Abdomen (Test 1) Flashcards
(218 cards)
1
Q
What are the side boundaries of the abdomen?
A
flank muscles
2
Q
What is the top boundary of the abdomen?
A
diaphragm
3
Q
What is the bottom boundary of the abdomen?
A
pelvic floor muscles
4
Q
The liver is in which abdominal quadrant?
A
RUQ
5
Q
The gallbladder is in which abdominal quadrant?
A
RUQ
6
Q
The pylorus of stomach is in which abdominal quadrant?
A
RUQ
7
Q
The duodenum is in which abdominal quadrant?
A
RUQ
8
Q
The head of pancreas is in which abdominal quadrant?
A
RUQ
9
Q
The right adrenal gland is in which abdominal quadrant?
A
RUQ
10
Q
The hepatic flexure is in which abdominal quadrant?
A
RUQ
11
Q
A portion of the ascending and transverse colon is in which abdominal quadrant?
A
RUQ
12
Q
The left lobe of liver is in which quadrant?
A
LUQ
13
Q
The spleen is in which abdominal quadrant?
A
LUQ
14
Q
The stomach is in which abdominal quadrant?
A
LUQ
15
Q
The body of the pancreas is in which abdominal quadrant?
A
LUQ
16
Q
The L adrenal gland is in which abdominal quadrant?
A
LUQ
17
Q
The splenic flexure is in which abdominal quadrant?
A
LUQ
18
Q
A portion of the descending and transverse colon is in which abdominal quadrant?
A
LUQ
19
Q
The cecum is in which abdominal quadrant?
A
RLQ
20
Q
A portion of the ascending colon is in which abdominal quadrant?
A
RLQ
21
Q
If the bladder is full, what abdominal quadrant is it in?
A
RLQ
22
Q
The ovaries and salpinx are in what abdominal quadrants?
A
R and LLQ
23
Q
If the uterus is enlarged, what abdominal quadrants is it in?
A
R and LLQ
24
Q
The R/L spermatic cord is in which abdominal quadrants?
A
R and LLQ
25
The R/L ureter are in which abdominal quadrants?
R and LLQ
26
What are the 7 solid organs?
1) liver
2) spleen
3) kidneys
4) adrenals
5) pancreas
6) ovaries
7) uterus
27
What are the 8 hollow organs?
1) stomach
2) small intestine
3) colon
4) gallbladder
5) bile ducts
6) fallopian ducts
7) ureters
8) urinary bladder
note: these cannot be palpated unless there is gas, fluid, or a mass present
28
What is the appearance associated with blood in stomach and results in bloody vomit?
coffee ground appearance (caused by ulcers or cancer)
29
Unexplained weight loss or gain think what organ issue?
thyroid
30
What are the 5 types of abdominal pain?
1) solid organ
2) hollow organ
3) referred pain
4) peritoneal
5) calculi (kidney or gallbladder)
31
What abdominal pain type would have these symptoms?
-cause= pleural stretching of organ
-constant, dull, hard, achy
-irritated with palpation
-pain varies with speed of the stretch
test q
solid organ pain
32
Stomach ulcers refer pain where?
shoulder
33
gallbladder pain refers to where?
tip of right scapula
34
Rectum, anus, or prostate pain refers to where?
low back
35
stomach, pancreas, spleen, or kidney pain would refer to where?
xyphoid
36
Small intestine pain or appendicitis refers to where?
umbilicus
37
heart pain refers to where?
neck and left arm
38
What abdominal pain type would have these symptoms?
-wave like
-comes and goes
-bile duct, ureters, intestines
test q
hollow organ pain
39
Pain in the RUQ is most likely what organ?
gallbladder
40
Pain in the LUQ is most likely what?
pancreatitis
41
Pain in the LLQ is most likely what?
boards q
diverticulitis
42
Pain in the RLQ is most likely what?
appendicitis
43
What is the order for an abdominal exam?
drag drop q
1) case hx
2) inspection
3) auscultation
4) percussion
5) palp
44
purple striae on the abdomen indicates?
cushings disease
45
What is the fancy word for stretch marks?
striae gravidrum
46
Spider nevi can be due to what vit deficiency?
vit B
47
What is cullen's sign?
periumbilical bluish discoloration
48
What are some causes of ascites?
