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CPD > Abdomen > Flashcards

Abdomen Flashcards

1
Q

What provides the efferent innervation of the abdominal viscera?

A

The sympathetic and parasympathetic (autonomic) nervous system.

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2
Q

What organs of the GI tract are retroperitoneal?

A

Most of the duodenum and the ascending and descending colon.

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3
Q

What artery supplies the following areas?

  1. The small intestine and the right half of the colon
  2. The left half of the colon and the superior rectum
  3. The upper abdominal structures
A
  1. Superior mesenteric artery
  2. Inferior mesenteric artery
  3. Celiac artery
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4
Q

What spinal level is the aortic hiatus of the diaphragm located at?

A

T12/L1

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5
Q

Does the following pain location get transmitted via the autonomic nervous system or somatic nervous system?

  1. Visceral pain
  2. Pain from the abdominal wall
  3. Pain experienced due to derangements of abdominal viscera
  4. Pain from the parietal peritoneum
A
  1. Autonomic
  2. Somatic
  3. Autonomic
  4. Somatic
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6
Q

What condition would we consider in an infant with projectile vomiting?

An adult?

A

Some sort of GI obstruction or hypertrophic pyloric stenosis.

Increased ICP

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7
Q

What occurs when patients ingest substances that are not well absorbed but have a high osmotic content?

A

Poor reabsorption of water in the GI tract which leads to diarrhea.

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8
Q

What is the difference in time period between acute and chronic diarrhea?

What is the difference in cause?

A

Acute diarrhea lasts for less than 7 days. Chronic diarrhea lasts for greater than 14 days.

Acute diarrhea is usually caused by toxins or bacteria whereas chronic diarrhea is usually caused by a chronic infection or a pathology of the GI system such as excess hormone secretion or celiac disease.

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9
Q

What might clay colored stool indicate?

A

Obstructive jaundice.

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10
Q

How do you define constipation?

Where do most causes of constipation have their origin?

A

Inabilty to pass stool more frequently than three times per week.

In the colon, rectum, or anus.

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11
Q

What is the most common cause of constipation in the elderly?

In neonates?

Pediatric age group?

A

Colonic obstruction

Imperforate anus and meconium ileus.

Hirchsprung’s disease

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12
Q

If a patient had a recent surgery and is presenting with jaundice, what may be causing the condition?

What if a patient presents with jaundice and inflammatory bowel disease?

A

Use of halogenated anesthesia

Primary sclerosing cholangitis (ie. Ulcerative colitis)

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13
Q

What three diseases should you think of when presented with an alcoholic?

A

Pancreatitis, hepatitis, and gastritis.

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14
Q

What GI condition causes leukonychia?

A

Albumin deficiency

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15
Q

Dupuytren’s contracture?

A

Alcoholic cirrhosis

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16
Q

Clubbing?

A

UC, GI lymphoma, liver cirrhosis, malabsorption conditions.

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17
Q

Palmar erythema?

A

Liver cirrhosis

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18
Q

Palmar crease pigmentation?

A

Addisons disease

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19
Q

Asterixis?

A

Encephalopathy secondary to renal and liver failure.

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20
Q

What can cause parotid enlargement that is associated with the GI tract?

A

Chronic alcoholism

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21
Q

Xanthelasma?

A

Primary biliary cirrhosis

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22
Q

Mucosal pigementation?

A

Peutz Jegher’s syndrome

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23
Q

Atrophic glossitis?

A

Vitamin B12 and iron deficiency

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24
Q

Fetor hepaticus?

A

Liver disease

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25
Q

What are the 9 F’s which cause protuberance/distension?

A

Fat, fluid, full bladder, feces, flatus, fetus, false pregnancy, fibroid, fatal tumor.

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26
Q

When do paradoxical abdominal movements occur?

A

When the diaphragm is paralyzed.

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27
Q

What is Cullen’s sign and what does it indicate?

A

Bluish discoloration of the umbilicus indicating intraperitoneal bleeding.

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28
Q

What is Grey Turner’s sign and what does it indicate?

