Chapter 14 - Abdominal Flashcards Preview

Pt Assess II Final > Chapter 14 - Abdominal > Flashcards

Flashcards in Chapter 14 - Abdominal Deck (114)
1

Which race has the highest incidence of colorectal cancer?

African Americans

2

Which race has the lowest incidence of colorectal cancer?

Native Americans

3

The lifetime risk of colonic cancer is 100% for patients with ____

Polyposis coli

4

What kind of diet puts a person at higher risk for colonic cancer?

Low fiber
High fat

5

What is the MC type of liver cancer?

Hepatocellular carcinoma

6

The incidence of liver cancer has been _____

Increasing

7

Rates of liver cancer are highest in which races?

Asians, Pacific islanders, Hispanics

8

MC causes of liver cancer in US/western countries

Alcohol-related cirrhosis and fatty liver disease from obesity

9

MC causes of liver cancer worldwide (outside of US)?

HBV and HCV

10

What increases the risk of pancreatic cancer?

Smoke and smokeless tobacco

11

Which organs are located posteriorly in the abdomen (so unlikely to be palpated)?

Kidneys
Duodenum
Pancreas

12

Why can a child's kidneys be palpated?

Less developed abdominal muscles

13

What is dysphagia?

Difficulty swallowing

14

What is chyme?

Semifluid creamy material produced by gastric digestion of food

15

Emptying of the stomach is normally complete within:

6 hours of eating

16

When is the flow of pancreatic juice maximal?

Approx. 2 hours after a meal

17

What are the 3 enzymes of chyme?

Lipase (fats)
Amylase (starches)
Trypsin (proteins)

18

Where are bile acids and Vit B12 absorbed?

Ileum

19

What is the dark color of stool caused by?

Presence of stercobilin (a metabolite of bilirubin)

20

What are acholic stools?

-No bile
-Pale brown to gray

21

Most abdominal disease manifests itself with:

Pain!

22

Abdominal pain can result from:

-Mucosal irritation
-Smooth muscle spasm
-Peritoneal irritation
-Capsular swelling
-Direct nerve stimulation

23

3 categories of abdominal pain

1. Visceral
2. Parietal
3. Referred

24

When does visceral pain develop?

Hollow abdominal organs contract forcefully or their walls are stretched

25

How is visceral pain usually described by the patient?

Gnawing, burning, aching
Difficult for pt to locate specifically

26

How does parietal pain develop?

Inflammation of peritoneum
-Extremely severe, patient can locate over a specific organ usually
-Movement exacerbates the pain

27

How does pain vary between gastric and duodenal ulcers?

-Gastric: pain 30 mins to 1 hr after a meal
-Duodenal: pain 2-3 hours after eating or before next meal

28

Nocturnal pain is a symptom of what abdominal condition?

Duodenal peptic ulcer

29

What triad of symptoms are found in abdominal angina?

Postprandial pain
Anorexia
Weight loss

30

What does abdominal angina result from?

Obstructive vascular disease in celiac axis or superior mesenteric artery

31

Cystitis vs. ureteral pain

-Cystitis: dull pressure a/w burning during urination
-Ureteral: extremely severe and colicky

32

Vomiting resulting from perforation is commonly ____

NOT massive

33

Vomiting resulting from obstruction is:

Episodic and at the height of pain

34

What generally causes persistent vomiting?

Toxins

35

In acute appendicitis, how do pain and vomiting usually present?

Pain precedes vomiting usually by a few hours

36

What is feculent vomitus usually caused by?

Intestinal obstruction

37

_____ is a disease of the colon that produces bloody diarrhea

Shigellosis
-Amebiasis is also a/w bloody diarrhea

38

Describe diarrhea/constipation in patients with colon cancer or diverticulitis

Diarrhea and constipation frequently alternate

39

_____ stools may result from malabsorption syndromes

Floating

40

How does diarrhea classically present in IBS?

More in the morning

41

"Pencil" diameter stools may result from:

Anal or distal rectal carcinoma

42

What are black feces a/w?