-cirrhosis
-hepatitis
-portal HTN
-liver cancer
-pancreatitis
-CHF
49
What are the 3 main sounds to detect with auscultation on abdomen?
1) bowel sounds
2) friction rubs
3) bruits
50
How are bowel sounds described?
clicks, gurgles
51
More than 34 bowel sounds in a min is considered abnormal. What causes increased bowel sounds?
test q
1) gastroenteritis
2) early bowel obstruction
3) laxative overuse
52
Less than 5 bowel sounds in a min is considered abnormal. What causes decreased bowel sounds?
test q
1) late bowel obstruction
2) inflammation of the peritoneum
3) abdominal surgery
53
borborygmi=
hyperactive bowel sounds
54
Friction rubs are caused by inflammation of the peritoneal surfaces from tumors, infections, and infarctions. What organs are frequently involved?
liver and spleen
55
If you hear a venous hum during artery auscultation of abdomen, what does this indicate?
portal HTN, secondary to cirrhosis of the liver
56
What are normal percussion sounds for abdomen?
Test q
tympany (air in stomach and intestines) and dull (in all other organs)
57
What is the superior border of traube's space?
6th rib
58
What is the inferior border of traube's space?
left costal margin
59
What is the lateral border of traube's space?
midaxillary line
60
Traube's space is an area to detect?
splenomegaly
61
What is a puddle sign?
free abdominal fluid heard during gastric air bubble percussion
62
What should be assessed with deep palpation of the abdomen?
1) general
2) liver
3) gallbladder
4) kidneys
5) aorta
63
What is the most common emergency abdominal surgery?
appendicitis
64
What is the MANTRELS mnemonic for appendicitis?
M= migration of pain
A= anorexia
N= nausea and vomiting
T= tenderness in RLQ
R= rebound tenderness
E= elevated temp
S= shift to the left (neutrophils, bands, etc)
65
What is the pain pattern for a peptic ulcer?
burning sensation
66
What is the pain pattern for biliary colic and gastroenteritis?
cramping
67
What is the pain pattern for kidney stones or appendicitis with impacted feces?
colicky
68
What is the pain pattern for pancreatitis?
knifelike
69
What is the pain pattern for an aortic dissection?
ripping/tearing
70
What is blumberg's sign?
sharp stabbing pain at the side of pressure during the rebound tenderness test
71
What is psoas sign?
pain indicates irritation of iliopsoas muscle and appendicitis
72
What is an obturator's sign?
pain in right hypogastric region= irritation of obturator muscle and ruptured appendix or pelvic abscess
73
Which test is this?
-pain at heart or stomach when palpating mcburney's point
-indicative of appendicitis
aaron test
74
Which test is this?
-palp at LLQ gives RLQ pain
rovsing test
75
Aaron test is testing for what?
appendicitis
76
Rovsing test is testing for what?
appendicitis and peritoneal irritation
77
Which test is this?
-jarring the body: pt on tippy toes with knees straight, relaxes and heels hit the floor
markle test
78
Markle test is testing for what?
appendicitis and peritoneal irritation
79
Which test is this?
-rebound tenderness and sharp pain with palp at a specific point
mcburney's test (at mcburney's point)
80
What is mcburneys test testing for?
appendicitis
81
What test is this?
-rebound tenderness
-testing for appendicitis and peritoneal irritation
blumberg test
82
What test is this?
-fixed dullness to percussion on left flank
-dullness on right flank which disappears with change in position
balance test
83
Balance test is testing for what?
peritoneal irritation
84
Which test is this?
-ecchymosis on flank at LUQ and RUQ
grey turner test
85
Grey turner test is testing for what?
-liver, spleen, or kidney injury
-pancreatitis
86
What test is this?
-ecchymosis around umbilicus
cullen test
87
What sign is this?
-abdominal pain referring to the tip of left shoulder
kehr sign
88
Kehr sign is seen when?
splenic rupture
89
What sign is this?
-pain or interruption of breathing when examiners fingers touch gallbladder
murphy's sign
90
when is murphy's sign seen?
Test q
cholecystitis
91
Which sign is this?
-pain down medial thigh to knee
romberg howship sign
92
When is romberg howship sign seen?
strangulated hernia (obturator)
93
Which sign is this?
