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Clin Med Year 1 > Abdomen > Flashcards

Abdomen Flashcards

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1
Q

Categories of Abdominal Pain:
Visceral

A

Hollow organs are stretched OR forcefully contract OR distended (bloat)

Symptoms: sweating, nausea, vomiting, restless aka DIFFICULT to localize aka general uncomfortable

ex. early acute appendicitis

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2
Q

Categories of Abdominal Pain
Parietal

A

Inflammation in parietal peritoneum

Symps: steady achy pain, worsens w/ movement or coughing, more severe than visceral so MORE PRECISEly localized

ex. late acute appendicitis

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3
Q

Categories of Abdominal Pain
Referred

A

superficial OR deep, develops as initial pain worsens

starts vague&raquo_space; localized

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4
Q

peritoneum

function

A

Holds abdominal organs in place w/i abdominal wall

EXCEPTION: kidneys retroperitoneal, not the same

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5
Q

OPQRST to always ask

A

onset, prior episodes, progression, palliate/provoke

OPPPP

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6
Q

OPQRST that’s helpful

A

quality, region, radiation, associated symps

QRRS

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7
Q

Contents of epigastric region

A

abdominal aorta + stomach + pancreas

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8
Q

Contents of hypogastric/suprapubic

A

bladder (if distended) + uterus

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9
Q

RUQ

A

liver + gallbladder + portion of R kidney

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10
Q

RLQ

A

cecum + appendix + R ovary + salpinx (fallopian tube)

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11
Q

LUQ

A

spleen + stomach

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12
Q

LLQ

A

sigmoid colon + L ovary + salpinx

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13
Q

Conditions of RUQ

A

cholecystitis/cholelithiasis
hepatitis
duodenal ulcer
pancreatitis
nephrolithiasis (basically everywhere)

bc liver, gallbladder, kidney

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14
Q

Conditions of Epigastric

A

AAA (abdominal aorta)
gastritis
GERD
pancreatitis
peptic ulcer

AA, stomach, pancreas

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15
Q

Conditions of LUQ

A

splenic rupture
gastritis
nephrolithiasis
colitis
peptic ulcer

spleen, stomach

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16
Q

Conditions of RLQ

A

appendicitis
ovarian torsion
ectopic pregnancy
PID
colitis
nephrolithiasis

appendix

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17
Q

Conditions of Hypogastric

A

cystitis
endometriosis
uterine fibroids
PID

bladder and uterus

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18
Q

Conditions of LLQ

A

diverticulitis most common
nephrolithiasis
ovarian torsion
ectopic pregnancy
PID
colitis

sigmoid colon, left ovary/salpinx

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19
Q

Radiation to right shoulder

A

Gall Bladder problems

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20
Q

Radiation to back

A

pancreatitis

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21
Q

OPQRST other important parts

A

PMH
PSH (scarring, adhesions) * C sections DO COUNT
Meds (side effects)
Social: smoking, alc, sex, travel, sick contacts

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22
Q

Alc screening CAGE

A

felt like you should CUT down?
people ANNOYED you by criticizing?
felt bad or GUILTY?
ever had a drink first thing in the morning to stead nerves OR get rid of hangover? (EYE opening)

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23
Q

Alc screening general

A

How many times in past year have you had 3+ drinks/day (women) OR 4+ drinks/day (men)

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24
Q

1 drink

beer

A

12 fl oz (5% alc)

