Abdomen Flashcards
(185 cards)
1
Q
Order of exam for abdomen
A
Inspect
Auscultate
Percuss
Palpate
2
Q
What does esophagus connect
A
Pharynx to stomach
3
Q
What valve between ileum and large intestine that prevents backflow
A
Iliocecal valve
4
Q
Putrefaction. What is is and what does it?
A
Live bacteria decompose undigestion food, I absorbed AA, cell debris and dead bacteria.
Large intestine
5
Q
Exocrine and endocrine function of pancreas
A
Exocrine: produce digestive juices
Endocrine: produce hormone to regulate body’s level of glucose
6
Q
Function of white pulp and red pulp of spleen
A
White: lymphoid tissue that filters blood and produces lymphocytes/monocytes (WBCs)
Red: storage and release of blood
7
Q
Location of kidneys
A
T12-L3
Retroperitoneal
8
Q
Function of kidney
A
Rids body of water solvable waste
- produce renin, erythropoietin, and biologically active vitamin D
- synthesize prostaglandins
9
Q
Aka for inguinal ligament
A
Poupart ligament
10
Q
In infant…pancreatic islet cells are developed by when? And do what?
A
12 weeks of gestation and begin producing insulin
11
Q
Spleen and infants
A
Spleen active in blood FORMATION during development and first year of life
After aids in destruction of blood cells and acts as lymphatic organ
12
Q
When can fetus begin to produce urine
A
12 weeks
13
Q
What may happen to skin/muscle postpartum when they separate?
A
Diastasis recti
14
Q
How to differentiate a minor umbilical hernia from an outie belly button?
A
Does it get worse with valsalva maneuver? If so, hernia.
15
Q
If limited movement of abdomen during respiration what may it be indicative of?
A
Peritonitis
Respiratory problems
Pain
16
Q
Indicate what if peristalsis is seen as a rippling movement?
A
Bowel obstruction
17
Q
Auscultation findings of abdomen
A
Heard as irregular clicks and gurgles 5-35/minute
18
Q
Long prolonged gurgles
A
Borborygmi
19
Q
Increased bowel sounds occur with?
A
Gastroenteritis
Early intestinal obstruction
Hunger
20
Q
High-pitched tinkling sound suggests
A
Intestinal fluid and air under pressure
Early obstruction
21
Q
Decreased bowel sounds with?
A
Peritonitis Paralytic ileus (paralyzed intestines—not just ileum)
22
Q
Absense of bowel sounds can be determines after how long of listening?
A
5 minutes
23
Q
What side of stethoscope do you use over liver adn spleen?
A
Diaphragm
24
Q
Use diaphragm over what organs to listen
A
Spleen and liver
25
Bell or diaphragm to listen for bruits and where
Bell
Aortic
Renal
Iliac
Femoral arteries
26
Where and when is venous hum heard
Epigastric region and around umbilicus as soft, low-pitched, continuous sound
With increased collateral circulation between portal and systemic venous systems (HTN)
27
Predominant sound during percussion in abdomen
Tympany due to stomach and intestines
28
Greater tympani in small intestines or large?
Small
29
Where do you usually percuss lower boarder of liver? And if percuss below expected?
Normal: inferior costal margin
Abnormal: more than 1 inch below costal margin
-hepatomegaly or downward displacement due to depressed diaphragm
30
Normal upper boarder of liver where?
5th intercostal space
31
What may cause liver to shift up? Down?
Up: abdominal mass/fluid
Down: diaphragm depressed
32
Usually size of liver at midclavicular? At mid sternal?
6-12 cm
4-8cm
33
Who usually has a larger liver span?
Males and tall people
34
How much should liver move descend during inspiration?
2-3cm
35
Where should splenic dullness be heard?
6-9th/10th intercostal spaces
36
What may produce a false positive for splenomegaly?
Full stomach
Feces-filled intestine
Left sided pleural effusion
37
Alternate method to percuss the spleen
Percuss at lowest costal interspace at left anterior axillary line. Should be tympanic. Have patient inhale and hold. Sound should still be tympanic.