-no bowel sounds in RLQ
dance sign
94
When is dance sign seen?
intussusception
95
What pathology is this?
-sensitivity to gluten
-mucosal damage with loss of villi and proliferation of crypts
celiac disease
96
What pathology is caused by antibiotic use for c diff or ischemia?
Test q
colitis
97
What pathology is also known as small bowel?
Test q
crohn's disease
98
Which pathology has skip lesions?
crohn's disease
99
What pathology is this?
-sac like mucosal projections through muscular layer of GI tract
-94% in sigmoid colon
diverticulitis
100
What pathology is this?
-multiple diverticula in colon
-segmental spasm of muscular coat of bowel
diverticulosis
101
What pathology is also known as spastic colon?
IBS
102
When do you see a coffee ground appearance?
anytime theres bleeding in stomach from ulcers or cancer and pt vomits blood
103
coffee ground color vomit is called
hemetemesis
104
What pathology is this?
-gastric acid contents enter esophagus
-most commonly from hiatal hernias and lower esophageal sphincter compromise
-recumbent positions are provocative
Test q
gastric reflux/ GERD which can cause metaplasia barrett esophagus
105
Esophageal carcinoma is characterized by what?
1) dysphagia
2) weight loss
3) anorexia
106
What pathology is this?
-varicose veins in esophagus
-caused by portal HTN, peptic ulcer, or mallory weiss syndrome
esophageal varices
107
What pathology is this?
-affects muscle function, coordination, peristalsis
-esophageal dysfunction is the most frequent visceral disturbance
-dysphagia starts due to impaired esophageal motility and reflux
systemic sclerosis/ scleroderma
108
What pathology is this?
-bulbar muscles are affected by lesions in the corticobulbar pathways in pyramidal tracts (CN 9-12)
bulbar and pseudobulbar palsies
109
What pathology is this?
-persistent contraction of lower esophageal sphincter and absence of peristalsis
-dilation of esophagus is caused by loss of ganglion cells in the myenteric plexus
-usually due to Chagas disease (trypanosoma cruzi)
-bird beak appearance on xray
Test q
achalasia
110
What pathology is this?
-hypertrophy of circular muscle layer of pylorus
-projectile vomiting in an infant within 1-2 weeks of birth, or as soon as they start drinking milk
Test q
pyloric stenosis
111
What pathology is this?
-inflammation of stomach
-acute causes: mucosa becomes inflamed, necrotic, and may hemorrhage
-acute ex: NSAIDs, cigs, alcoholic, burn injury (curling ulcer "can burn yourself with curling iron"), or brain injury (cushing ulcer "brain is cushy")
-chromic causes: chronic inflammation and atrophy of mucosal glands
-chronic ex: autoimmunity due to H pylori (most common cause)
gastritis
112
What is the most common cause of gastritis?
H pylori
113
What pathology is this?
-breach in the mucosa of the alimentary canal leading to erosion of the gastric mucosa
-usually occurs at/near lesser curvature
-not dependent on gastric acid secretion but pepsin and acid may play a role
-caused by H pylori, increased permeability to H+ ion or bile
peptic ulcers
114
Who most commonly gets gastric carcinoma?
-50 y/o
-type a blood
-men
115
Supraclavicular lymph node involvement due to metastasis from stomach is called
virchow node
116
Bilateral ovary involvement due to metastasis from stomach is called
krukenberg tumor
117
T/F: ulcers are deeper than erosions and penetrate the muscularis mucosa
true
118
Peptic ulcers are most common with what blood type?
O
119
What are the 2 types of peptic ulcers?
gastric and duodenal
120
What is the most common cause of peptic ulcers?
H pylori
121
What pathology is this?
-tumor of pancreas or duodenal wall
-hypergastrinemia, gastric hypersecretion, and gastric ulcer
zollinger ellison syndrome
122
What ulcer is this?
-consistent pain
-classic mid morning pain which is relieved by eating
-pain awakens patient at night
duodenal ulcer
123
What ulcer is this?
-inconsistent pain
-eating makes pain worse
gastric ulcer
124
What pathology is this?
