Gastrointestinal

Question 1

organs of the right upper quadrant

Answer 1

liver (right lobe), gallbladder, duodenum, pancreas (head), right kidney (upper pole), right adrenal gland, hepatic flexure of colon, ascending colon, traverse colon and stomach (pylorus)

Question 2

organs of the left upper quadrant

Answer 2

stomach, liver (left lobe), spleen, pancrease (body), latter adrenal gland, left kidney (upper pole), splenic flexure of colon, transverse colon, descending colon

Question 3

organs of the right lower quadrant

Answer 3

right kidney, cecum, appendix, ascending colon, right ovary, right fallopian tube, right ureter, right spermatic cord

Question 4

organs of the left lower quadrant

Answer 4

left kidney, descending colon, sigmoid colon, left ovary, left fallopian tube, uterus (if enlarged), left ureter, left spermatic cord

Question 5

components of the large intestine

Answer 5

ascending, transverse, descending colon, the rectum and the anal canal

Question 6

pain of appendicitis

Answer 6

perimubilical or epigastric pain, starts colicky then localizes to RLQ

Question 7

pain of cholecystitis

Answer 7

sever epigastric or RUQ pain that refers to the shoulder

Question 8

pain of diverticulitis

Answer 8

epigastric pain radiates to the left side of the abdomen especially after eating

Question 9

pain of intestinal obstruction

Answer 9

sever, abrupt, spasm-like pain that refers to umbilicus and epigastrium (described as gripping)

Question 10

pain of leaking abdominal aneurysm

Answer 10

steady, throbbing, midline, pain over aneurysm that may radiate to back or flank (described as tearing)

Question 11

pain of pancreatitis

Answer 11

acute, excruciating, LUQ umbilical or epigastric pain that may be referred to the flank and left shoulder. pain may be so severe that fainting occurs.

Question 12

pain of perforated gastric or duodenal ulcer

Answer 12

abrupt, RLQ pan that may refer to shoulder, described as burning

Question 13

pain of rupture of abdominal organ

Answer 13

pain is felt all, no localization

Question 14

pain of biliary stones

Answer 14

intense pain in the RUQ described as cramping

Question 15

pain of GERD

Answer 15

occurs 30-60 minutes after a meal

Question 16

important associated symptoms

Answer 16

projectile vomiting (head injury, cranial lesion, pyloric obstruction), fever (viral syndrome, appendicitis), diaphoresis, dizziness, chest pain (MI), vomiting followed by eagerness to eat again and weight loss (pyloric stenosis)

Question 17

nausea without vomiting

Answer 17

common in patients with hepatocellular disease, pregnancy and metastatic disease

Question 18

quality of vomitus

Answer 18

stomach contents - acute gastritis
greenish-yellow - biliary conditions
billious fecal smelling - obstruction

Question 19

GI conditions associated with stomach resection

Answer 19

dumping syndrome, anemia, delayed emptying, malabsorption

Question 20

GI conditions associated with esophageal resection

Answer 20

fat malabsorption, abnormal swallowing and obstruction

Question 21

GI conditions associated with small bowel resection

Answer 21

steatorrhea, fat malabsorption, anemia (vit B12 malabsorption), and short bowel syndrome

Question 22

GI conditions associated with pancreatic resection

Answer 22

insufficient insulin secretion, glucagon, and pancreatic enzymes

Question 23

inspection of the abdomen

Answer 23

inspect for striae, scars, veins, ecchymoses, hernia, inflmmation of ubilicus, blugling flakns, suprapublic bulges, tumores, peristaltic waves, pulsations

Question 24

auscultation of the abdomen

Answer 24

in all 4 quadrants for bowel sounds, bruits over the renal artery, iliac arteries, femoral arteries, and aorta, for friction rubs of liver tumor or splenic infarct, venous hum in the epigastric and umbilical area to the right of the midline (indicate increased collateral circulation between the portal and venous system)

Question 25

percussion of the abdomen

Answer 25

percuss for patterns of tympany and dullness, looking for ascites, go obstruction, pregnant uterus, ovarian tumor, purcuss for size of liver and spleen

Question 26

palpate the abdomen

Answer 26

lightly and then deeply for masses or tenderness, tumors, distention, rebound tenderness

Question 27

normal liver spans

Answer 27

4-8 cm at the midsternal line and 6-12 cm in right midclavicular line

Question 28

sounds of the abdomen on percussion

Answer 28

hyperresonnance around umbilicus, tyranny over stomach and small intestines, dullness over liver and spleen

Question 29

rebound tenderness

Answer 29

pain that increases when deep palpation ends, usually indicating peritoneal irritation. If presen int eh RLQ (McBurne’s point) it suggests appendicities

Question 30

murphy’s sign

Answer 30

when palpating deeply ask the patient to take a deep breath, if they stop mid-inspiration due to pain, this is a positive murphy’s sign

Question 31

obturator test

Answer 31

to assess for ruptured append or plevic infection, place patient in supine position with right left flexed at hip and kneed. place a hand just above the patient’s knee with your other hand at the ankle rotate the patients leg internally and externally, if the patient feels pain in the hypogastric area, the appendix may be ruptured or the patient has pelvic infection

Question 32

additional exam for complaint of abdominal pain

Answer 32

pelvic exam, rectal exam

Question 33

choleycystitis/choleylithiasis

Answer 33

pain in the epigastrium or RUQ, radiating to the high scapular region or back, severe, dull, boring or constant in nature, develops hours after a meal and occurs frequently at night, with associated symptoms of nausea , vomiting, pleuritic pain and fever. On exam, fever, epigastric or RUQ tenderness, fullness in RUQ, murphy’s sign, guarding during palpation, jaundice (20%), sepsis

Question 34

peptic ulcer disease

Answer 34

abdominal pain in the epigastrium to LUQ, buying, might radiate to tieback, occurs 1-5 hours after eating, relieved by food, antacids (duodenal), or vomiting (gastric), following a daily pattern specific to the patient.
on exam mild epigastric tenderness, normal bolwel sounds, and sign of peritonitis or GI bleeding (fever and pain)

Question 35

pancreatitis

Answer 35

pain in the epigastrium or URQ, may radiate to the back, recent surgeries and invasive procedures, family history of hypertriglycerieds, history of biliary colic and binge ETOH consumption, N/V
On exam fever, tachdrdia, tachypnea, hypotension, abd. tenderness, distention, guarding on palpation, rigidity, mild jaundice, dim or absent blowl sounds, asilar rals on lung ascultation, Grety-Turners’s sign and cullen’s sign

Question 36

Grey-Turner’s sign

Answer 36

bluish discoloration of the flanks in pancreatitis

Question 37

Cullen’s sign

Answer 37

bluish discoloration of the periumbilical area

Question 38

the four F’s

Answer 38

common characteristics of a choleycystitis patient - female, over forty years old, fair comlextion, fat