38
Determine whether mass is superficial or deep mass
Palpate while patient does partial sit-up. If you can’t feel it its deep
39
Tender gallbladder indicates
Cholecystokinin
40
A non tender but palpable gallbladder indicates
Bile duct obstruction
41
Murphy’s sign
If suspected cholecystitis (tender and palpable)
Hook left thumb under costal margin and have patient take deep breath. Positive if pain and halt in inspiration
42
What kidneys usually not palpable
Left
43
Why is right kidney more palpable
Due to the liver
44
Aorta is where
Left of midline
45
Detect ascites
Percuss for tympany and dullness when supine and then recumbent. Boarder of dullness shifts to dependent side (aka approaches midline)
Fluid wave
46
Fluid wave for what and how
Ascites
Supine patient. Patients knife edge upright and middle of tummy. Doctors hands on each side. And hit one side. Will feel impulse of fluid wave if adipose.
47
Stats on fluid wave tactic
If positive its highly likely fluid. If negative, may still have fluid
48
Appendicitis
MC 2nd decade of life
Initial periumbilical pain that then migrates to RLQ
+Pisa’s sign and rebound tenderness
49
Rebound tenderness. What when
Appendicitis
Push deep in area of abdomen and retract hand quick at area other than issue. Pain at McBurney’s point in RLQ = appendicitis
Pain at area of compression = + Blumberg sign = peritoneal inflammation
50
Iliopsoas muscle test
Place hand on thigh and have patient raise straight leg
Pain= irritation of ilipsoas (and inflamed appendix irritates ilipsoas)
51
Obturator muscle test
When and what
Suspect ruptured appendix or pelvic abcess
Flex right leg and hip at 90 degrees and then doctor grabs above knee and at ankle and rotates leg laterally and medically
+ pain in R hypogastric region indicates irritation of obturator (ruptured appendix or pelvic abscess irritates)
52
Aaron sign
Pain in area of heart of stomach on palpation of McBurney’s point
Appendicitis
53
+ Aaron test
Appendicitis
54
Ballance sign
Fixed dullness to percussion in left flank and dullness in right flank that disappears on change of position
Peritoneal irritation
55
+ ballance sign
Peritoneal irritation
56
Blumberg sign
Rebound tenderness
Peritoneal irritation
Appendicitis
57
+ Blumberg sign
Perritoneal irritation
| Appendicitis
58
Cullen sign
Ecchymosis around umbilicus
Hemoperitoneum
Pancreatitis
Ectopic pregnancy
59
Cullen sign +
Hemoperitoneum
Pancreatitis
Ectopic pregnancy
60
Dance sign
Absence of bowel sounds in RLQ
Intussusception (ilium goes into cecum)
61
+dance sign
Intussusception
62
Grey turner sign
Ecchymosis of flanks
Hemoperitoneum
Pancreatitis
63
+ grey turner
Hemoperitoneum
| Pancreatitis
64
Kehr sign
Abdominal pain radiating to left shoulder
Spleen rupture
Renal calculus
Ectopic pregnancy
65
+ Kehr sign
Spleen rupture
Renal calculi
Ectopic pregnancy
66
Markle sign
Raise up on toes and relaxes that causes abdominal pain
Peritoneal irritation
Appendicitis
67
+ markle sign
Peritoneal irritation
| Appendicitis
68
McBurney sign
Rebound tenderness and sharp pain when McBurney’s point palpated
Appendicitis
69
+ McBurney sign
Appendicitis
70
Murphy sign
Abrupt cessation of inspiration on palpation of GB
Cholecystitis
71
+ Murphy sign
Cholecystitis
72
Romberg-Howship sign
Pain down medial aspect of thigh to knees
Strangulated obturator hernia
73
+ Romberg-Howship sign
Strangulated obturator hernia
74
Rovsing sign
RLQ pain intensified by LLQ palpation
Peritoneal irritation
Appendicitis
75
+ Rovsing sign
Peritoneal irritation
| Appendicitis
76
Burning
Peptic ulcer
77
Cramping
Biliary colic/gastroenteritis
78
Colicky
Appendicitis with impacted feces
79
Aching
Appendiceal irritation
80
Knifelike
Pancreatitis
81
Ripping/tearing
Aortic dissection
82
Gradual onset
Infection
83
Sudden onset
Duodenal ulcer
Acute pancreatitis
Obstruction
Perforation
84
In infants scaphoid (concave) abdoment and respiratory distress may indicate what?
