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530 Health Assessment > Week 9: Abdomen > Flashcards

Week 9: Abdomen Flashcards

1
Q

What symptoms are more consistent with GI pain? (13)

A
  1. abdominal pain
  2. indigestion
  3. nausea
  4. vomiting
  5. hematemesis
  6. anorexia
  7. early satiety
  8. dysphagia
  9. odynophagia
  10. change in bowel function
  11. diarrhea
  12. constipation
  13. jaundice
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2
Q

What symptoms are more consistent with GU pain? (12)

A
  1. suprapubic pain
  2. dysuria
  3. urgency
  4. frequency
  5. hesitancy
  6. decreased stream
  7. polyuria
  8. nocturia
  9. incontinence
  10. hematuria
  11. flank pain
  12. ureteral colic
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3
Q

What are the screening recommendations for colorectal cancer?
What are the recommendations for stool based tests vs. direct visualization tests?
What are the recommendations for high risk patients?

A

USPSTF: colorectal cancer screening in average-risk adults from 50-75

Stool based tests
- FIT annually
- Fecal occult blood testing annually
- FIT DNA every 1 or 3 years
Direct visualization tests
- Colonoscopy every 10 years
- Sigmoidoscopy every 5 years
- Flexible sigmoidoscopy every 10 years with FIT every 3 years

High risk persons: personal hx of colorectal cancer, long-standing IBS - start screening earlier than age 50

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4
Q

What are the screening recommendations for alcohol abuse? Hepatitis C?

A
  • Alcohol abuse: all primary care patients

- Hepatitis C: those born between 1945-1965

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5
Q

What are the screening recommendations for an abdominal aortic aneurysm? How do you perform this assessment?

A

Men over 50 who have smoked

Assessment: press deeply into the upper abdomen with one hand on each side of the aorta - should be approx 3 cm wide

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6
Q

When auscultating the abdomen, what would be normal findings? What would bruits indicate? Venous hum? Friction rubs?

A

Normal bowel sounds occur 5-34x per minute
Bruit: hepatic indicates carcinoma of the liver or cirrhosis; arterial bruits suggest partial occlusion of the aorta or large arteries
Venous hum: indicates increased collateral circulation between portal and systemic venous systems (hepatic cirrhosis)
Friction rubs: inflammation of the peritoneal surface of an organ
Palpation: normal abdominal assessment you should not be able to feel individual organs

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7
Q

What should a systolic bruit + hepatic friction rub make you suspect?

A

carcinoma of the liver

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8
Q

How would you describe visceral pain?

A
  • nonspecific and difficult to localize
  • Quality: gnawing, burning, cramping, aching
  • Occurs when hollow organs contract forcefully or are distended or stretched, or when capsules of solid organs are stretched, can occur with ischemia
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9
Q

How would you describe parietal pain?

A

Parietal pain: steady, aching pain, more precisely localized, will be aggravated by coughing or moving
Example: occurs in peritonitis

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10
Q

How would you define referred pain? What is an example?

A

Referred pain: felt in more distant sites that are innervated at approximately the same spinal levels as the impaired structure

Example: pain from the duodenal or pancreatic origin may be referred to the back

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11
Q

What techniques can the FNP use to assess the liver? In the pediatric patient?

A

Percussion to determine size and palpation of the liver edge

Percussion is better for assessment in pediatrics than palpation

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12
Q

What techniques can the FNP use to assess for ascites?

A

Percuss from area of central tympany to area of dullness on supine patient

Test for shifting dullness

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13
Q

Define dysphagia, what are some etiologies (3)?

A

Dysphagia: difficulty swallowing, food seems to not go down right

Etiologies: oropharyngeal dysphagia, esophageal dysphagia (mucosal rings and webs; esophageal stricture, esophageal spasm), motor disorders (diffuse esophageal spasm, scleroderma, achalasia)

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14
Q

Define odynophagia, what are some etiologies (7)?

