PE of abdomen and rectum- Stasio 12/1

Question 1

common Sx abdominal disease

Answer 1

pain, nausea, change in bowel habits

Question 2

what is visceral pain

Answer 2

colic pain
hollow organ from distention or stretching
comes and goes, crescendo/decrescendo

Question 3

what is parietal pain

Answer 3

inflammation of peritoneum

steady pain

Question 4

referred pain

Answer 4

from distant site
gall bladder- R shoulder
pancreas- back
spleen - L shoulder

Question 5

epigastric pain ddx?

Answer 5

MI
peptic ulcer
acute cholecystitis
perforated oesophagus

Question 6

what is melena

Answer 6

black tarry stools

above ligament of treitz

Question 7

what is hematochezia

Answer 7

red blood usually at level of colon or lower

Question 8

blood outside of stool suggests what

Answer 8

bleeding in anus

Question 9

congenital ddx for GI bleed

Answer 9

telangiectasias, hemophilia, meckel diverticulum, A-V malformations

Question 10

inflammatory immune causes GI bleed

Answer 10

ulcerative colitis, crohns disease, PUD

Question 11

neoplastic causes GI bleed

Answer 11

polyps, cancer, zollinger ellison syndrome

Question 12

metabolic/toxic causes GI bleeed

Answer 12

NSAID, Vit K deficiency, anticoagulants

Question 13

mechanical/trauma causes GI bleed

Answer 13

mallory weiss tear, impaction, intussusception

Question 14

currant jelly stool, most likely?

Answer 14

intussusception

Question 15

signs Sx jaundice

Answer 15

yellow, scleral yellowing
pruritis
urine color is dark
acholic feces- malodorous gray-light colored stools

Question 16

etiologies of increased unconj hyperbilirubinemia

Answer 16

hemolysis
sickle cell
ineffective erythropoiesis
deficient hepatic uptake
deficient hepatic conjugation- hepatitis

Question 17

what other value is elevated in conjugated hyeprbilirubinemia

Answer 17

serum alkaline phosphatase

Question 18

what can cause conjugated hyperbilirubinemia

Answer 18

intracellular: hepatocellular disease, drugs, sepsis, primary biliary cirrhosis
extrahepatic: gallstone, biliary carcinoma, sclerosing cholangitis, parasites, pancreatic cancer, pancreatitis

Question 19

painless jaundice is what until proven otherwise

Answer 19

pancreatic cancer

Question 20

4 signs of ascietes

Answer 20

bulging flanks
tympany at top of abdomen
fluid wave
shifting dullness

Question 21

Ddx ascites

Answer 21

cirrhosis (80-85%)
malignancy (10%)
CHF (5%)
Tuberculous peritonitis
dialysis
nephrotic syndrome
bile or pancreatic ascites
lymphatic tear

Question 22

Portal HTN triad

Answer 22

hemorrhoids
caput medusa
esophageal varices

Question 23

what is an ileus

Answer 23

no peristalsis

Question 24

when can you report a bowel as absent sounds

Answer 24

after 2 minutes

Question 25

normal liver size

Answer 25

<10cm | MCL

Question 26

Ddx peritonitis

Answer 26

``` spontaneous bacterial secondary bacterial pancreatic ascites PID ectopic pregnancy Fitz-Hugh-Curtis syndrome ```

Question 27

fitz hugh curtis syndrome

Answer 27

disseminated gonorrhea or chlamydia | out of uterus out of fallopian tubes

Question 28

liver palpation where

Answer 28

11th 12th rib

Question 29

ddx hepatomegaly

Answer 29

``` hepatitis fatty liver cirrhosis CHF carcinoma or metastatic cancer leukemia or lymphoma autoimmune infiltrative sickle cell glycogen storage disease ```

Question 30

What liver function levels test for function

Answer 30

bilirubin, albumin and PT

Question 31

what enzymes are included in liver panel

Answer 31

ALT AST ALP released d/t inflammation, tissue damage or obstruction

Question 32

what is anasarca

Answer 32

generalized edema

Question 33

if all liver enzymes elevated but ALP is really really high

Answer 33

extra hepatic

Question 34

Ddx splenomegaly

Answer 34

``` infections leukemia/lymphoma EMH CHF polycythemia vera/thrombocytosis SLE RA- feltys syndrome metastatic disease amyloidosis ```

Question 35

ddx CVA tenderness

Answer 35

nephrolithiasis pyelonephritis renal cell carcinoma DJD degenerative joint disease

Question 36

condylotmata cuminata

Answer 36

HPV

Question 37

condylomata lata

Answer 37

syphilis

Question 38

procidentia

Answer 38

complete rectal prolapse