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Advanced Health Assessment > Abdominal, Gastrointestinal, and Urologic Assessment > Flashcards

Abdominal, Gastrointestinal, and Urologic Assessment Flashcards

1
Q

Where are the abdominal contents specifically located in the body?

A

inferior to the diaphragm and superior to the pelvic floor

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2
Q

What bony landmarks outline the inferior aspect of the abdomen?

A

Right and left iliac crests

pubic tubercle

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3
Q

What are the posterior bony structures overlying the abdomen?

A

The T10 spinal vertebrae and articulating ribs, and bilateral iliac crests

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4
Q

What are the innermost abdominal muscles?

A

internal obliques and transverse abdominas muscles

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5
Q

What are the external abdominal muscles?

A

external obliques and rectus abdominus

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6
Q

Why is it important to know the internal and external abdominal muscles?

A

To understand light and deep palpation techniques.

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7
Q

Why is it difficult to determine cause of abdominal pain?

A

Due to the nonspecific neuro recepters within the visceral cavity that are only sensitive to stretch and chemical irritation.

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8
Q

Common causes of abdominal pain

A 
"nonspecific"- 43% of patients
acute appendicitis- 4-20%
acute cholecystitis- 3-9%
small bowel obstruction- 4%
gastroenteritis
gastritis
peptic ulcer disease
reflux esophagitis
GERD
IBS
diverticulitis
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9
Q

What is imperative to consider when assessing the origin of abdominal pain?

A

referred pain

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10
Q

What are the two general causes of abdominal pain?

A

functional and/or organic

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11
Q

What is the general nature of abdominal pain?

A

acute or chronic

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12
Q

What is the juncture that separates the esophagus from the stomach?

A

Lower esophageal sphincter (LES)

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13
Q

What marks the beginning of the duodenum?

A

pyloric sphincter

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14
Q

Where is the stomach located?

A

left upper abdomen

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15
Q

What is the term for digested food?

A

chyme

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16
Q

What is the primary function of the small intestine?

A

facilitation of further digestion and absorption of nutrients

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17
Q

What are the three segments of the small intestine?

A

duodenum, jejunum, and ileum

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18
Q

What is the most striking aspect of the small intestine?

A

Its length of 21 feet

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19
Q

What are the primary digestive actions that occur in the ileum?

A

absorption of vitamin b12 and bile salts

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20
Q

How many segments is the large intestine composed of?

A

Seven

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21
Q

What are the segments of the large intestine?

A

cecum, ascending colon, transverse colon, descending colon, sigmoid colon, rectum, and anus

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22
Q

What are the main functions of the large intestine?

A

To absorb water and electrolytes from the chyme and facilitate elimination of the residual, undigested food as feces.

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23
Q

Ileocecal valve

A

A sphincter muscle that prevents backflow of chyme from the cecum to the ileum.

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24
Q

What marks the beginning of the ascending colon?

A

Cecum

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25
Q

Where are 30% of cancerous tumors found in the colon?

A

Ascending colon

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26
Q

What are the accessory organs of the digestive system?

A

liver, gallbladder, pancreas

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27
Q

Where is the liver located?

A

RUQ

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28
Q

What are the main functional cells of the liver?

A

hepatocytes

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29
Q

What are three main functions of hepatocytes?

A

metabolic, endocrine, and secretory functions

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30
Q

All blood that leaves the ____ and ____ passes through and is processed by the ____.

A

stomach, intestines, liver

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31
Q

Key functions of the liver

A

metabolizing nutrients to produce energy for the body, bile production, immune factors, cholesterol, protein synthesis, breaking down toxins and bacteria, converting ammonia to urea, removing bilirubin, clotting factor regulation, hemoglobin processing to extract iron, amino acid regulation

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32
Q

About __% of bile secreted from the liver passes from the ___ ____ duct into the ____ via the ____ duct.

A

75, common hepatic, gallbladder, cystic

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33
Q

Function of bile

A

to promote emulsification of fats

34
Q

Where is the pancreas located?

A

just below the stomach

35
Q

What are the two main functions of the pancreas?

A

exocrine digestive enzyme secretion and endocrine hormone secretion

36
Q

What is the primary function of the urologic system?

A

filter wastes, toxins, and foreign matter from the bloodstream

37
Q

Where are the kidneys located?

A

Anterior to the 11th and 12th ribs at the costovertebral angle between T12 and L3 of the vertebral column. The left slightly higher than the right.

38
Q

What is the main function of the spleen?

A

It is an immune system organ that filters the blood by removing old or damaged RBCs and platelets, stores breakdown products of RBCs and lymphocytes, and returns the RBC breakdown products to the bone marrow, stores blood that can be released in case of significant blood loss, and fights infections.

39
Q

What are some age-related changes that occur within the urinary system?