A

Odynophagia: painful swallowing

Etiologies: esophageal ulceration from ingestion of aspirin or NSAIDS, caustic ingestion, radiation, infection with candida, CMV, HSV, HIV

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15
Q

What is the murphy sign and what does it indicate?

A

deeply palpate the RUQ at the location of the pain, ask the patient to take a deep breath - positive sign if sharp halting in inspiratory effort due to pain from palpation of the gallbladder

Indicates cholecystitis

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16
Q

What is the psoas sign and what does it indicate?

A

place hand above the R knee and ask them to raise the thigh against your hand

Indicates appendicitis (psoas irritation due to appendix inflammation)

17
Q

What is the obturator sign and what does it indicate?

A

flex the R thigh at the hip, with the knee bent rotate the leg internally at the hip

Indicates appendicitis (obturator irritation due to appendix inflammation)

18
Q

What is the Rovsing sign and what does it indicate?

A

referred rebound tenderness to the RLQ when pressing on the LLQ

Indicates appendicitis

19
Q

What is rebound tenderness and what does it usually indicate?

A

pain expressed by the patient after the examiner presses down on an area of tenderness and suddenly removes the hand

Indicates peritonitis

20
Q

What are the characteristics of appendicitis?

Location, quality, timing, aggravating factors, relieving factors, associated symptoms and setting

A

Location: poorly localized periumbilical pain, usually RLQ

Quality: mild but increasing, possibly cramping; steady and more severe

Timing: continues to worsen until treatment

Aggravating factors: movement or cough

Relieving factors: Consider perforation if the pain subsides temporarily

Associated symptoms and setting: anorexia, nausea, possibly vomiting, low fever

21
Q

What are the characteristics of cholecystitis?

Location, quality, timing, aggravating factors, relieving factors, associated symptoms and setting

A

Location: RUQ or epigastrium pain, may radiate to R shoulder or interscapular area

Quality: steady, persistent, aching

Timing: Gradual onset, course longer than in biliary colic

Aggravating factors: prior history of biliary colic symptoms

Relieving factors: N/A

Associated symptoms and setting: anorexia, nausea, vomiting, fever

22
Q

What are the characteristics of pancreatitis? (Acute vs. chronic)
Location, quality, timing, aggravating factors, relieving factors, associated symptoms and setting

A

Location: epigastric pain may radiate to the back or other areas of the abdomen

Quality: sharp, knife-like pain; steady, progressive and severe

Timing: acute or chronic

Aggravating factors: movement; alcohol, medication

Relieving factors: hydration, bowel rest

Associated symptoms and setting: nausea, vomiting, abdominal distention; pancreatic enzyme insufficiency, diarrhea with steatorrhea, DM

23
Q

What are the characteristics of diverticulitis?

Location, quality, timing, aggravating factors, relieving factors, associated symptoms and setting

A

Location: LLQ, pelvic

quality: may be cramping at first, then steady
timing: often gradual onset

aggravating factors: N/A

relieving factors: analgesia, bowel rest, abx

associated symptoms and setting: fever, diarrhea, urinary symptoms, anorexia, tender underlying mass

24
Q

What are the characteristics of obstruction?

Location, quality, timing, aggravating factors, relieving factors, associated symptoms and setting

A

Location: generalized abdominal pain, nonspecific

quality: cramping, colicky
timing: progressive, intermittent

aggravating factors: ingestion of food or liquids

relieving factors: bowel rest, hydration

associated symptoms and setting: no passage of flatus or bowel movement, nausea, vomiting, progressive abdominal distention

25
Q

What history and exam findings are consistent with IBS? (Timing and associated symptoms)

A

timing: worse in the morning, rarely at night; pain for 12 weeks in preceding 12 months

associated symptoms: crampy lower abdominal pain, abdominal distention, flatulence, nausea, urgency, pain relived with defecation, change in frequency and form of BMs

26
Q

What are the characteristics of dyspepsia?