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25
1 drink | Malt Liquor
8-9 fl oz (7% alc)
26
1 drink | wine
5 fl oz (12% alc)
27
1 drink | shots
1.5 fl oz (40% alc) | 80 proof
28
Risk Factors Colorectal Cancer
1.older than 50 2. history of colorectal cancer or FAP 3.personal history intestinal polyps or inflammatory bowel (crohns or ulcerative colitis) 3.obesity 4.smoking 5.lack exercise 6.alc consumption | important to screen bc high mortality
29
When to screen 45-49
Family history, vulnerable to risk factors, certain populations (black people)
30
What to do at age 75 | screening
Assess health- if good health then continue screens if bad (won't live next 5-10 yrs) then stop
31
FIT Screening | colorectal cancer
every year non-invasive, doesn't matter what's eaten prior, check for hemoglobin in stool | fecal immunochemical test
32
Stool DNA-FIT
every 1-3 yrs
33
Computed tomography colongraphy
invasive every 5 yrs | alternative: do every 10 years + annual FIT
34
Colonoscopy
invasive every 10 yrs
35
Exam Tips
pt supine and abdomen fully exposed entire exam from right side (optional) hands and stethoscope warm good light source watch pt face for signs of pain since won't say **examine painful area last** empty bladder if needed
36
Exam Sequence | HAVE TO KNOW FOR OSCE
1. INSPECTION 2. AUSCULATION 3. PERCUSSION 4. PALPATION | will mess up bowel sounds if do percussion or palpation before
37
Inspection | things to look for
Pt behavior shape of abdomen (flat, rounded, scaphoid) discoloration (jaundice, redness, ecchymosis, linea nigra) striae or scars umbilical hernia (common under 1 so give time) dilated veins >> cirrosis of liver
38
Ecchymosis
AAA, ectopic preg, pancreatitis Ruptured things >> lots of trauma
39
Signs of ecchymosis | 2
1. Grey-Turners: flank, from blood tracking subcutaneuosly from retroperitoneal or intraperitoneal source 2. Cullens sign: periumbilical, suggests hemoperitoneum | kidneys are retro
40
Auscultation | how to do
use diaphragm in AT LEAST 1 quadrant use bell for bruits in epigastrium and both upper quadrants listen over the liver and spleen for friction rubs | want 1 quadrant to be LLQ bc end of digestive tract so if heard here the
41
How long to listen for bowel sounds before concerning
full 2 minutes
42
increased bowel sounds
gastroenteritis, early obstruction, hunger
43
decreased bowel sounds
constipation, peritonitis
44
high-pitched tinkling
potentially small bowel obstruction
45
absent sounds
surgical emergency
46
Percussion
pt legs extended helps assess amount/distribution of gas/masses/ size of liver and spleen
47
Percussion | distended abdomen
if diffusely tympanitic suggests intestinal obstruction
48
Tympany | Percussion
normal @over air filled viscera | higher pitch than resonance
49
Dullness | Percussion
@over solid organs adjacent to air filled structures or stool | short note w/little resonance
50
Resonance
@over lung tissue and sometimes abdomen | sustained moderate pitch
51
Hyperresonance
@base of lung | b/t tympany and resonance
52
Liver Span
measure vertical span @ R midclavicular line start RLQ work up until dull start nipple line work down until dull **distance should be 6-12 cm**
53
Palpation Sequence
pt flex knees to relax muscles palpate all 4 quadrants 3. light palpation (1 cm) 4. deep palpation (2 hands) 5. organs
54
Liver palpation | option 1
left hand under pt lower ribs right hand on right abdomen lateral to rectus muscle palpate on inspiration in midclavicular line 3 cm below R costal margin
55
Liver palpation | option 2
stand to R of pt chest both hands on R abdomen below liver press in and up toward costal margin ## Footnote helpful for obese pts
56
Spleen palpation
left hand lift lower L rib cage R hand below L costal margin press in repeat on other side if needed w/legs flexed
57
Enlarged Liver ## Footnote hepatomegaly
hepatitis NASH (fatty liver) cirrhosis
58
Enlarged spleen ## Footnote splenomegaly
portal hypertension hematologic malignancies (leukemia)
59
Kidney Palpation
L hand under patient 12th rib and lift R hand in RUQ or LUQ try to capture b/t hands
60
Enlarged kidneys
polycystic kidneys wilms tumor (peds renal tumor)
61
Lloyd's test
kidney pain/costovertebral angle tenderness palpate first then light thump w/ heel of hand ## Footnote only thump if can tolerate since very painful
62
Lloyd's test
kidney pain/costovertebral angle tenderness palpate first then light thump w/ heel of hand ## Footnote only thump if can tolerate since very painful
63
Bladder palpation
can't do unless very full (at least 400 ml) check suprapubic tenderness
64
Aorta palpation
press firmly/deep in upper ab w/ thumb and index finger @slightly left midline assess width if 50+ yr **normal width less than 3 cm**
65
Peritonitis
imflammation of peritoneum from infection, bleeding, autoimmune
66
Guarding
voluntary contraction | in response to peritonitis to assess
67
Rigidity
involuntary contraction but not as serious
68
Rebound tenderness
pain when hand removed/let go from ab | bc peritoneum irritated
69
Percussion Tenderness
self explanatory, assess for petitonitis
70
Rovsing's Sign | Paritoneal
pain in RLQ when palpate deep LLQ | opposite
71
Psoas Sign | Peritoneum
pt flex hip vs resistance supine if pain then positive
72
Obturator sign | Peritoneum
flex hip and knee 90 degrees then internal/external rotate
73
Heel jar test | Peritoneal
pt stand with knees straight on toes then drop to flat foot
74
Ascites | Tests
fluid wave: hands on both sides of ab with pt hand at midline depressing 2-3 cm tap briskly on one side - will feel wave fluid shifting dullness: percuss from umbillicus laterally toward flank pt supine then pt turn on side- percuss superior to table dullness will shift to the side against the table
75
Acute cholecystitis
Murphy's sign RUQ palpate hook fingers under costal margin @midclav line, if halt inspiration when deep breath then positive
76
Appendicitis
McBurney's point 1/3 from ASIS to umbilicus palpate
77
Ascites | causes
heart failure- pump back up cirrhosis-block hepatic portal vein cancer- also block hepatic vein

Clin Med Year 1 (4 decks)

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