A

decreased perfusion
reduced urine concentrating ability
decreased effectiveness of ADH

40
Q

Red Flags of GI/GU systems

A 
arthritis
bilious emesis
delayed puberty
dysphagia
hematuria, hematemesis
hepatospleenomegaly
nighttime pain or diarrhea
oral ulcers
perianal skin tags
persistent RUQ or RLQ pain
melena
unintentional weight loss
41
Q

List some differential diagnoses for abdominal pain

A

functional GI disorder, celiac disease, IBD, cholelithiasis, pancreatitis, gastritis, PUD, UTI pyelonephritis, appendicitis, SBO, hepatitis, AAA, GERD, reproductive disorder, diverticulitis

42
Q

Questions for history of present illness of abdominal pain

A 
Onset
Location
Quality
Intensity
Duration
Associated symptoms
Aggravating/Alleviating factors
Attempted treatment
43
Q

Medical history concerns for GI

A 
chronic diseases
food allergies
abdominal surgeries
growth/development
recent illness/trauma
CV disease
mental health condition (eating disorder)
H. Pylori
44
Q

Family history concerns for GI

A 
family history of GI disease
CA
autoimmune disorders
cystic fibrosis
migraines
mental health disorders
45
Q

Social history concerns for GI

A 
impact on daily living
family dynamic/environment
socioeconomic factors
stress
emotional/behavioral symptoms
recent travel
exposure to lakes/streams
animal or food contact
smoking/tobacco
substance abuse/alocohol abuse
46
Q

Medical history concerns for GU

A 
UTI/pyelonephritis
incontinence
recent vaginal childbirth
obesity
pelvic prolapse
neurological disease
dementia/confusion
DM/HTN
BPH
mobility issues
medications: diuretics, antibiotics
hematuria
47
Q

Family history concerns for GU

A

chronic diseases
obesity
renal/bladder CA
DM

48
Q

Social history concerns for GU

A 
caffeine intake
sexual activity
water/fluid intake
impact on daily living
family dynamic
stressors
smoking/etoh/substance abuse
49
Q

In what ethnic group are gallstones and gallbladder CA more prevelant?

A

Mexican and Native Americans

50
Q

In what ethnic group is gastric or stomach CA more prevelant?

A

Individuals from Japan, China, and Southern and Eastern Europe, and South and Central America

51
Q

What is the appropriate order for the physical exam of the abdomen?

A

inspection
auscultation
percussion
palpation

52
Q

What is a technique that helps lower the diaphragm and move abdominal organs downward?

A

Asking the patient to take a deep breath and hold it

Then asking the patient to raise their head from the exam table

53
Q

What are Grey Turner’s sign and Cullen’s sign?

A

Flank ecchymosis and umbilical ecchymosis
Clues to abdominal hemorrhage, acute pancreatitis, or ectopic pregnancy
controversy regarding sensitivity and specificity

54
Q

What is a sister Mary Joseph nodule?

A

An protruding deep purple umbilical nodule that often signifies malignancy or metastatic cancer

55
Q

What does the majority of evidence recommend for assessing bowel sounds?

A

The majority of available evidence does not exist to recommend auscultating bowel sounds.

56
Q

What should be auscultated on the abdomen?

A

Bruits over the aorta, iliac, renal, and femoral arteries

Friction rubs over the liver and spleen

57
Q

What type of bruit is abnormal?

A

continuous across systole and diastole

58
Q

What other type of sound is abnormal when auscultating abdominal sounds?

A

Friction rubs: may signify inflammation of the peritoneal surface from a mass or tumor

59
Q

What is the purpose of percussing the abdomen?

A

to assess size, density, and location of abdominal organs and structures which can detect fluid or air in the abdomen

60
Q

How is percussing performed?

A

by placing the distal joint and tip of the middle finger of the non dominant hand firmly on the area and using the middle finger of the dominant hand to strike the distal interphalangeal joint of the stationary finger on the area. Using short, quick motions.

61
Q

Where is the liver typically percussed?

A

mid-clavicular line and fifth intercostal space

62
Q

What is the typical liver span?

A

6-12 cm (2-5 inches)

63
Q

Where is the spleen percussed?

A

posterior to the left mid-axillary line from the sixth to tenth rib (Traube’s space)

64
Q

How is percussion of the kidneys performed and why?

A

By striking costovertebral angle using the ulnar surface of the fist or left hand to assess for pain/inflammation

65
Q

What is the scratch test utilized for?

A

to detect liver size

66
Q

How is the scratch test performed?

A

By placing a stethoscope on the xiphoid process while using a finger to scratch the abdominal surface. There will be a difference in sound transmission over solid and hollow organs.

67
Q

Should you be able to palpate the gallbladder?

A

No

68
Q

Is the spleen normally palpable?

A

Only in 3% of the population, otherwise the exam is considered abnormal, splenomegaly may be present

69
Q

When should special tests for the abdomen be completed?

A

LAST

70
Q

What does rebound tenderness indicate?

A

appendicitis

71
Q

What is McBurney’s point?

A

pain with palpation of the RLQ which indicates appendicitis

72
Q

What is Rovsings’s sign?

A

pain in the right iliac fossa with palpation of the left iliac fossa which often indicates appendicitis

73
Q

What is Psoas test?

A

An indication of an inflammed appendix.

While the patient raises their right leg the provider pushes down on the knee causing irritation of the psoas muscle.

74
Q

What is Murphy’s sign?

A

Indication of cholecystitis when the provider deeply palpates the RUQ.

75
Q

What are some laboratory considerations for the GI and GU conditions?

A 
Antibody tests to r/o celiac disease
CBC with diff
electrolytes 
LFTs
hemoccult stool test
ESR
CRP
CMP (liver function/IBS)
AST/ALT/GGT (often elevated in acute hepatitis)
amylase/lipase (pancreatitis)
76
Q

When is a CT abdomen indicated?

A

when the amylase/lipase are not elevated and there is no certain diagnosis

77
Q

At what age does the USPSTF recommend colorectal screening?

A

50-75 years of age

78
Q

What are the most reliable methods for detecting hepatomegaly?

A

CT and MRI

79
Q

What should be the first imaging test for a suspected appendicitis?

A

ultrasound in conjunction with scoring system

80
Q

When should an abdominal aortic aneurysm be considered?

A

When abdominal pain is in the epigastric area

Advanced Health Assessment (7 decks)

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