week 3 Highlights of ABD-LF

Question 1

what is the most important part of any patient assessment

how do we do chief complaint

Answer 1

patient history. try to stay relevant to current problems.

chief complaints are exactly what patient says

Question 2

PQRST

Answer 2

precise location
quality/quantity
radiant/referred
severity
time frame

Question 3

what are the A’s of what else you can tell me about your problem

Answer 3

what else can you tell me

associated symptoms
absent symtpoms
alarm symptoms

Question 4

most common GI diagnosis

Answer 4

gerd

Question 5

review of abdomen exam

Answer 5

inspection
auscultation
percussion
palpate (light and deep)

Question 6

Right Upper Quadrant structures

Answer 6

Liver
Gallbladder
Duodenum
Head of the pancreas
Right kidney and adrenal
Part of the ascending and transverse colon (Umbilical)

Question 7

Left Upper Quadrant

Answer 7

Stomach (Epigastric)
Spleen
Left lobe of the liver
Body of the pancreas (Epigastric)
Left kidney and adrenal
Part of the transverse and descending colon (Umbilical)

Question 8

Right Lower Quadrant

Answer 8

Cecum
Appendix
Right ovary and tube
Right ureter
Right spermatic cord

Question 9

Left Lower Quadrant

Answer 9

Part of the descending colon
Sigmoid colon
Left ovary and tube
Left ureter
Left spermatic cord

Question 10

Suprapubic

Answer 10

Bladder

Uterus

Question 11

visceral pain
parietal pain
referred pain

Answer 11

v- pain associated with hollow/solid organs

P-occurs with inflammation of hollow or solid organs that effect the parietal peritoneum

referred-felt at distant sites that share innervation from the spinal level,

Question 12

Developmental Considerations

Infants and Children

Answer 12

Breast feeding vs bottle feeding – formula used
Eating habits of the child
Constipation
Childhood obesity

Question 13

Developmental Considerations

Elderly

Answer 13

ADLS are important to consider – how do they receive and prepare food
Blunting of abd pain is common
Bowel habits
Dentition

Question 14

why is order important for abdomen exam

Answer 14

because if you percuss or palpate before auscultation- it will elicit bowel sounds and does not give an accurate indication of patients condition

Question 15

inspection of abdomen includes what odd thing that hammon discussed in class

Answer 15

tangential lighting for peristalsis and pulsations

Question 16

name all the places to auscultate on the abdomen

Answer 16

bowel sounds each quadrant.

diaphragm over aorta, iliac, femoral - checking for bruits/hums

place diaphragm over liver and spleen to listen for friction rub

Question 17

where do you percuss
for tympani

dullness

Answer 17

tympani- over intestines

dullness -liver, spleen, large stool, or mass.

Question 18

when should percussion of the spleen be tympanic

Answer 18

percussing the lowest interspace in the left anterior axillary lines. then have the patient take a deep breath and repeat.

called splenic percussion sign

Question 19

deep palpation detects

Answer 19

masses

Question 20

light palpation detects

Answer 20

tenderness and guarding

Question 21

if patient is obese what technique can help locate the liver

Answer 21

hooking technique

Question 22

patient has ascites- what is the presentation?

what will percussing the middle and sides produce

testing fluid wave

Answer 22

protuberant abdomen with bulging flanks

tympany in the center. dullness lateral sides

tap the side for fluid wave with hand in the center of abdomen

Question 23

what are reasons for enlarged spleen

should it be palpable

Answer 23

mono
hematological disorders- cause enlargements of spleen

should not be palapble

Question 24

murphy signs

Answer 24

with cholecystitis there is pain when you hold your fingers under the liver border and have the client take a deep breath. The test is positive when the client cannot complete the breath but rather stops the breath abruptly.

Question 25

pancreas presents with abdominal pain radiating where. what symptoms are common

Answer 25

to the back n&v alcoholism accounts for 80% of admissions

Question 26

school age children who present with stomach pain- suspect what

Answer 26

bully at school anxiety can cause belly pain

Question 27

what is concerning about the spleen and significant trauma

Answer 27

it can easily rupture

Question 28

stomach Positive hemoccult Tenderness Bruits

Answer 28

can indicate upper GI bleed or malignancy- should occur with any epigastric pain PUD and pancreatitis abdominal aortic aneurysm

Question 29

Blumberg’s sign

Answer 29

appendicitis | Pushing perpendicular on the abdomen in a site away from the pain. Release of the pressure will cause pain

Question 30

McBurney’s point

Answer 30

appendicitis- Mild palpation to RLQ will increase pain significantly

Question 31

Rovsing’s sign

Answer 31

appendicitis- (referred rebound tenderness in the right lower quadrant when the left lower quadrant is palpated and released)- can also hit on bottom of foot

Question 32

Psoas sign

Answer 32

appendicitis-the patient flexes his thigh against the examiner’s hand; pain indicates a positive sign)

Question 33

Obturator sign

Answer 33

flex the patient’s thigh and rotate the leg internally at the hip; pain indicates positive signs hypogastric pain with the hip and knee flexed and hip internally rotated.

