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Clin Med Year 1 > Abdomen > Flashcards

Abdomen Flashcards

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
Q

1 drink

Malt Liquor

A

8-9 fl oz (7% alc)

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26
Q

1 drink

wine

A

5 fl oz (12% alc)

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27
Q

1 drink

shots

A

1.5 fl oz (40% alc)

80 proof

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28
Q

Risk Factors Colorectal Cancer

A

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

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29
Q

When to screen 45-49

A

Family history, vulnerable to risk factors, certain populations (black people)

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30
Q

What to do at age 75

screening

A

Assess health-
if good health then continue screens
if bad (won’t live next 5-10 yrs) then stop

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31
Q

FIT Screening

colorectal cancer

A

every year
non-invasive, doesn’t matter what’s eaten prior, check for hemoglobin in stool

fecal immunochemical test

32
Q

Stool DNA-FIT

A

every 1-3 yrs

33
Q

Computed tomography colongraphy

A

invasive
every 5 yrs

alternative: do every 10 years + annual FIT

34
Q

Colonoscopy

A

invasive
every 10 yrs

35
Q

Exam Tips

A

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
Q

Exam Sequence

HAVE TO KNOW FOR OSCE

A
  1. INSPECTION
  2. AUSCULATION
  3. PERCUSSION
  4. PALPATION

will mess up bowel sounds if do percussion or palpation before

37
Q

Inspection

things to look for

A

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&raquo_space; cirrosis of liver

38
Q

Ecchymosis

A

AAA, ectopic preg, pancreatitis
Ruptured things&raquo_space; lots of trauma

39
Q

Signs of ecchymosis

2

A
  1. Grey-Turners: flank, from blood tracking subcutaneuosly from retroperitoneal or intraperitoneal source
  2. Cullens sign: periumbilical, suggests hemoperitoneum

kidneys are retro

40
Q

Auscultation

how to do

A

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
Q

How long to listen for bowel sounds before concerning

A

full 2 minutes

42
Q

increased bowel sounds

A

gastroenteritis, early obstruction, hunger

43
Q

decreased bowel sounds

A

constipation, peritonitis

44
Q

high-pitched tinkling

A

potentially small bowel obstruction

45
Q

absent sounds

A

surgical emergency

46
Q

Percussion

A

pt legs extended
helps assess amount/distribution of gas/masses/ size of liver and spleen

47
Q

Percussion

distended abdomen

A

if diffusely tympanitic suggests intestinal obstruction

48
Q

Tympany

Percussion

A

normal
@over air filled viscera

higher pitch than resonance

49
Q

Dullness

Percussion

A

@over solid organs adjacent to air filled structures or stool

short note w/little resonance

50
Q

Resonance

A

@over lung tissue and sometimes abdomen

sustained moderate pitch

51
Q

Hyperresonance

A

@base of lung

b/t tympany and resonance

52
Q

Liver Span

A

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
Q

Palpation Sequence

A

pt flex knees to relax muscles
palpate all 4 quadrants

  1. light palpation (1 cm)
  2. deep palpation (2 hands)
  3. organs
54
Q

Liver palpation

option 1

A

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
Q

Liver palpation

option 2

A

stand to R of pt chest
both hands on R abdomen below liver
press in and up toward costal margin

helpful for obese pts

56
Q

Spleen palpation

A

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
Q

Enlarged Liver

hepatomegaly

A

hepatitis
NASH (fatty liver)
cirrhosis

58
Q

Enlarged spleen

splenomegaly

A

portal hypertension
hematologic malignancies (leukemia)

59
Q

Kidney Palpation

A

L hand under patient 12th rib and lift
R hand in RUQ or LUQ
try to capture b/t hands

60
Q

Enlarged kidneys

A

polycystic kidneys
wilms tumor (peds renal tumor)

61
Q

Lloyd’s test

A

kidney pain/costovertebral angle tenderness
palpate first then light thump w/ heel of hand

only thump if can tolerate since very painful

62
Q

Lloyd’s test

A

kidney pain/costovertebral angle tenderness
palpate first then light thump w/ heel of hand

only thump if can tolerate since very painful

63
Q

Bladder palpation

A

can’t do unless very full (at least 400 ml)
check suprapubic tenderness

64
Q

Aorta palpation

A

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
Q

Peritonitis

A

imflammation of peritoneum
from infection, bleeding, autoimmune

66
Q

Guarding

A

voluntary contraction

in response to peritonitis to assess

67
Q

Rigidity

A

involuntary contraction but not as serious

68
Q

Rebound tenderness

A

pain when hand removed/let go from ab

bc peritoneum irritated

69
Q

Percussion Tenderness

A

self explanatory, assess for petitonitis

70
Q

Rovsing’s Sign

Paritoneal

A

pain in RLQ when palpate deep LLQ

opposite

71
Q

Psoas Sign

Peritoneum

A

pt flex hip vs resistance supine
if pain then positive

72
Q

Obturator sign

Peritoneum

A

flex hip and knee 90 degrees then internal/external rotate

73
Q

Heel jar test

Peritoneal

A

pt stand with knees straight on toes then drop to flat foot

74
Q

Ascites

Tests

A

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
Q

Acute cholecystitis

A

Murphy’s sign
RUQ palpate
hook fingers under costal margin @midclav line, if halt inspiration when deep breath then positive

76
Q

Appendicitis

A

McBurney’s point
1/3 from ASIS to umbilicus palpate

77
Q

Ascites

causes

A

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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