Week 9: Abdomen Flashcards
What symptoms are more consistent with GI pain? (13)
- abdominal pain
- indigestion
- nausea
- vomiting
- hematemesis
- anorexia
- early satiety
- dysphagia
- odynophagia
- change in bowel function
- diarrhea
- constipation
- jaundice
What symptoms are more consistent with GU pain? (12)
- suprapubic pain
- dysuria
- urgency
- frequency
- hesitancy
- decreased stream
- polyuria
- nocturia
- incontinence
- hematuria
- flank pain
- ureteral colic
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?
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
What are the screening recommendations for alcohol abuse? Hepatitis C?
- Alcohol abuse: all primary care patients
- Hepatitis C: those born between 1945-1965
What are the screening recommendations for an abdominal aortic aneurysm? How do you perform this assessment?
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
When auscultating the abdomen, what would be normal findings? What would bruits indicate? Venous hum? Friction rubs?
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
What should a systolic bruit + hepatic friction rub make you suspect?
carcinoma of the liver
How would you describe visceral pain?
- 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
How would you describe parietal pain?
Parietal pain: steady, aching pain, more precisely localized, will be aggravated by coughing or moving
Example: occurs in peritonitis
How would you define referred pain? What is an example?
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
What techniques can the FNP use to assess the liver? In the pediatric patient?
Percussion to determine size and palpation of the liver edge
Percussion is better for assessment in pediatrics than palpation
What techniques can the FNP use to assess for ascites?
Percuss from area of central tympany to area of dullness on supine patient
Test for shifting dullness
Define dysphagia, what are some etiologies (3)?
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)
Define odynophagia, what are some etiologies (7)?
Odynophagia: painful swallowing
Etiologies: esophageal ulceration from ingestion of aspirin or NSAIDS, caustic ingestion, radiation, infection with candida, CMV, HSV, HIV
What is the murphy sign and what does it indicate?
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
What is the psoas sign and what does it indicate?
place hand above the R knee and ask them to raise the thigh against your hand
Indicates appendicitis (psoas irritation due to appendix inflammation)
What is the obturator sign and what does it indicate?
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)
What is the Rovsing sign and what does it indicate?
referred rebound tenderness to the RLQ when pressing on the LLQ
Indicates appendicitis
What is rebound tenderness and what does it usually indicate?
pain expressed by the patient after the examiner presses down on an area of tenderness and suddenly removes the hand
Indicates peritonitis
What are the characteristics of appendicitis?
Location, quality, timing, aggravating factors, relieving factors, associated symptoms and setting
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
What are the characteristics of cholecystitis?
Location, quality, timing, aggravating factors, relieving factors, associated symptoms and setting
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
What are the characteristics of pancreatitis? (Acute vs. chronic)
Location, quality, timing, aggravating factors, relieving factors, associated symptoms and setting
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
What are the characteristics of diverticulitis?
Location, quality, timing, aggravating factors, relieving factors, associated symptoms and setting
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
What are the characteristics of obstruction?
Location, quality, timing, aggravating factors, relieving factors, associated symptoms and setting
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