-may affect any part of the GI tract but is most common at distal ileocecum, small intestine, and colon
-can lead to carcinoma
-thickening of involved areas with a decrease in lumen
-submucosal edema with normal mucosa on surface has a cobblestone appearance**
-skip lesions, fisulas, granulomas
Test q
crohn's disease
125
What pathology is known for its cobblestone appearance and skip lesions?
Test q
crohn's disease
126
What is the most common congenital anomaly of SI?
meckel diverticulum
127
What pathology is this?
-remnant of vitelline duct and located in distal small bowel
meckel diverticulum
128
What pathology is this?
-telescoping of intestines
-invagination of a proximal segment of bowel into a distal segment
-results in intestinal blockage
intussusception
129
What pathology is this?
-twisting of the intestine leading to blockage
volvulus
130
What are the 3 malabsorption syndromes discussed in class?
1) celiac disease
2) whipple disease
3) pancreatic insufficiency
131
What pathology is this?
-sensitivity to gluten
-blurring of small intestinal villi
-scalloped/shiny intestines
Test q
celiac disease
132
What pathology is this?
-bacterial infection predominantly in middle aged males
-anemia
-skin pigmentation
-weight loss
-diarrhea
-severe malabsorption
-polyarthralgia and arthritis
whipple disease
133
What are the 3 types of tumors found in small intestine?
1) adenocarcinoma
2) lymphoma
3) carcinoid
134
What is the most common primary malignant tumor of small intestine?
adenocarcinoma
135
A group of tumors arising from neuroendocrine cells especially from GI tract like stomach, appendix (most common), and ileum is called
carcinoid
136
What are the 2 pathologies that are congenital but NOT inherited in the GI tract?
potential drop and drag q
pyloric stenosis and hirschsprung disease
137
What pathology is known as "congenital megacolon"?
hirschsprung disease
138
What pathology is this?
-congenital megacolon
-dilation of the colon due to absence of ganglion cells of submucosal and myenteric neural plexuses
-dilation if proximal to the aganglionic area of involvement
hirschsprung disease
139
What pathology is this?
-NO inflammation
-presence of ***multiple diverticula "out pockets"****
-low fiber diets are a factor
Short response test q
diverticulosis
140
What pathology is this?
-inflammation
-bright red rectal bleeding is common (hematochezia)
-abdominal pain, tenderness, fever, leukocytosis
-complications: perforations, abscesses, peritonitis, and bowel stenosis
diverticulitis
141
What are 2 examples of irritable bowel disease (IBD)?
crohn's disease and ulcerative colitis (UC)
142
What pathology is this?
-disorder of the GI tract/functional bowel disorder
-diagnosed by what it is NOT
-common in young females
-fluctuating bowel habits (diarrhea and constipation)
-improved by bowel movement
-bloating, abdominal pain, worse after eating
irritable bowel syndrome (IBS)
143
What are the predilection factors of IBD?
1) polyarthritis
2) uveitis (inflamed uvea) and episcleritis (inflamed episclera) (both of these are in the eye)
3) sacroiliitis (inflamed SI joints)
4) erythema nodosum
5) sclerosing cholangitis -> chronic cholestasis and portal HTN
144
What are the 3 types of colitis?
1) regular
2) ischemic
3) ulcerative
145
Which colitis is caused by C. diff and is the most common cause of diarrhea in care facilities?
Test q
regular colitis
146
What colitis is this?
-decrease blood flow leading to inflammation and tissue damage
-most commonly at splenic flexure (*superior mesenteric artery*) and rectosigmoid area (*inferior mesenteric artery*)
-loose bloody stool
-abdominal pain
Test q
ischemic colitis
147
What colitis is this?
-mucosal inflammation and ulceration of large intestines
-*rectum is ALWAYS involved**
-involves mucosal and submucosal layer with crypts of lieberkuhn= crypt abscess with PMNs
-mucosa appears red and granular
-hallmark= chronic diarrhea that is bloody with mucous, bright red rectal bleeding
-complication= toxic megacolon (medical emergency)
T/F question
ulcerative colitis
148
What are the 2 broad categories for polyps?
1) non-neoplastic
2) neoplastic/ adenomatous
149
What pathology is this?