Diaphragmatic hernia
Other s/s: bowel sounds in chest
85
Enlarged spleen in infancy may indicate what
Hemolytic disease or sepsis
Usually spleen is palpable in infant a few weeks after birth
86
Hepatomegaly present in infants when liver is where
3 or more cm below right costal margin
87
Duration of acute diarrhea
Less than 4 weeks
88
Tenesmus
Feeling of incomplete defecation
89
GERD cause
Backward flow of gastric contents into esophagus due to relaxation/incompetence of lower esophageal sphincter
**delayed gastric emptying is predisposing factor
**difficulty swallowing
90
Risk factors for GERD
Obesity
Hiatal hernia
Pregnancy
CT disorders (scleroderma)
91
GERD has an association with what other issue(s)
Asthma
75% of asthma patients experience GERD
People with asthma 2x likely to have GERD
And diabetes
92
IBS
Disorder of intestinal motility
Late adolescence and early adulthood (rarely over 50 onset)
93
Alternating constipation and diarrhea is a good indicator of what disease
IBS
94
Hiatal hernia
Part of stomach passes through the esophageal hiatus into chest cavity
Women 50+
95
Two types of hiatal hernias
Sliding and PEH (paraesophageal)
96
Sliding hernia
More common, less dangerous
Esophagus pulled upwards
97
PEH (paraesophageal hernia)
Part of esophagus and stomach through esophageal hiatus
98
Causes of hiatal hernias
MC 50+ females
Weakened muscle allows stomach to bulge through
Injury
Congential Ly large hiatus
Persistent and intense pressure on surrounding muscles (coughing, straining excessive lifting etc)
99
Peptic ulcer causes
```
Helicobacter pylori infection
Long term aspirin/NSAIDS
Smoking
Alcohol
Men
```
100
S/s of peptic ulcer
A
Localized epigastric pain (burning) when stomach empty
Hematemesis
101
Crohn’s where does it affect
Can inflect any part of GI
Terminal ileum and colon MC
102
What might give RLQ pain
Crohn’s or appendicitis
103
S/s of crohn’s
```
RLQ pain
Perianal skin tags
Cobblestone appearance of mucosa on colonoscopy
Fistulas
Ulcers
```
104
Risk factors for crohns
- white/Jewish
- history
- cigarette smoking (MC risk factor)
- urban/industrialized country
105
Ulcerative colitis issues where
Large intestine and rectum
106
How to differentiate crohns and ulcerative colitis
UC: NO fistulae or perianal disease
107
S/s of UC
Bloody, frequency watery diarrhea
108
How long is the alimentary tract? And each part
```
27 feet
Esophagus 10 inches
Stomach
SI-21 feet
LI-4.5-5 feet
```
109
What does the stomach secrete to do what
HCL and enzymes to break down fats and proteins
110
Two functions of LI
Water absorption
| Putrefaction (live bacteria decompose undigested food etc)
111
What synthesizes, concentrates and stores bile
Liver synthesizes
| GB: concentrates and stores
112
Path of bile release
Into cystic duct—> C. Bile duct —> duodenum
113
When is meconium first produced?
17 weeks
114
When is GI tract capable of adapting to extrauterine life
36-38 weeks
115
Elasticity, musculature, and control mechanisms continue to develop, reaching adult functioning levels when
2-3 years
116
What organ is large at birth
Liver
| Heaviest organ in the body
117
When can a fetus produce urine
12 weeks
118
When does development of new nephrons stop
36 weeks
119
What are some things seen with pregnancy
```
Heartburn
Gallstones (MC in 2/3rd tri)
Urinary stasis/urgency
Constipation/flats
Hemorrhoids
Linea nigra (was linea alba but when stretched turns dark)
```
120
Things seen with older adults
-motility slows
-secretion/absorption slows
-digestive ability declines —> food intolerances
-increase in biliary lipids—> gallstones
No change in pancreas
121
Inspection of abdoment procedure
Look at contour (concave/scaphoid, flat, convex/round) from side and head of table
- have pt. Take deep breath and hold
- pt raise head from table (hernias?)
122
During auscultation of abdomen, what abnormal sounds are heard with bell and diaphragm
Bell: bruits and venous hum
Diaphragm: friction rubs
123
What does friction rub heard with diaphragm in stomach indicate
Inflammation of peritoneal surface of organ from tumor, infection or infarct
124
Where are the upper and lower boards typically of the liver
5th intercostal space to inferior costal margin
125
Determining if mass or distended structure (felt as resistance) is voluntary or involuntary
Palpate while patient breathes slowly through mouth.