A

Bluish discoloration of the flanks indicating retroperitoneal bleeding such as seen in hemorrhagic pancreatitis.

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29
Q

What direction do superficial veins of the abdomen drain above the umbilicus and below the umbilicus?

A

Above - upwards

Beow - downwards

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30
Q

What causes reversal of this flow?

A

Inferior vena cava obstruction.

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31
Q

What do high pitched tinkling sounds indicate when listening to the bowel?

A

Fluid and air under tension in a dilated bowel.

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32
Q

What are the soft tissue layers of the abdomen?

A 
Skin
Subcutaneous tissue
Muscle
Fascia
Parietal peritoneum
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33
Q

What is the normal movement of of the abdomen during breathing?

A

Outward during inspiration

Inward during expiration

34
Q

What is found in the right upper quadrant?

A

Liver, gallbladder, duodenum, right kidney and adrenals, head of pancreas, parts of the ascending and transverse colon, ureter

35
Q

What is found in the left upper quadrant?

A

Stomach, spleen, body and tail of pancreas, splenic flexure of the colon, parts of the transverse and descending color, left kidney and adrenals, ureter

36
Q

What is found in the left lower quadrant?

A

Parts of the descending colon, sigmoid colon, ovaries, ureter

37
Q

What is found in the right lower quadrant?

A

Cecum, appendix, ascending colon, ureter

38
Q

What is found in the midline of the abdomen?

A

Aorta, uterus if enlarged, bladder if distended

39
Q

What is found in the right hypochondrium region?

A

Liver, gallbladder, hepatic flexure, transverse colon, right kidney

40
Q

What is found in the right lumbar region?

A

Tip of the right lobe of liver, ascending colon, right kidney, ileum

41
Q

What is found in the right iliac/inguinal region?

A

Cecum, appendix, ileum, ascending colon, right ovary

42
Q

What is found in the suprapubic/hypogastrium region?

A

Sigmoid colon, rectum, ileum, urinary bladder, right and left ureter, right and left ovaries

43
Q

What is found in the umbilical region?

A

Transverse colon, jejunum, ileum, stomach, pancreas, right and left kidneys with ureter

44
Q

What is found in the epigastric region?

A

Liver, stomach, right and left kidney with adrenals, transverse colon, pancreas, jejunum

45
Q

What is found in the left iliac/inguinal region?

A

Descending colon, sigmoid, jejunum, left ovary

46
Q

What is found in the left lumbar region?

A

Part of the transverse colon, descending colon, left kidney, jejunum

47
Q

What is found in the left hypochondrium region?

A

Stomach, transverse colon, splenic flexure, part of descending colon, pancreas (tail), spleen, left kidney, ileum

48
Q

What are the characteristics of visceral pain?

A

Dull, aching, crampy, intermittent
Poorly localized; perceived in the midline, difficult to describe
Sensitive to stretch, spasm, distention, ischemia, inflammation, traction
Accompanied by - nausea, vomiting, sweating, pallor, referral to cutaneous structures

49
Q

What are the characteristics of somatic pain?

A

Sharp, constant
Well localized; clearly described; usually unilateral
Sensitive to pressure on abdominal wall, friction, burning, jarring, deep inspiration, inflammation
Seldom has accompanying symptoms

50
Q

What abdominal parts are foregut derivatives? Where is the pain felt?

A

Stomach, duodenum, liver and pancreas

Upper abdomen

51
Q

What abdominal parts are midgut derivatives? Where is the pain felt?

A

Small bowel, proximal colon, appendix

Periumbilical area

52
Q

What abdominal parts are hindgut derivatives? Where is the pain felt?

A

Distal colon and genitourinary tract

->Lower abdomen

53
Q

What causes pain in the right upper quadrant?

A

Acute cholecystitis

54
Q

What causes generalized abdominal pain?

A

Diffuse abdominal involvment, such as peritonitis, secondary to ruptured viscus

55
Q

Where do you feel pain from acute appendicitis?