-elevation of intestinal tissue
-pedunculated or sessile
-non-neoplastic type is anywhere in intestines and has no clinical significance
-adenomatous type: tubular is most common which is small, pedunculated and considered precursor to malignancy
polyps
150
What pathology is this?
-dilated internal and external venous plexuses in anal canal
hemorrhoids
151
-colon and rectal cancer, one of the most common neoplasms in the world
-CEA is a diagnostic lab but not specific
adenocarcinoma
152
What are the most common places for hernia?
1) umbilicus
2) diaphragmatic
3) hiatal
4) disc
5) groin
153
What are the 3 types of groin hernias?
1) direct inguinal
2) indirect inguinal (most common)
3) femoral (least common)
154
Diaphragmatic hernia is due to ______________ defect
structural
155
Most diaphragmatic hernias are on what side?
left
156
What hernia is this?
-structural defect, usually on left side
-potential respiratory problems depending on severity
-bowel sounds heard in chest and stomach
-intestinal gas is heard in chest
-heart is displaced to the right
diaphragmatic hernia
157
Omentum or intestine can protrude through umbilicus is called
omphalocele
158
diastatis rectus abdominis=
muscles dont close
159
Hiatal hernias are usually with
Test q
esophagitis
160
What is a predisposing factor for hiatal hernia?
muscle weakness with pregnancy, obesity, ascites, or wearing tight belts
161
What is the most common groin hernia?
indirect inguinal
162
Which groin hernia is this?
-soft swelling in internal ring
Test q
indirect inguinal
163
Which groin hernia is this?
-external ring
-bulge in triangle area
direct inguinal
164
What groin hernia is this?
-through femoral ring, canal, and fossa ovalis but NEVER in scrotum
-severe pain
femoral
165
What pathology is this?
-yellow discoloration of skin, sclera, and tissue from hyperbilirubinemia
jaundice
166
Acute hepatitis is characterized by jaundice and increased serum _______
AST and ALT
167
What are the 2 hepatitis viruses that are transmitted through fecal oral route?
A and E
168
What are the 2 hepatitis viruses that are transmitted through sex and parenteral route?
B and D
just parenteral= C
169
Chronic hepatitis is the persistence of abnormalities in viral hepatitis for more than _______ months
6
170
What inflammatory liver disorder has councilman bodies that are remnants of dying hepatocytes?
yellow fever
171
What are the other names for yellow fever?
weil disease and leptospirosis
172
Hydatid disease in the liver is caused by?
echinococcus granulosis (tapeworm eggs)
173
What pathology is this?
-mircovesicular
-small fat vacuoles in parenchymal cells of the liver
-different from steatosis (fatty change)
-causes:
>>reye syndrome (aspirin toxicity in children)
>>*rare pregnancy complications may cause acute hepatic failure in 3rd trimester**
>>tetracycline toxicity (hypersensitivity reaction)
Test q
fatty liver
174
What is the most common form of liver disease in the US?
alcoholic liver disease
175
What pathology has mallory bodies?
alcoholic hepatitis
176
What pathology is this?
-descriptive term for chronic liver disease characterized by generalized disorganization of hepatic architecture with nodule formation and scarring
-all forms have an increased risk of hepatocellular carcinoma
cirrhosis
177
What are the 3 types of cirrhosis?
1) alcoholic
2) biliary
3) post necrotic
178
What are the 4 clinical findings in all cirrhosis types?
1) jaundice
2) hypoalbuminemia
3) coagulation factor deficiencies
4) palmar erythema/ spider nevi
179
What are the 4 consequences of liver scarring?
1) esophageal varices
2) caput medusa (venous collaterals)
3) splenomegaly
4) rectal hemorrhoids
180
What are the 6 changes due to liver damage and portal HTN?
1) peripheral edema
2) ascites
3) increased portal vein pressure
4) decreased plasma oncotic pressure
5) retention of sodium and water
6) encephalopathy
181
What pathology is known as bronze diabetes?
Test q
hemochromatosis
182
What pathology is an inherited defect of iron absorption by intestinal mucosa?
hemochromatosis
183
What is the clinical triad for hemochromatosis?
test q
1) cirrhosis
2) diabetes mellitus
3) skin pigmentation
184
What pathology is known as hepatolenticular degeneration?
Test q
wilson's disease
185
What pathology is this?
