when does the person specifically get pain?
what 2 things make it worse?
three things to avoid?
AFTER FATTY MEALS!!
lying down and bending over make it worse
3. fatty meals
describe the pain see in PUD?
gnawing, burning achiing
what is the most common type of stomach cancer?
what doesn't make it better?/
not relieved by food to antacids
where is the pain?
what if it stops?
periumbilical pain followed by lower right quadrant pain
if subsides temporairly suspect perforation of appendix
nause vomiting followed by onset of pain and low fever
where is the pain?
2 things make it worse
right upper quadrant pain that may radiate to right scular area
2. deep breathing
where it the pain?
pt might be....
right upper quadrant that radiates to right scapula and shoulder
where is the pain?
2 things in hx?
epigastric may radiate to back
improves: leaing forward to truck flexed
**may see hx of alcohol abuse or gallstones**
left lower quadrant
crampy pain to steady
acute bowel obstruction
location of pain?
2 things that can happen in SI?
1. adhesions or herias SMALL INTESTINE, periumbicial pain
2. cancer or diverticulis: COLON, periumbicial at first then diffuse
these can happen in SMALL INTESTING OBSTRUCTION
**vomiting of bile and mucous=high obstruction
vomiting of feces=low obstruction**
what does oropharyngeal dysphagia mean?
what is this?
3 causes of this?
motor disorders affecting the pharyngeal muscles
aspiration into the lungs or nose with attempt to swallow
esophageal dysphagia is...
explain the dysphagia you would see with someone who has esophageal dysphagia from esophageal cancer?
starts with slids and progresses to liquids
explain the pain that you would see with esphageal spasm?
what can make it better?
chest pain that minics angina pectoris or MI and lasts minutes to hours
***NITRO CAN IMPROVE THIS**
what can you do to relieve the sxs associated with schleroderma
1. repeated swallowing
2. straightening the back
3. raising arms
4. valsalva maneuver straining down against closed glottis
what is a false expectation when it comes to bowel habits?
expectations of regularity
what are the requirements for dxing irritable bowel syndrome?
symptoms for 6 months
pain for 3 months
and 2 of 3:
1. improvement with defecation
2. onset with change in stool frequency
3. change in stool form and appearance
what are two manifestations you might see with rectal cancer?
2. pencil shaped stool!!
who is fecal impaction common in?
debilitated, bedridden and elderly patients
what might the stool look like in an intussusception?
currant jelly stools
RED WITH MUCOUS
what can painful anal lesions cause?
spasm of the external spincter and involuntary inhibition of the defecation reflex
what are the 3 medications that can cause constapation?
3. antacids with calcium or aluminum
what are 3 conditions that can neurological disorders that lead to constapation?
1. spinal cord injuries
2. multiple sclerosis
3. hirschsprungs disease
what are three metabolic conditions that can lead to constapation?
what is the difference between the stool and sxs of secretory infection and inflammatory infection?
secretory-watery w/o blood pus or mucous temp normal
inflammatory-watery/loose with blood, pus, or mucous urgency, tenemus, fever
what are 7 bacteria that cause secretory infection?
1. s aureus
2. b cereus
3. c. perfringens
4. e. coli
6. giardia lamblia
what type of bacteria typically cause secretory infection?
those that make bacterial toxins
what are 5 bacteria that typically cause inflammatory diarrhea?
irritable bowel syndrome
3 characteristics of the pain
worse in the morning, rare at night
pain relieved with defecation
who is cancer of the sigmoid colon common in?
those over 55
what are people with ulcerative collitis at increased risk for?
