Flashcards in Midterm Deck (95)
What is the key thing that causes abdominal discomfort?
rapid distension of hollow organ smooth muscle
What is the most sensitive structure in the abdomen (pain threshold)?
What is the least sensitive structure in the abdomen (pain threshold)?
Where is visceral pain often first noticed? (location on abdomen)
closer to midline of abdomen
Is visceral pain made worse by palpation?
Is visceral pain made worse by movement/coughing/breathing deeply?
Is the underlying musculature tense/painful with visceral pain?
Is visceral pain easily localized?
No (V for visceral, V for vague)
Three potential sources for localized abdominal pain?
1. peritonitis 2. nerve root/intercostal pain 3. MFTPs
What might a pt have if they complain of pain localized to the abdominal wall, or a diffuse discomfort that mimics visceral pain?
Why do pts not realize the area of tenderness is extremely localized and superficial with MFTPs?
They are preoccupied with the large area of pain spread
Where does peritoneal pain usually manifest? (location on abdomen)
Is peritoneal pain easy to localize?
Is peritoneal pain made worse by movement/coughing/deep respiration?
Is peritoneal pain made worse by palpation?
What can peritoneal irritation lead to? (muscles)
reflexive contraction of segmental msls
If visceral pain changes location and starts becoming parietal pain and you can't find evidence of an NMS condition or MFTP as the source of pain, what should you start to think about?
What is Dunphy's sign?
localized pain that increases with coughing
What is the "jar test"?
sudden vibration increases/localizes the pain
What position must the pts knees be in to begin abdominal exam?
pt supine, hips and knees flexed
What represents the first physical contact with the pt's abdomen?
Do abdominal bruits assist in the Dx of AAA?
What kind of bruits are more sensitive for renal vascular dz?
anterior bruits near the umbilicus
what kind of bruits are more specific for renal vascular dz
How deep is superficial palpation?
Up to 1 cm
what is the purpose of superficial palpation?
compare underlying abdominal msl tone from side to side
what is possible the most important component in assessment of suspected peritonitis?
how deep is deep palpation?
> 1 cm
What is the best use of deep palpation?
evaluation of abdominal aorta (normal = 2.5-4 cm wide)
palpation of what structure is tender in pts with IBS? (test question!)
sigmoid colon (can also cause pain to radiate to rectum and anus)
what does Murphy's sign assess?
what is considered a contraindication to spleen palpation?
what musculoskeletal finding may be associated with SI joint dysfunction?
what is used to assess a chronic and unremitting abdominal pain?
when performing Carnetts, what is not included as a component/layer of the abdominal wall?
what test is not considered helpful at ruling IN peritonitis?
Carnett's (might be helpful at ruling OUT peritonitis)
what are the abdominal red flags/classic signs of peritonitis?
abdominal tenderness, fever >105, vomiting
what are "very bright" red flags of the abdomen?
abdominal distension, palpable masses, ecchymosis, hypotension/shock
When interpreting Carnett's test, with abdominal muscles contracted, what indicates that pain does NOT originate from anterior abdominal wall?
pain DECREASES in intensity
which ribs are most likely to be hypermobile?
what cause of costochondral pain has pain but no swelling?
what cause of costochondral pain has pain AND swelling?
what is a common cause of acute abdominal pain?
What are 2 characteristics of acute abdominal pain?
<7 day duration of pain/tenderness
What is the Acute Abdomen aka?
the surgical abdomen (urgent referral)
what are entry level red flags for the acute abdoment?
abdominal tenderness, fever, vomiting
what are the extreme red flags for the acute abdomen?
ascites, herniated umbilicus, jaundice, cullens/turners signs, shock
what characteristics (of acute abdomen) favor a surgical dx?
lasts >6 hrs, sudden onset
what is the most valuable single test for the acute abdomen?
periodic repetition of physical exam (let them sit) done by the same doctor
what are the signs of peritonitis?
abdominal tenderness, fever >100.5, vomiting
what kind of peritonitis is the most common?
what causes inflammatory peritonitis?
inflammation of an adjacent structure (no direct infection of the peritoneum)
what is the best indicator of peritonitis?
what is "true guarding"?
guarding that doesnt diminish with reassurance and continued palpation
What is the unofficial gold standard for peritonitis?
What is Rovsings sign aka?
contralateral tenderness or indirect rebound tenderness (classically used for acute appendicitis, may be more accurate than direct rebound tenderness)
what are the 2 big functional esophageal disorders?
functional heartburn, functional chest pain
what can gross aspiration lead to?
what does peppermint leaf/oil do?
smooth muscle relaxant
what is the side effect of peppermint leaf/oil?
what should you avoid when on statin therapy?
peppermint or grapefruit juice (competes for R/C sites)
T/F: upper esophageal sphincter is not a true sphincter
T/F: lower esophageal sphincter is not a true sphincter
what are the most common structural abnormalities in the esophagus?
rings and webs
After the upper esophageal sphincter, what is the last place in the GI tract that has well localized symptoms?
what kind of obstruction does trouble swallowing solids indicate?
what are two examples of intrinsic obstruction?
Plummer-Vinson syndrome and Zenker diverticulum
What is the classic triad for zenker diverticulum?
dysphagia, halitosis, and regurgitation
where does a Mallorie-Weiss tear occur?
what does the E in CREST syndrome stand for?
T/F: when an infant is choking, abdominal thrusts are recommended
what does decreased LES tonus lead to?
increased risk of heartburn
what is the only thing that has shown to be consistently effective for GERD?
weight loss and elevating the head of the bed
how often does heartburn refer pain to the spine?
40% (left arm/shoulder = 5%)
T/F: severeness of heartburn symptoms doesn't always correlate with degree of damage
what kind of population usually presents with atypical GERD?
what are the heartburn alarm symptoms?
angina pectoris mimic, dysphagia, odynophagia, weight loss, blood loss
what are oral osteoporosis meds notorious for damaging?
where does H. Pylori tend to colonize?
gastric antrum (beneath mucous layer)
how do most people with hiatal hernias present?
what are the dyspepsia alarm symptoms?
anorexia/dysphagia/wt. loss, bleeding/melena/anemia, age/family Hx of gastric cancer, personal Hx of PUD, jaundice/masses
which layer of the stomach produces the most bleeding with erosion?
what layer of the stomach produces the least amount of bleeding with erosion?
what does chronic alcohol ingestion decrease the delivery of?
what does cigarette smoking significantly reduce?
what is known to dissipate surface active phospholipids?
bile acids/some NSAIDs/aspirin
what is the possible turnover time of human gastric epithelium?
what do non-selective OTC NSAIDs inhibit?
COX 1 and COX 2
what is considered to be the most ulcerogenic OTC NSAID?
what does alcohol stimulate?
gastric secretions (and also, bad decisions)
what has bile reflux been linked to?
long term use of proton pump inhibitors (PPIs)
what conditions are H. pylori infection often assoc. with? (4)
1. GERD and dyspepsia 2. PUD 3. chronic antral gastritis 4. increased risk of gastric cancer
how do you differentiate the initial clinical presentations of acute gastritis, chronic gastritis, and PUD?
they are indistinguishable
how often is acute GI hemorrhage due to acute gastritis?
30% of cases (most common cause of blood in large quantities in GI tract)