If resistance remains, probably involuntary
126
Rebound tenderness over site that was compressed. Sign? Indicates?
Blumberg
| Peritoneal inflammation
127
Rebound tenderness over RLQ. Sign? Indicates?
McBurney’s sign
| Appendicitis
128
If scaphoid abdomen in infant what may it indicate
Diaphragmatic hernia
129
Who has more tympany in abdomen?
Infants and children because they swallow air when feeding
130
When may an enlarged liver be found in infants
Mother with poorly controlled insulin-dependent DM or gestational diabetes
131
Is spleen usually palpable within the first few weeks after birth
Yes
| 1-2cm below left costal margin
132
Bacteria associated with acute diarrhea and travel? Camping/well water?
E.coli/samonella/shigella
Giardia/campylobacter
133
What is a predisposing factor for GERD
Delayed gastric emptying
134
Stats on IBS
1 in 5 Americans
135
What is IBS
Disorder of intestinal motility
136
What may a large hernia lead to
Allow food and acid backup into the esophagus and causes heartburn
137
Demographics of MC people with hiatal hernia
MC in women and 50+
138
Hiatal hernias associated with?
Obesity
Pregnancy
Ascites
Tight fitting belts/clothing
139
What causes hiatal hernia with esophagitis
Weakened muscles allow stomach to bulge through
Age related
Injury
Congenitally large hiatus
Persistent/intense pressure on surround muscles (coughing/vomiting/straining during bowel)
140
Two types of peptic ulcers
Gastric-inside stomach
| Duodenal-inside duodenum
141
Hematemesis
Vomiting blood
142
Complications of peptic ulcer
- Internal bleeding (anemia/black bloody stool/vomit)
- Infection (perforate stomach/SI wall)
- obstruction (swelling/inflammation/scarring)
143
What does Crohn’s disease cause
Ulceration, fibrosis and malabsorption
144
Risk factors for Crohn’s disease
- before 30
- whites/Jewish
- family history (1/5)
- cigarette smoking (Most controllable)
- environmental factors-urban/industrialized —high fat/refined
145
Complications of crohns
```
Bowel obstruction
Ulcers (anywhere in Dig. Tract)
-fistulas
-anal fissure (when ulcer extend through intestinal wall Mc: perianal)
-malnutrition (B12/Iron)
-colon CA (due to inflammation/scarring)
```
146
What is a fistula
When ulcer extend through intestinal wall
MC perianal
147
Tx for crohns
None
Diet and stress aggravate
Anti-inflammatory drugs
Immunosuppressants
Nearly 1/2 have 1 surgery at least
148
S/s of Ulcerative Colitis
- Frequent bloody/watery diarrhea
- NO fistulae/perianal disease
- abdominal pain/cramping
- rectal pain/bleeding
- urgency to defecate
- inability to defecate despite urgency
- fever
149
Risk factors for ulcerative colitis
- family
- before 30
- whites
150
Complications of ulcerative colitis
- bleeding
- perforated colon (infection)
- severe dehydration
- osteoporosis (decreased absorption of VitD/Ca plus meds they take decrease bone density)
- inflammation of skin/joints/eyes
- increased risk fo colon CA
- rapid swelling colon (toxic megacolon)
- increased risk of blood clots
151
Tx of ulcerative colitis
```
Anti-inflammatory drugs
Immunosuppressants
AB
Anti-diarrheal medications
-pain relievers
-iron supplements
-surgery
```
152
Where stomach CA usually found
Lower half
153
S/s of stomach CA
- decreased appetite
- feeling full
- weight loss
- dysphasia
- persistent epigastric pain
- severe,persistent heartburn
154
Risk factors for stomach CA
- GERD
- high salt/smoked food. Low fruit and veggies
- family history
- infection with Helicobacter pylori
- long term stomach inflammation
- smoking
155
Diagnose stomach CA upon exam
- mid-epigastric tenderness
- hepatomegaly
- enlarged supraclavicular nodes (VIRCHOWS)
- ascites
156
Diverticular disease/ diverticulitis
Saclike mucosal outpouchings that form in a lining of digestive system
157
When is diverticulitis MC?