Location, quality, timing, aggravating factors, relieving factors, associated symptoms and setting

A

Location: epigastric, may radiate straight to the back

quality: variable; epigastric gnawing or burning
timing: intermittent

aggravating factors: variable

relieving factors: food and antacids may bring relief

associated symptoms and setting: nausea, vomiting, belching, bloating, more common in the young (20-29 yrs), postprandial fullness, early satiety

27
Q

What history and exam findings are consistent with peritonitis?

A

pain, absent bowel sounds, rigidity, percussion tenderness and guarding

28
Q

What history and exam findings are consistent with colon cancer? (3)

A
  • change in bowel habits
  • diarrhea, abdominal pain, bleeding and occult blood in stool
  • weight loss
29
Q

What are the various presentations of bloody stool and their etiologies? (4)

A

Melena (black tarry stool): gastritis, GERD, peptic ulcer, stress ulcer, esophageal or gastric varices, reflux esophagitis, Mallory-Weiss tear in esophageal mucosa

Black stool: ingestion of iron, bismuth salts, licorice or chocolate cookies

Stool with red blood: colon cancer, hyperplasia or adenomatous polyps, diverticula of the colon, inflammatory conditions, ischemic colitis, hemorrhoids, anal fissure

Reddish but nonbloody stool: ingestion of beets

30
Q

What are the etiologies for constipation? (7)

A
  1. Life activities and habits
  2. Irritable bowel syndrome
  3. Mechanical obstruction
  4. Painful anal lesions: anal fissures, painful hemorrhoids, perirectal abscesses
  5. Drugs
  6. Depression
  7. Neurologic disorders
31
Q

What could change in the color of stool indicate? (4)

A

Grey or light colored stools: obstructive jaundice

Red or maroon colored: bleeding in colon

Steatorrhea: malabsorption in celiac, pancreatic insufficiency, small bowel bacterial growth

Carotenemia: ingestion of carrots

32
Q

What are some reasons for bulges in the abdominal wall? How would you assess for these and what would you expect to see on exam? (5)

A

Umbilical hernia: protrusion through defective umbilical ring; usually closes within 1-2 years

Diastasis recti: separate of the two rectus abdominis muscles, seen when patient raises head and shoulders

Incisional hernia: protrusion through operative scar - palpation

Epigastric hernia: midline protrusion occurs between xiphoid process and umbilicus; can assess by having the pt cough or perform Valsalva maneuver

Lipoma: well demarcated, nonreducible and nontender fatty tumors; press finger on it

33
Q

When inspecting the abdomen of a newborn, what would be considered a normal finding but abnormal in the adult?

A

Umbilical hernia
Diastasis recti
increased bowel sounds, musical sounding
can easily feel spleen and sometimes kidneys

34
Q

What would the FNP expect to see in the examination of the newborn umbilical cord? What would be some abnormal findings of the umbilical cord?

A

Normal

  • Skin should be the same as surrounding skin
  • May see periumbilical edema and erythema
  • Umbilical hernia may be present until 1-2 years
  • One vein and two arteries
  • Usually falls off within 2 weeks

Abnormal
- infection = omphalitis; redness, swelling, pus and foul odor

35
Q

What are the symptoms and exam findings of pyloric stenosis?
What population does this occur in?

A

Deep palpation in RUQ or midline can reveal an olive shaped mass, peristaltic waves

Affects infants

36
Q

What techniques can the FNP use to make the abdominal examination of the pediatric patient easier?

A
  1. Distract with conversation
  2. Place whole hand flush on skin
  3. Place child’s hand under yours to help them feel comfortable
37
Q

What is the difference between organic and functional causes of abdominal pain? What are some examples of each?

A

Organic causes: identified underlying cause
- Examples of causes: Medications, amyloidosis, diabetes, CNS disorders

Functional causes: no specific underlying cause from HPI and exam
- Examples of causes: normal transit, slow transit, impaired expulsion

38
Q

What findings would you expect in functional dyspepsia?

A

3 month history of nonspecific upper abdominal discomfort or nausea not attributable to structural abnormalities or PUD

530 Health Assessment (15 decks)

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