-autosomal recessive disorder of copper metabolism
-decreased ceruloplasmin
-liver disease
-kayser fleischer rings in cornea
-copper accumulates in liver, kidney, brain, and corneas
-basal ganglia in brain is also involved: extrapyramidal motor signs
test q
wilson's disease
186
What are the 3 inborn error of metabolism disorders leading to cirrhosis?
test q
1) alpha 1 antitrypsin
2) glycogen storage diseases
3) galactosemia (galactose 1 phosphate uridyl transferase deficiency)
187
What pathology is this?
-venous collaterals develops in submucosal veins of esophagus, hemorrhoidal plexus, and others sites
portal HTN
188
What pathology is this?
-caused by *thrombotic occlusion** of major hepatic veins
-spider webbing in collateral circulation
-nutmeg color liver due to RBC congestion
Test q
budd chiari
189
What are the 2 pathologies that cause a nutmeg color liver?
Test q
budd chiari and right sided congestive heart failure
190
What is the most common benign tumor of the liver?
Test q
hemangioma
191
What is the most common primary liver malignancy?
hepatocellular carcinoma
192
What pathology is this?
-acute: inflammation of gallbladder
-chronic: thickening gallbladder walls from fibrosis and stones
cholecystitis
193
What is the fancy word for gallstones?
cholelithiasis
194
What are the different types of gallstones?
1) cholesterol
2) bilirubin
3) cholesterol and calcium (most common)
195
What pathology is this?
-pseudocysts
-almost always associated with alcoholism
-progressive fibrosis and calcification of organ
-steatorrhea (pancreatic insufficiency and cannot digest fat due to lack of lipase)
-night blindness (vit A def)
-osteomalacia (vit D def)
chronic pancreatitis
196
What is trosseau sign?
migratory thrombophlebitis
197
Which organ is VERY susceptible to traumatic rupture?
spleen
198
What are the 2 main categories of glomerular disease?
1) nephrotic
2) nephritic
199
Which glomerular disease type is this?
-increased basement membrane permeability
-examples: diabetic or SLE nephropathy, membranous glomerulonephritis
-massive proteinuria
-hypoalbuminemia
-edema
nephrotic syndrome
200
Which glomerular disease type is this?
-inflammatory rupture of glomerular capillaries (bleeding into urinary space)
-examples: post strep glomerulonephritis, goodpasture syndrome, alport syndrome
-oliguria
-azotemia
-HTN
-hematuria
nephritic syndrome
201
Are urinary tract obstructions congenital or acquired in children?
congenital
202
Are urinary tract obstructions congenital or acquired in adults?
acquired from stones or BPH (benign prostatic hyperplasia)
203
What are the 2 types of UTIs?
1) cystitis
2) pyelonephritis
204
UTIs are usually caused by what?
e coli
205
What is the fancy word for bladder infection?
cystitis
206
What is the fancy word for urinary kidney infection?
pyelonephritis
207
What UTI type is this?
-pyuria (bacteria in urine)
-hematuria
-NO WBC CASTS**
Test q
cystitis
208
What UTI type is this?
-*WBC CASTS**
-pyuria (bacteria in urine)
-hematuria
-fever
-leukocytosis
-flank tenderness
Test q
pyelonephritis
209
What pathology is this?
-hypercalcemia leads to renal failure
-caused by hyperparathyroidism, excessive ingestion of antacids, milk alkali syndrome, and hyperphosphatemia
nephrocalcinosis
210
What pathology is this?
-calculi in urinary tract
-painful
urolithiasis
211
What are the 4 types of stones in urinary tract?
1) calcium
2) uric acid
3) cystine
4) ammonium magnesium phosphate
212
azotemia=
Test q
decreasing *renal* function
213
uremia=
urine in blood
214
What are some features of renal cell carcinoma?
-hematuria
-flank pain
-fever
-palpable mass
-secondary polycythemia
-ectopic hormone production like EPO
215
What is the most common renal malignancy?
renal cell carcinoma
216
What is the most common renal malignancy in children 2-4 y/o?
wilms tumor (nephroblastoma)
217
What is the most common tumor of urinary system?
transitional cell carcinoma
218
What is the main feature of transitional cell carcinoma?
hematuria