After 40
158
What is affected in diverticulitis
Sigmoid colon
159
S/s of diverticulitis
```
LLQ
Anorexia
Nausea/vomit
Constipation
Decreased bowel sounds
Pain localized to site of inflammation
Abdominal distinction
Tympany with percussion
Lower GI bleeding
```
160
Risk factors for diverticulitis
- increased age
- obesity
- smoking
- lack of exercise
- high fat, low fiber diet
- medications
161
S/s of colon cancer
```
Change in bowel habits
Blood in stool ***
Abdominal cramps
Fatigue
Weight loss
Early stage may have no s/s
RIBBON/PENCIL like stool
```
162
Risk factors for colon cancer
```
AA
Age
History
Inflammatory conditions
Low fiber, high fat
Sedentary
Diabetes
Obesity
Smoking
Alcohol
```
163
Screening recommendations for colon CA
Average risk: at 45
| Increased risk: before 45
164
Cause of hepatitis
Viral infection
| Alcohol, drugs, toxins
165
Hepatitis
Diffuse or patchy hepatocellular necrosis
166
S/s of hepatitis
```
A
Anorexia
Fatigue
Abd pain
Jaundice (skin and sclera)
Clay colored stools
Tea colored urine
```
167
Cirrhosis causes
Hepatitis C
| Chronic alcoholism etc
168
Exam findings with cirrhosis
```
Jaundice
Prominent abd vascular
Spider angiomas
Liver enlargement with non-tender boarder
Liver size decrease with scarring
Portal HTN/ascites
Muscle wasting
```
169
Primary hepatocellular carcinoma
Arises in the setting of cirrhosis 20-30 years after injury/disease
High mortality
170
S/s of primary hepatocellular carcinoma
```
A
Fatigue
Fullness
Clay colored stool
Tea colored urine
Jaundice
Hepatomegaly with HARD IRREGULAR BOARDER *****
-nodules present and palpable (tender or non)
```
*cirrhosis has large liver with hard non-tender boarder recall
171
Cholelithiasis
Gallstones
172
Cholelithiasis s/s
```
Murphy’s sign +
Colic
RUQ pain
Pain in back and right shoulder
Nausea/vomit
```
White with black center on X-ray
(Kidney stones are solid white stones)
173
Cholecystitis
Inflammation of gallbladder
174
MC cause of cholecystitis
Obstruction of cystic duct from cholelithiasis
Acute or chronic
175
Acute cholecystitis
90% have stone formation that causes obstructoin and inflammation
176
Chronic cholecystitis
Repeated attacks of acute cholecystitis in GB that is scarred and contracted
177
Cholecystitis s/s
Acute and chronic
```
RUQ pain that radiates to right scapula
Fiber
Jaundice
Anorexia
Pain abrupt for 2-4 hours
```
Chronic: may have fat intolerance, flatulence, nausea, anorexia and non-specific abdominal pain
178
nonalcoholic fatty liver disease (NAFLD)
Spectrum ranging from steatosis to cirrhosis and hepatocellular carcinoma
Too much fat stored in liver cells
Hepatic cell inflammation and injury thought o arise from accumulation of triglycerides in the liver
179
MC cause of chronic liver disease in US
Nonalcoholic fatty liver disease
180
Thought to be cause of NAFLD
Inflammation and injury arise from accumulation of triglycerides in liver
Insulin resistance important factor
181
S/s of NAFLD
```
A
RUQ
Fatigue
Malaise
Jaundice
Physical exam unremarkable
1/2 patients have hepatomegaly
```
182
Acute pancreatitis causes what
Release of pancreatic enzymes that leave to auto digestion
183
Causes of acute pancreatitis
- Biliary disease (cholelithiasis)
| - Chronic alcohol abuse
184
S/s of acute pancreatitis
- Sudden onset of persistent epigastric pain
- RADIATES TO BACK 50%
- Constant/dull
- abd distention
- fever
- anorexia
- diffuse abd. Pain
- decreased bowel sounds
- Cullen/grey turner signs
- tachycardia
- dyspnea
185
Complications of acute pancreatitis
- pseudocyst
- infection
- kidney failure
- breathing issues
- diabetes
- malnutrition
- pancreatic CA
