Exam 3 - abdominal Flashcards
What are the screening recommendations for colorectal cancer?
Adults 50-75 years
- Fecal occult blood testing (FOBT) annually
- Sigmoidoscopy every 5 years with FOBT every 3 years
- Colonoscopy every 10 years
Adults 76-85 years - do not screen routinely
- Individual decision making if screening for first time
Adults older than 85 years - DON’T screen
What are the screening recommendations for an abdominal aortic aneurysm?
Increased pulse pressure, age >65 years, history of smoking, male, first degree relative with history of AAA repair
Periumbilical or upper abdominal mass with expansile pulsations that is >3cm in diameter
When auscultating the abdomen, what would be normal findings?
- Increased* –> diarrhea or early intestinal obstruction
- Decreased* (then absent) –> adynamic ileus, peritonitis (listen for at least 2 min or longer)
- High pitched tinkling sounds* –> intestinal fluid and air
- Rushes of high pitched sounds w/ abdominal cramp* –> intestinal obstruction
What would bruits indicate with auscultation?
- Hepatic bruit* –> carcinoma of liver or cirrhosis
- Aterial bruit w/ systolic/diastolic* –> partial occlusion of aorta or large arteries
- Bruits in epigastrum* are suspicious for renal artery stenosis or renovascular HTN
What would a venous hum indicate on auscultation?
Rare soft humming noise with systolic and diastolic components
Indicates increased collateral circulation between portal and systemic venous systems (i.e. hepatic cirrhosis)
What would a friction rub indicate with auscultation?
Grating sound that indicates inflammation of peritoneal surface of an organ (i.e. liver cancer, chlamydia, gonococcal perihepatitis, recent liver biopsy, splenic infarct)
Suspect carcinoma of liver with systolic bruit that is accompanied with a hepatic friction rub
What is the difference between visceral pain, parietal pain, and referred pain?
MOA: hollow abdominal organs contract unusually forcefully or are distended/stretched
Can be gnawing, burning, cramping, aching; if severe, will cause sweating, pallor, N/V, restlessness
- Ex: RUQ - liver distention from hepatitis
- Ex: periumbilical pain - acute appendicitis
What is the difference between visceral pain, parietal pain, and referred pain?
Inflammation of parietal peritoneum (peritonitis)
Steady, aching pain usually more severe than visceral pain; more localized over involved structure
Aggravating: movement, coughing
Relieving: lying still
What is the difference between visceral pain, parietal pain, and referred pain?
Pain felt in more distant sites which are innervated at same spinal levels as disordered structures
Can be referred to the abdomen from the chest, spine, pelvis
Ex: pleurisy, inferior wall MI (referred to epigastric area)
What techniques can the FNP use to assess the liver?
Percussion - identify liver span (tympany vs dullness)
Palpation - liver edge (“hooking” technique)
What techniques can the FNP use to assess the liver in the pediatric patient?
Scratch test
- Place diaphragm of stethoscope above R costal margin at MCL
- Lightly scratch with fingernal skin of abdomen along MCL, from below umbilicus toward costal margin
- Will hear change in sound as it passes the liver
What techniques can the FNP use to assess for ascites?
- Percuss for dullness outward in several directions from central area of tympany
- Test for shifting dullness - percuss border for tympany/dullness with patient supine, ask pt to roll to one side, percuss and mark border (in pt w/o ascites, border between tympany and dullness stays constant)
- Test for fluid wave - press edges of both hands down midline of abdomen, tap one flank and feel on opposite flank for impulse
- Ballottement - brief jabbing movement toward anticipated structure
What is dysphagia? How does it present? What are some various etiologies?
Dysphagia: difficulty swallowing from impaired passage of solid foods/liquids from mouth to stomach
Causes -
- Oropharyngeal - drooling, nasopharyngeal regurg, cough from aspiration
- Mechanical narrowing (mucosal ring and webs, esophageal stricture and cancer) - gurgling, regurg of undigested food in GERD
- Motor disorders (diffuse esophageal spasm, scleroderma, achalasia)
What is odynophagia? How does it present? What are common etiologies?
Odynophagia: pain w/ swallowing
Causes: esophageal ulceration from ingestion of ASA or NSAIDS, caustic ingestion, radiation, infection w/ candida, CMV, herpes simplex, HIV
What is the Murphy sign and what does it indicate?
Used to assess possible acute cholecystitis (RUQ pain and tenderness)
What is the Psoas sign and what does it indicate?
Used to assess possible appendicitis
- Increased abdominal pain = positive –> irritation of psoas muscle by inflamed appendix
What is the Obturator sign and what does it indicate?
Used to assess possible appendicitis
- Right hypogastric pain = positive (from irritation of obturator muscle by inflammed appendix)
What history and exam findings are consistent with appendicitis?
- RLQ pain or pain that migrates from periumbilical region, abdominal wall rigidity on palpation
- Rebound tenderness, guarding
- Aggravating: movement, cough
What history and exam findings are consistent with cholecystitis?
- Pain in RUQ or epigastrum, may radiate to R shoulder or interscapular area
- Steady, aching pain
- Murphy sign - sharp increase in tenderness w/ inspiration
- Aggravating: jarring, deep breathing
What history and exam findings are consistent with chronic/acute pancreatitis?
- Epigastric pain, radiating to the back
- Steady, severe, persistent, deep pain
- Rebound tenderness, soft abdominal wall
- Aggravating: lying supine, heavy or fatty meals
- Relieving: leaning forward with trunk flexed
What history and exam findings are consistent with diverticulitis?
- LLQ pain (cramping at first, then steady)
- Abdominal mass w/ rebound tenderness
What are some reasons for bulges in the abdominal wall - umbilical hernia?
Protrustion through defective umbilical ring
- Common in infants
- Closes spontaneously within 1-2 years
What are some reasons for bulges in the abdominal wall - incisional hernia?
Protrusion through an operative scar; palpate to detect length and width of defect
Small defect, through which a large hernia has passed, has greater risk for complications than large defect
What are some reasons for bulges in the abdominal wall - epigastric hernia?
Small midline protrustion through a defect in the linea alba occurs between xiphoid process and umbilicus
With patient coughing or performing a Valsalva maneuver, palpate by running fingerpad down linea alba
What are some reasons for bulges in the abdominal wall - diastasis recti?
Separation of two rectus abdominus muscles through which abdominal contents form a midline ridge typically extending from xiphoid to umbilicus
Seen when patient raises head and shoulders
Present in patients with repeated pregnancies, obesity, chronic lung disease (usually benign)
What are some reasons for bulges in the abdominal wall - lipoma?
Common, benign, fatty tumor in SQ tissues anywhere in the body (soft, often lobulated)
Press finger down on edge of lipoma –> tumor slips out from under finger; well demarcated, nonreducible, nontender