-Meds like Pepto Bismol, dietary iron supplements
-Foods like black licorice or blueberries

43

What is hematochezia and what is it a/w?

-Bright red blood per rectum (BRBPR)
-Can occur from colonic tumors, diverticular disease, ulcerative colitis

44

What is tenesmus?

-Painful ineffective straining at stool
-Caused by inflammation or a space-occupying lesion (e.g. tumor)

45

What is a common cause of hematochezia?

Hemorrhoidal bleeding

46

What is melena?

-Black, tarry stool-Results from bleeding above the first section of duodenum w/partial digestion of hemoglobin

47

Silver-colored stools

-RARE
-Pathognomonic of acholic stools with melena
-Strongly suggestive of cancer of ampulla of Vater in the duodenum

48

Presence of icterus or jaundice results from:

Decreased excretion of conjugated bilirubin into the bile

49

Medical jaundice results from:

Intrahepatic biliary obstruction

50

Surgical jaundice results from:

Extrahepatic biliary obstruction

51

What condition can be linked to ingestion of raw shellfish?

Hepatitis A

52

Viral hepatitis is a/w

N/V
Loss of appetite
Aversion to smoking (if in the habit)

53

What is the MC chronic blood-borne infection in the US?

HCV

54

What is the MC indication for liver transplantation?

End stage liver disease secondary to HCV infection

55

How does obstructive jaundice present?

Slowly developing accompanied by pale stools and cola-colored urine

56

What is suspected if jaundice accompanied by fever and chills?

Cholangitis

57

Cholangitis may result from:

-Stasis of bile in bile duct (gallstone)
-Cancer of pancreas head

58

What are the MC occupational exposures known to cause liver disease?

-Carbon tetrachloride
-Vinyl chloride

59

Abdominal distention may be related to:

-Increased gas in GI tract
-Presence of ascites

60

What can cause increased gas in the GI tract?

-Malabsorption
-Irritable colon
-Aerophagia

61

What can cause ascites?

-Cirrhosis
-CHF
-Portal HTN
-Peritonitis
-Neoplasia

62

What could an abdominal mass be?

-Neoplasm
-Hernia

63

What is the MC complaint of an abdominal hernia?

Swelling (may or may not be painful)

64

When is a hernia termed "reducible"?

When it can be emptied of its contents by pressure or a change in posture

65

What does a pulsatile abdominal mass indicate?

Possible aortic aneurysm!

66

What is pruritus ani?

Localized itching of anal skin
*Cleanliness is almost never a factor

67

How are bowel movements characterized in IBD?

10-30 watery or blood BMs a day

68

What do patients develop from IBD due to malabsorption?

Osteopenia/osteoporosis

69

What is the most reported characteristic of patients with IBD?

Dependency
(also obsessive-compulsive)

70

Is denial an issue with IBD patients?

No - typically they are obsessed with the details of their condition

71

How does sexual activity present in patients with IBD?

-Low level
-Many prefer to be fondled like a child
-Many reject any genital contact
-Many view sex as "dirty", "unclean"

72

What may be the basis of depression in IBD patients?

Fear of cancer

73

What is an unappreciated major complication of IBD?

Substance abuse

74

Which side should the examiner stand on for abdominal examination?

Patient's right side

75

How should you examine abdominal pain?

Examine that area last! Otherwise, abdominal muscles will tighten

76

How do patients present in renal/biliary colic vs. peritonitis?

-Renal/biliary colic writhe in bed, can't find comfortable position
-Peritonitis have intense pain on movement so they lay very still in bed

77

How should you evaluate for jaundice?

In natural light if possible

78

When does jaundice become apparent?

When serum bilirubin exceeds 2.5 mg/dL in adults (above 6 mg/dL in neonates)

79

What can spider angiomas indicate?