A

Starts in the periumbilical area (visceral midgut)

Shifts of the lower right quadrant (location of the appendix)

56
Q

What are the pathophysiological causes of diarrhea?

A 
Decreased mucosal transport or secretory dysfunction
Increase osmotic load
Malabsoprtion
Excessive exudates
Altered bowel motility
57
Q

What do you think of when a alcoholic is having abdominal problems?

A

Pancreatitis
Hepatitis
Gastritis

58
Q

What do you think of when an IV drug user is having abdominal problems?

A

SBE

Septic embolization to the gut

59
Q

What are GIT causes of clubbing?

A 
Chronic inflammatory bowel disease (i.e. ulcerative colitis)
GI lymphoma
Cirrhosis of the liver
Malabsorption condition (celiac disease)
Pulmonary disease
Congenital heart disease
60
Q

What causes koilonychia?

A

Spoon-shaped nail

->Iron deficiency

61
Q

What causes leukonychia?

A

Non-uniform, white lines or spots, occurring in a random distribution
Albumin deficiency

62
Q

What causes Dupuytren’s contracture?

A

Contraction of the palmar fascia with gradual pulling the metacarpophalangeal joints and proximal interphalangeal joints of the little and ring fingers in flexion.
Results in the inability to extend these joints.
Seen in alcoholic cirrhosis.

63
Q

What can cause Palmar erythema?

A

Reddening of the palms involving the thenar and hypothenar eminences
Causes: liver cirrhosis, rheumatoid arthritis, thyrotoxicosis, diabetes mellitus

64
Q

What can cause asterixis?

A

Encephalopathy secondary to renal and liver failure

Other causes: CO2 narcosis, drug overdose with barbiturate, phenytoin and electrolyte disturbances

65
Q

What causes palmar crease pigmentation?

A

Addison’s disease

66
Q

What causes Fetor hepaticus?

A

Sweet fecal smell

Due to liver disease

67
Q

What cause atrophic glossitis?

A

Vit B12

Iron deficiency

68
Q

What cause mucosal pigmentation?

A

Peutz Jegher’s syndrome

69
Q

What can cause gynaecomastia?

A

Liver failure

High circulating estrogen

70
Q

What are the 9 Fs of protuberance?

A 
Fat
Fluid
Feces
Flatus
Fetus
Fibroid
Full bladder
False pregnancy
Fatal tumor
71
Q

Define Cullen’s sign

A

Bluish discoloration of the umbillicus

72
Q

Define Grey Turner’s sign

A

Blush discoloration of the flanks

73
Q

What do normal bowel sounds, sound like?

A

Intermittent, low pitch, chuckling (clicks and gurgles) at intervals of 5-34/min
Borborygmi (prolonged gurgles of hyper-peristalsis)
Normal peristalsis produces bowel sounds when gas, fluid and food are passed though the instestinal lumen

74
Q

What causes high pitched tinkling sounds in the abdomen?

A

Fluid and air under tension in a dilated bowel

Intestinal obstruction

75
Q

When do you hear decreased bowel sounds?

A

Following general or spinal anesthesia

76
Q

Define ileus

A

Failure of peristalsis and is a normal response of bowel to laparotomy and peritonitis

77
Q

When do you hear absent bowel sounds?

A

Adynamic ileus
Ischemia of the bowel wall
Inflammation of bowel
Peritonitis

78
Q

What are the special tests for peritonitis?

A

Direct tenderness
Guarding (voluntary)
Rigidity (involuntary)
Rebound tenderness

79
Q

What are the special tests for ascites?

A

Bulging at the flanks
Fluid wave
Shifting dullness

80
Q

What are the tests for appendicitis?

A

->Signs of peritonitis

->Rovsing’s sign
(pressure to right side)

->Psoas sign
(flex left hip to left shoulder)
- retroperoteneal retrocecal

->Obturator sign
(flex left hip to right shoulder)
- pelvic appendices

->DRE

81
Q

What are the tests for cholecystitis?

A

Murphy’s sign

Boa’s sign

82
Q

What are the tests for pyelonephritis?

A

Fist percussion

CPD (12 decks)

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