Abdominal Exam

Question 1

what is a key to the abdominal exam?

Answer 1

get an accurate description of the problem

Question 2

when asking about abdominal pain, what should you do?

Answer 2

have the patient point to where they feel the pain and try to identify the size of the pain

Question 3

what is an extra timing question you must ask for belly pain?

Answer 3

timing in relation to

• food
• BM
• nausea

Question 4

nocturnal symptoms that affect sleep are

Answer 4

more concerning

Question 5

BHC / CBH

Answer 5

bowel habit change / change in bowel habits

Question 6

what can positional changes pain indicate?

Answer 6

adhesional types of pain

Question 7

what GI problem could surgical history create?

Answer 7

adhesion

Question 8

what is LNMP?

Answer 8

last normal menstrual period

Question 9

what are common causes of GI complaints?

Answer 9

DM (slow motility, early satiety, nausea, side effect of medication)
renal

depression
arthritis

hyperlipidemia
endometriosis

Question 10

what meds can influence GI symptoms?

Answer 10

NSAIDS
new or changes in meds

DM
statins (hepatotoxicity, renal failure)
biphosphonantes (GERD, reflux, esophogeal erosion)

antibiotics (diarrhea)
diuretics
laxatives (abdominal cramping)

Question 11

what family hx considerations are involved in GI?

Answer 11

IBD
colon CA
liver dz

Question 12

what special considerations in the social hx involve GI?

Answer 12

IV drug use (liver damage)
diet changes/exercise (hemorrhoids)
recent travel
water source
ill contacts
tobacco, alcohol use

Question 13

how can regurg pts be SOB?

Answer 13

at night, they aspirate small amts of the regurgitant products

Question 14

what is visceral pain?

Answer 14

constriction or dilation of hollow organs
(sheath touching the organ)
-typically felt as a cramp
-comes and goes

Question 15

what is parietal pain?

Answer 15

inflammation of the peritoneum
(sheath touching the abdominal wall)
-steady, aching, severe
-more precisely localized
-aggravated by movement, coughing

Question 16

what is referred pain?

Answer 16

inflammation along shared nerve roots

Question 17

what is NUD?

Answer 17

non ulcerative dyspepsia

-no organic source for the pain and symptoms

Question 18

will the pt be able to localize visceral pain?

Answer 18

not often

Question 19

what is a less common form of visceral pain?

Answer 19

capsular distention of solid organs (capsule surrounded by fluid)

Question 20

what do pts do when they have severe visceral pain?

Answer 20

they will become restless and writhing (don’t like to be still)

Question 21

what do pts do when they have parietal pain?

Answer 21

lie still

Question 22

how will you know if it is a referred pain?

Answer 22

when nothing matches up

-pressure at site of pain doesn’t increase pain

Question 23

what is waterbrash?

Answer 23

stomach content taste

Question 24

what is the difference between vomit and regurgitation?

Answer 24

effort and amount

Question 25

what is pyrosis?

Answer 25

heartburn

Question 26

where can pyrosis be located?

Answer 26

epigastric | retrosternal

Question 27

how is pyrosis relieved?

Answer 27

acid suppression therapy

Question 28

what will be the next step if acid suppression therapy doesn't work?

Answer 28

upper endoscopy to look for sphincter problems

Question 29

what is dyspepsia?

Answer 29

upper abdominal pain (NOT heartburn)

Question 30

what is odynophagia?

Answer 30

pain with swallowing

Question 31

what does odynophagia indicate?

Answer 31

inflammation

Question 32

what is dysphagia?

Answer 32

difficulty swallowing

Question 33

what are the classes of dysphagia?

Answer 33

``` obstructive or non oro pharyngeal (neuro/strokes) vs esophageal chocking sensation ```

Question 34

how is diarrhea identified?

Answer 34

increased frequency and decreased consistency | -with urgency (pathologic) or without (non-pathologic)

Question 35

how is constipation identified?

Answer 35

``` decreased frequency increased consistency difficult passage (straining) painful BM (tumor, tear, ulcer) need manual manipulation ```

Question 36

what does pain with thin stools mean?

Answer 36

wierd

Question 37

what is hematochezia?

Answer 37

blood in stool (maroon or red) - usually a lower source - mixing in of blood with stool - below ligament of treitz (rest of small and large bowel)

Question 38

what is melena?

Answer 38

black or tarry stool - usually an upper source - above ligament of treitz (stomach and duodenum)

Question 39

what is BRBPR?

Answer 39

bright red blood per rectum (bleeding from the rectum, not from the bowels

Question 40

what are the screening questions that go along with the GI exam?

Answer 40

alcohol consumption viral hepatitis colon cancer screening

Question 41

what constitutes excessive drinking?

Answer 41

f: > 3 per occasion or 7 per week m: > 4 per occasion or 14 per week

Question 42

what is HAV?

Answer 42

hepatitis A virus, food borne illness | -usually goes away on its own

Question 43

what is HBV?

Answer 43

hepatitis B virus, blood born illness - more common amongst asians, lived in Vietnam - latent for a long long time

Question 44

what is HCV?

Answer 44

hepatitis C virus, - more common with baby boomers - latent for a long long time - has no vaccine

Question 45

what do all hepatitities cause?

Answer 45

cirrhotic liver

Question 46

how often do you have a colonoscopy?

Answer 46

every 10 yrs after the age of 50 (average) - every 5 yrs beginning 10 yrs prior to age of family's diagnosis age (family hx) - personal hx of adenomatous polyps at least every 5 yrs - personal hx of IBD (especially UC) annually beginning 10 yrs post dx

Question 47

what is a stethescope sign?

Answer 47

push using your stethescope on the painful area