Sensitive for alcoholic cirrhosis but non-specific (can occur in pregnancy and collagen vascular disorders)

80

Pyoderma gangrenosum

-Tender ulcerations commonly on lower extremities
-A/w IBD, especially ulcerative colitis

81

Half and half nails can indicate:

Cirrhosis
(Lindsay's nails)

82

Peutz-Jeghers syndrome

-Melanin deposition around and in oral cavity
-Genetic disorder causing GI and mucocutaneous pigmentation
-Benign polyps in jejunum (rarely become malignant)

83

Osler-Weber-Rendu syndrome

-Multiple telangiectases of lips, tongue, GI tract
-May bleed insidiously causing anemia

84

How does Cushing's syndrome present in the abdominal/GI system?

Obesity (90% pts)

85

Scaphoid abdomen and what it can be a/w

-Concave
-May be a/w cachexia

86

Protuberant abdomen may result from:

-Gaseous distention of intestines
-Ascites
-Massive splenomegaly
-Obesity

87

When a patient with ascites lays supine:

Fluid bulges in the flanks

88

What are silver striae vs. pinkish-purple striae?

-Silver are consistent with weight loss
-Purple are a/w Cushing's

89

What does an everted umbilicus often indicate?

Increased abdominal pressure usually from ascites or a large mass

90

What is Grey Turner's sign?

-Massive ecchymoses on abdomen or flanks (SC purpura)
-Result of hemorrhagic pancreatitis or strangulated bowel

91

What is Cullen's sign?

Bluish discoloration of the umbilicus resulting from hemoperitoneum of any cause

92

What is caput medusae?

-Dilated veins that appear to radiate from the umbilicus
-Seen in pts with portal HTN

93

What are borborygmi and what are they a/w?

-Low pitched rumbling bowel sounds
-A/w hyperperistalsis
-Common in early acute intestinal obstruction

94

When could a peritoneal friction rub be heard?

Hepatic or splenic inflammation

95

What is the MC percussion note in the abdomen?

Tympany
-Caused by presence of gas in stomach, SI, colon
-Suprapubic area may sound dull if bladder is distended or a woman's uterus enlarged

96

Percussion note over the liver

Dull until colon (tympanic)

97

What is Traube's space?

-Where spleen is found in normal individuals
-Within rib cage against posterolateral wall

98

What is the most sensitive sign for ascites?

Shifting dullness

99

What is the most specific sign for ascites?

Prominent fluid wave

100

With patients who are ticklish, what may be useful to assist in palpation of the abdomen?

Sandwich their hand between your hands

101

Describe rigidity vs. guarding in abdominal exam

-Rigidity is involuntary spasm of abdominal muscles
-Guarding is voluntary spasm of abdominal muscles

102

Murphy's sign

-Pain is elicited in LUQ on inspiration
-Suggestive of acute cholecystitis

103

What is Sims' position?

-Left lateral prone
-Used for DRE in pts who are weak and confined to bed

104

What is a sessile polyp?

Attached by a base

105

What is a pedunculated polyp?

Attached by a stalk

106

What is Blumer's shelf?

Shelflike structure that projects into rectum as a result of infiltration of Douglas' pouch with neoplastic cells

107

What do the guaiac or benzidine tests assess?

Occult blood in the stool

108

What are tests that find colorectal polyps and cancer?

-Flexible sigmoidoscopy every 5 years
-Colonoscopy every 10 years
-Double contrast barium enema every 5 years
-CT colonography every 5 years

109

What are tests that primarily find colorectal cancer?

-FOBT (fecal occult blood test) yearly
-Fecal immunochemical test yearly

110

Anal cancer is ____ in both men and women _____

Increasing
worldwide

111

Which populations have higher risk for anal cancer?

-MSM
-HIV positive
-Transplant recipients
-Women with cervical neoplasia

112

What is the leading cancer diagnosed among men in the US?

Prostate

113

What population has the highest rates of prostate cancer in the world?

African Americans in the US

114

Describe PSA

-Produced by prostate
-Mostly found in semen, but also blood
-When cancer develops, PSA rises
-Many false positives for cancer