Question 34

h pylori testing

Answer 34

breath ID- breath into a bag carbon 13 urea- helps identify the present of h pylori if h pylori is present carbon 13 gets metabolized in the stomach and you breath it out. otherwise it is naturally eliminated

Question 35

what are polyps considered

Answer 35

precancerous

Question 36

colonoscopy at age

Answer 36

50 or before with a family history of colon cancer

Question 37

what should you not use on hernias

Answer 37

nitrous

Question 38

who do we see umbilical hernias on

Answer 38

seen at birth or may be seen in clients with chronic ascites or increased pressure in the adbomen

Question 39

are ovaries palpable in post menopausal women

Answer 39

no

Question 40

what is the concern with very large ovaries being removed

Answer 40

they can have their own blood supply and bleed alot

Question 41

7 F’S OF ABDOMINAL DISTENTION

Answer 41

``` Fat- remember, fat is symmetrical Flatus- after eating? No bowel sounds? Fluid- ascites, ileus Fetus- “I can’t believe I am pregnant” Feces- hmmm Fetal growth- refer to above Fibroid- Tumor? asymmetrical ```

Question 42

what bad habit is highly associated with bladder ca

Answer 42

Smoking is highly associated with bladder CA

Question 43

medications- NSAIDS can present with what in the urine

Answer 43

protein!

Question 44

male urinary history

Answer 44

``` ask about stream, start and stop and strength infant hernia repair vasectomy family history sexual history ```

Question 45

PID

Answer 45

Often presents with pain, bleeding, and discharge

Question 46

Metrorrhagia

Answer 46

Bleeding at irregular intervals

Question 47

Menorrhagia

Answer 47

Excessive bleeding during the menstrual cycle

Question 48

always check pregnancy status

Answer 48

last cycle | all women are presumed pregnant unless proven

Question 49

red glass for GI

Answer 49

``` Hematuria Abrupt onset of testicular pain Decreased or absent urine Acute urinary retention Kidney mass Toxic appearing patient with any of the above ```

Question 50

Red flags for female GYN

Answer 50

``` Pain is unilateral when doing a bimanual exam or lower abd Uterine bleeding Ascites Post menopausal bleeding or discharge Ovaries fixed, hard or nodular ```

Question 51

Red flags for male reproductive

Answer 51

``` Sudden onset testicular pain Cellular or necrotic changes in skin of penis or scrotum Erection greater than 30 minutes Decreased urination Increased pain or new mass ```

Question 52

perimenopausal changes

Answer 52

FSH and LH may be normal, subjective data for DX, decrease of length and flow and other S/S

Question 53

Amenorrhea primary secondary

Answer 53

Amenorrhea – primary at age 16, secondary is after 3 months in a woman who had menses

Question 54

uterine bleeding and discharge in peri or post menopausal

Answer 54

In young often benign BUT in post or peri-menopausal may be a red flag

Question 55

BV odor

Answer 55

fishy

Question 56

chalamydia

Answer 56

yellow no order origin in cervix

Question 57

GC

Answer 57

yellowish no odor

Question 58

what is yeast

Answer 58

an overgroth - NOT INFECTION- associated with post antibiotic tx

Question 59

PCOS

Answer 59

increased LH | decreased FSH

Question 60

in AA and hispanics PCOS can have what skin condition

Answer 60

acanthosis-dark discoloration in body folds

Question 61

Ectopic pregnancy

Answer 61

Severe RLQ pain Amenorrhea Positive pregnancy test Rebound tenderness

Question 62

Ovarian Cyst

Answer 62

Younger women Fluid filled Tenderness increases in cycle

Question 63

Bartholin's Cysts

Answer 63

between vagina and rectum Swollen and painful Usually I&D, antibiotic and C&S

Question 64

clap | GH

Answer 64

Chlamydia - Yellow discharge no odor | Gonorrhea – purulent discharge

Question 65

Trich

Answer 65

Trich -Grayish foul discharge, travels with other STD’s, strawberry spots, macroscopic exam for flagellated protozoa

Question 66

which std's are bff

Answer 66

C and GH

Question 67

BV

Answer 67

BV – non infection results from increased pH and change in flora, fishy odor, whiff test

Question 68

Prolapse 1,2,3 degree designation

Answer 68

Increased with older women Increased number of pregnancies Obesity Cysto or retro (bimanual and bear down) Presents with frequency and infection DX by examination

Question 69

Torsion

Answer 69

``` 6-8 hour window Most often in early puberty Abdominal pain Nausea and or vomiting Scrotal swelling Unilateral ```

Question 70

Prostatitis

Answer 70

Acute bacterial Chronic bacterial Inflammatory/ non inflammatory Asymptomatic inflammatory