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Flashcards in Midterm Deck (95)
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1

What is the key thing that causes abdominal discomfort?

rapid distension of hollow organ smooth muscle

2

What is the most sensitive structure in the abdomen (pain threshold)?

parietal peritoneum

3

What is the least sensitive structure in the abdomen (pain threshold)?

parenchymatous organs

4

Where is visceral pain often first noticed? (location on abdomen)

closer to midline of abdomen

5

Is visceral pain made worse by palpation?

no

6

Is visceral pain made worse by movement/coughing/breathing deeply?

no

7

Is the underlying musculature tense/painful with visceral pain?

NO

8

Is visceral pain easily localized?

No (V for visceral, V for vague)

9

Three potential sources for localized abdominal pain?

1. peritonitis 2. nerve root/intercostal pain 3. MFTPs

10

What might a pt have if they complain of pain localized to the abdominal wall, or a diffuse discomfort that mimics visceral pain?

MFTPs

11

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

12

Where does peritoneal pain usually manifest? (location on abdomen)

dermatomes T5-L2

13

Is peritoneal pain easy to localize?

Yes

14

Is peritoneal pain made worse by movement/coughing/deep respiration?

Yes

15

Is peritoneal pain made worse by palpation?

yes

16

What can peritoneal irritation lead to? (muscles)

reflexive contraction of segmental msls

17

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?

peritonitis

18

What is Dunphy's sign?

localized pain that increases with coughing

19

What is the "jar test"?

sudden vibration increases/localizes the pain

20

What position must the pts knees be in to begin abdominal exam?

pt supine, hips and knees flexed

21

What represents the first physical contact with the pt's abdomen?

auscultation

22

Do abdominal bruits assist in the Dx of AAA?

No

23

What kind of bruits are more sensitive for renal vascular dz?

anterior bruits near the umbilicus

24

what kind of bruits are more specific for renal vascular dz

flank bruits

25

How deep is superficial palpation?

Up to 1 cm

26

what is the purpose of superficial palpation?

compare underlying abdominal msl tone from side to side

27

what is possible the most important component in assessment of suspected peritonitis?

superficial palpation

28

how deep is deep palpation?

> 1 cm

29

What is the best use of deep palpation?

evaluation of abdominal aorta (normal = 2.5-4 cm wide)

30

palpation of what structure is tender in pts with IBS? (test question!)

sigmoid colon (can also cause pain to radiate to rectum and anus)

31

what does Murphy's sign assess?

gall bladder

32

what is considered a contraindication to spleen palpation?

mononucleosis

33

what musculoskeletal finding may be associated with SI joint dysfunction?

psoas MFTPs

34

what is used to assess a chronic and unremitting abdominal pain?

Carnett's

35

when performing Carnetts, what is not included as a component/layer of the abdominal wall?

parietal peritoneum

36

what test is not considered helpful at ruling IN peritonitis?

Carnett's (might be helpful at ruling OUT peritonitis)

37

what are the abdominal red flags/classic signs of peritonitis?

abdominal tenderness, fever >105, vomiting

38

what are "very bright" red flags of the abdomen?

abdominal distension, palpable masses, ecchymosis, hypotension/shock

39

When interpreting Carnett's test, with abdominal muscles contracted, what indicates that pain does NOT originate from anterior abdominal wall?

pain DECREASES in intensity

40

which ribs are most likely to be hypermobile?

"false" ribs

41

what cause of costochondral pain has pain but no swelling?

costochondritis

42

what cause of costochondral pain has pain AND swelling?

Tietze's syndrome

43

what is a common cause of acute abdominal pain?

food poisoning

44

What are 2 characteristics of acute abdominal pain?

