ with radiation to R shoulder
N/V
subjective fever
historical risk factors of cholecystitis
prior gallbladder disease, family history, recent fatty meal, acute illness, >40, females>males
objective/physical exam findings for cholecystits
+murphy’s sign
low grade fever
jaundice
diagnostics for cholecystitis
RUQ US
HIDA scan
liver enzymes, WBC, CRP
historical findings for pancreatitis
alchohol abuse *
HLD
medication induced (Diabetetes)
vascular disease
hyperparathyroidism and hypercalcemia
renal transplant pt
subjective findings for pancreatits
severe abdominal pain (RUQ or Epigastric) with radiation to the back
severe N/V
subjective fever
physical exam for pancreattisis
abdominal tenderness/distention, hypoactive bowel sounds, signs of severe disease/shock, diaphoresis
diagnostics for pancreatitsi
high amylase and lipase
leukocytosis
CT scan
abdominal Xrays
historical findings for appendicitis
common ages 10-30
gynecologic disorders aned gastroenteritis commonly present as appendicitis
peritonisits development in approx 36 hours
subjective findings for appendicitis
severe RLQ pain
nausea
loss of appetitie
feeling need to defecate
increased pain with movement or cough
subjective fever
objective findings for appendicitis
RLQ rebound tenderness
rosvings sign, obturator sign, psoas sign
fever
diverticulitis
inflammation of a diverticulum
historical findings for diverticulitis
> 60
connective tissue disease
marfan syndrome
chronic constipation
history of diverticula
subjective findings for diverticulitis
generalized LLQ pain
subjective fever
constipation or diarrhea
N/V
very GENERAL symptom
diagnostics for diverticulitis
CT scan can confirm, but usually done by clinical diagnosis
+stool for occult blood
leukocytosis
abdominal film
colonoscopy once less inflammed 7-10 days
historical risk factors for GERD
medication use
common triggers such as citrus, tomatoes, caffeine, alcohol, chocolate
smoking
obesity
GERD
the lower esophageal sphincter decreased resting tone, it allows gastric contents to go back up into the esphageal area and that relaxation that causes GERD
subjectie findings for GERD
heartburn
relieved by antacids
frequent belching
cough,wheeze,aspiration,hoarseness, sensation of globus
diagnostics for GERD
clinical diagnosis
trial of PPI
endoscopy if not resolved
historial risk factors for PUD
h pylori infection
NSAID use
systemic corticosteroid use
age >50-55
differences between gastric ulcer and duodenal ulcer
gastric- pain worsens after eating
duodenal- improves with eating
indications for EGD
Bleeding
odynophagia
weight loss (unplanned)
early satiety
dysphagia
historical risk factors of ectopic pregnancy
endometrisis, multiple D&Cs, abortions, history of tubal infection, infertility, PID, previous tubual surgery, IUD
subjective findings of ectopic pregnancy
amenorrhea followed by spotting
sudden onsent of sever elower abdominal pain
back pain
physical exam for ectopic pregnancy
tenderness on pelvic exam with palpable mass and blod in he pculdesac
abdominal distention with peritoneal signs
diagnostics for ectopic pregnancy
urine or serum hCg
pelvic US
immediate surgery if rupture
urinary calculi historical factors
men>women
heavy sodium/protein diet
hot humid climate
fam history
subjective findings of urinary calculi
pain in flank, RLQ, LLQ, suprapubic area
severe acute colicky pain
N/V
urgency or frequency
report of hematuria
physical exam for urinary calculi
CVA tenderness
otherwise normal