2 places this occurs
characteristic of diarreah
what group of people more prevalent in
**diarreah can awaken patient in night**
MORE COMMON IN PEOPLE OF JEWISH DESCENT
describe the stool
bulky, soft, yellow to gray
greasy oily and frothy
floats in toilet
vitamin K deficiencies cause
vitamin D deficiciencies can cause
vitamin B deficiencies can cause...
a protein deficiency can cause
people with lactose intolerance lack...
lactase and have an issue after drinking milk or milk products
what are the 3 racial groups particullary influenced by lactose intolerance?
at least 60 mL of blood into gastrointestinal tract usually from esophagus, stomach, duodenum
when would you typically get pain after eating with duodenal ulcer?
2-3 hours later
what is the main cause of esophageal or gastric varices?
cirrhosis of the liver
what is mallory- weiss tear attributed to?
retching and vomiting after recent ingestion of alcohol
what are 3 things that can cause a black stool that is negative for occult?
2. bismuth salts
what is melena?
black tarry stool
what is hematochezia
red blood in the stool originating form the colon, rectum, and anus
hemmoroids and anal fissure
3 ways you might see the blood
blood on the toilet paper or on surface of stool or dripping into the toilet
what does the ingestion of beets do you the urine and stool? why?
turns in pink and turns the stool reddish from poor metabolism of betacyanin
what is a umbilical hernia? in who?
protrusion thought defective unmilcal ring MC in infants
protrusion through an opertive scar
what is an epigastric hernia?
when is it seen the best?
small midline protrusion though a defect in the linea alba between the xiphoid and umbilicus
**seen better with patients head and shoulders raised**
what is this?
when does it occur?
3 things common in?
separation of the two rectus abdominis mucles through which the abdominal contents for a midline ridge when the patient raises head and shoudlers
3. chronic lung disease
what do they feel/look like?
soft and often lobulated
**if you push down on it, it likely will slip out from underneath**
what is a pannus?
what can happen to the umbilicus?
apron of fatty tissue
umbilicus amy be sunken
explain the percussion pattern common with this? why?
dullness over the abdominen, typmpani above
**this is because the tumor displaces the air upwars**
what does this person show?
what is characteristic of the pattern?
goes to the lowest point in the abdomen that causes bulging flanks taht are dull to precussion
when person terns on their side, detect a fluid shift
increased bowel sounds indicated...2
early intestinal obstruction
decreased bowel obstruction indicates...2
how long must you listen before determining there is no bowel sounds?
what do high pitched tinkling sounds in the bowel suggest?
intestinal fluid and air under tension in dilated bowel
what do rushes of high-pitched sounds with cramping indicate?
a hepatic bruit suggests...2
carcinoma of the liver or alcholic hepatitis
arterial bruits with both systolic and diastolic compents suggest....
partial occlusion of the aorta or large arteries
what does a venous hum indicate? ex?
increased collateral circulation between the portal and systemic venous system
seen in hepatic cirrhosis
where do you hear a venoux hum?
epigastic and umbical
what is a friction rub and what does it indicate?
grating sound with repiratory variation
indicates inflammation of the peritoneal surface of an organ
where are two places you might hear a friction rub?
hepatic and splenic
if you hear a systolic bruit and hepatic friction rub what should you suspect?
carcinoma of the liver
what are the sxs?
where does it occur?
motion of the uterus causes pain
(inflammation of fallopian tubes)
just above the inguinal ligaments
where do you look for acute cholecystisits?
upper right quadrant
where does pain from acute pancreatitis occur?
may also have?
CAN HAVE REBOUND TENDERNESS
where does the pain from acute apendicitis occur?
RIGHT LOWER QUADRANT
****BETWEEN LINE JOINING UMBILICUS AND ACIS****
where does diverticularits occur?
lower left quandrant
explain a normal variation of liver shape and who might you find this in?
riedels love which means that the liver is elongated but no change in volume or size
typically in lanky people!! stretches it out!!
**this makes the liver palpable since it points towards the iliac**
what conditions can produce a smooth, large liver?
1. NONTENDER EDGE
2. TENDER EDGE
venous congestion in right heart failure
what does a enlarged, hard, irregular edge of liver suggest?