<7 day duration of pain/tenderness

45

What is the Acute Abdomen aka?

the surgical abdomen (urgent referral)

46

what are entry level red flags for the acute abdoment?

abdominal tenderness, fever, vomiting

47

what are the extreme red flags for the acute abdomen?

ascites, herniated umbilicus, jaundice, cullens/turners signs, shock

48

what characteristics (of acute abdomen) favor a surgical dx?

lasts >6 hrs, sudden onset

49

what is the most valuable single test for the acute abdomen?

periodic repetition of physical exam (let them sit) done by the same doctor

50

what are the signs of peritonitis?

abdominal tenderness, fever >100.5, vomiting

51

what kind of peritonitis is the most common?

infectious

52

what causes inflammatory peritonitis?

inflammation of an adjacent structure (no direct infection of the peritoneum)

53

what is the best indicator of peritonitis?

rigidity/"true guarding"

54

what is "true guarding"?

guarding that doesnt diminish with reassurance and continued palpation

55

What is the unofficial gold standard for peritonitis?

Rovsing's sign

56

What is Rovsings sign aka?

contralateral tenderness or indirect rebound tenderness (classically used for acute appendicitis, may be more accurate than direct rebound tenderness)

57

what are the 2 big functional esophageal disorders?

functional heartburn, functional chest pain

58

what can gross aspiration lead to?

pneumonia

59

what does peppermint leaf/oil do?

smooth muscle relaxant

60

what is the side effect of peppermint leaf/oil?

heartburn

61

what should you avoid when on statin therapy?

peppermint or grapefruit juice (competes for R/C sites)

62

T/F: upper esophageal sphincter is not a true sphincter

true

63

T/F: lower esophageal sphincter is not a true sphincter

false

64

what are the most common structural abnormalities in the esophagus?

rings and webs

65

After the upper esophageal sphincter, what is the last place in the GI tract that has well localized symptoms?

anal sphincter

66

what kind of obstruction does trouble swallowing solids indicate?

intrinsic

67

what are two examples of intrinsic obstruction?

Plummer-Vinson syndrome and Zenker diverticulum

68

What is the classic triad for zenker diverticulum?

dysphagia, halitosis, and regurgitation

69

where does a Mallorie-Weiss tear occur?

gastroesophageal junction

70

what does the E in CREST syndrome stand for?

esophageal dysmotility

71

T/F: when an infant is choking, abdominal thrusts are recommended

false

72

what does decreased LES tonus lead to?

increased risk of heartburn

73

what is the only thing that has shown to be consistently effective for GERD?

weight loss and elevating the head of the bed

74

how often does heartburn refer pain to the spine?

40% (left arm/shoulder = 5%)

75

T/F: severeness of heartburn symptoms doesn't always correlate with degree of damage

true

76

what kind of population usually presents with atypical GERD?

older

77

what are the heartburn alarm symptoms?

angina pectoris mimic, dysphagia, odynophagia, weight loss, blood loss

78

what are oral osteoporosis meds notorious for damaging?

esophagus

79

where does H. Pylori tend to colonize?

gastric antrum (beneath mucous layer)

80

how do most people with hiatal hernias present?

asymptomatic

81

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

82

which layer of the stomach produces the most bleeding with erosion?

submucosa

83

what layer of the stomach produces the least amount of bleeding with erosion?

mucosa

84

what does chronic alcohol ingestion decrease the delivery of?

mucus glycoproteins

85

what does cigarette smoking significantly reduce?

mucus synthesis

86

what is known to dissipate surface active phospholipids?

bile acids/some NSAIDs/aspirin

87

what is the possible turnover time of human gastric epithelium?

2-4 days

88

what do non-selective OTC NSAIDs inhibit?

COX 1 and COX 2

89

what is considered to be the most ulcerogenic OTC NSAID?

aspirin

90

what does alcohol stimulate?

gastric secretions (and also, bad decisions)

91

what has bile reflux been linked to?

long term use of proton pump inhibitors (PPIs)

92

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

93

how do you differentiate the initial clinical presentations of acute gastritis, chronic gastritis, and PUD?

they are indistinguishable

94

how often is acute GI hemorrhage due to acute gastritis?

30% of cases (most common cause of blood in large quantities in GI tract)

95

what are the physical characteristics of a peptic ulcer?

extend through muscularis mucosa and are greater than 5 mm in diameter