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NR509 - Advanced Assessment > Week 5 - Abdomen > Flashcards

Week 5 - Abdomen Flashcards

1
Q

Visceral pain

A
  • Caused when hollow organs are forcefully distended or stretched
  • Difficult to localize, felt midline
  • Gnawing, cramping, aching (start)
  • Symptoms may progress to nausea, sweating, restlessness, pallor, vomiting
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2
Q

Somatic pain

A
  • Caused by inflammation of the peritoneum (peritonitis)
  • Localized over structure involved
  • Sharp, steady, intense, localized,
  • aggravated by movement or coughing
  • Patient prefers to lie still
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3
Q

Referred pain

A
  • Pain caused at sites that are innervated at same level but distant from primary problem
  • Palpation does not results in tenderness
  • pain usually at same spinal level as disordered structure
  • pain starts in one area and becomes stronger and then may radiate
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4
Q

Pain with pyelonephritis or UTI

A

dull, achy, steady

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5
Q

Pain from renal colic

A
  • sharp, comes and goes, radiates around the trunk or abdomen
  • patient usually moving to try and find a comfortable position
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6
Q

Steps of assessing the abdomen

A
  1. inspect
  2. auscultate
  3. palpate
  4. percuss
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7
Q

Murphy’s sign

A

Patient pulls away sharply when palpating the gallbladder

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8
Q

McBurney’s Point

A

press on this point and quickly release, rebound pain can indicate appendicitis

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9
Q

Hep A

A

is a highly contagious short-term liver infection spread from person to person or by consuming contaminated food or drinks.

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10
Q

Hep B

A

Transmitted through contact with infectious blood or body fluids through sex, puncture through the skin

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11
Q

Hep C

A

illicit IV drug use or blood transfusion

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12
Q

Steps for anorectal and prostate exam

A
  1. Properly position the patient for the exam (left side)
  2. Inspect sacrococcygeal and perianal areas (lesions, ulcers, inflammation, rash, excoriation)
  3. Inspect the anus (lesion, mass, skin breakdown)
  4. Perform a digital rectal examination
  5. Assess anal sphincter tone
  6. Palpate the anal canal and rectal surface (mass, tenderness, mucosal breaks, nodules, irregularities, induration)
  7. In person with prostates, palpate the prostate gland (size, shape, mobility, consistency, nodule tenderness)
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13
Q

Prostate is comprised of

A

Right and left lateral lobes that are palpable. Posterior, anterior and medial lobes (non palpable).
Lies around the urethra.

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14
Q

Anorectal cancer - what does palpating feel like

A

Firm, nodular with rolled edge on examination

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15
Q

Prostate cancer screening recommendation

A

USPSTF recommendations
- Age 55-69
ACS recommendation -
- age 50 to <10 years life expectancy
AUA
- age 55 to <10 years life expectancy

PSA test
Shared decision making

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16
Q

Risk factors for prostate cancer

A
  • Age
  • Ethnicity
  • Family history (having it or early diagnosis – before 55)
  • Smoking
  • Diets high in animal fat
  • Obesity
  • Cadmium exposure
  • Possibly agent orange exposure
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17
Q

Examination findings for prostate cancer

A
  • Hardness or gland,
  • Distinct nodules for firmness
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18
Q

Symptoms of proctitis

A
  • anorectal pain
  • feeling of incomplete evacuation
  • discharge
  • bleeding

Can feel anal fissures, pain on exam

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19
Q

What generally causes proctitis?

A

STDs

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20
Q

Murphy’s sign

A

Palpation of gallbladder that results in swift patient retraction. Assess for cholecystitis.

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21
Q

McBurney’s Point

A

Point between the umbilicus and right iliac crest that is tender when palpated or during rebound that assesses for appendicitis.

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22
Q

Steps for abdominal examination

A
  • Inspect
  • Auscultate
  • Palpate
  • Percuss
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23
Q

Steps of the abdominal exam

A
  • Inspect the surface, contours, and movements of the abdomen including skin temperature, color, and presence of scars or striae.
  • Prior to palpation or percussion, place the diaphragm of your stethoscope in one abdominal region and listen for bowel sounds (presence, characteristics, bruits).
  • Percuss the abdomen lightly in all four quadrants (tympany, dullness, area of change).
  • Palpate lightly with one hand in all four quadrants (masses, tenderness, guarding).
  • Palpate deeply with two hands in all four quadrants (liver edge, masses, tenderness, pulsations).
  • Check for signs of peritonitis (guarding, rigidity, rebound tenderness).
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24
Q

Liver assessment

A

Estimate size along the right midclavicular line using percussion

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25
Q

Spleen assessment

A

Percuss for splenic enlargement along Traube space
Palpate for splenic edge with the patient supine in right lateral decubitis position.

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26
Q

Kidney assessment

A

Check for tenderness at costovertebral angle using fist percussion.

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27
Q

Urinary Bladder assessment

A

Percuss bladder for distention and tenderness

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28
Q

Dyspepsia

A

chronic or recurrent discomfort or pain centered in the upper abdomen, characterized by epigastric pain or burning, fullness or early satiety (or both), excessive postprandial pain

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29
Q

Functional (Non-Ulcer) dyspepsia

A

a 3-month history of nonspecific upper abdominal discomfort or nausea not attributable to structural abnormalities or peptic ulcer disease (PUD)

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30
Q

Heartburn

A

Rising retrosternal burning pain or discomfort occurring weekly or more often. Aggravated by foods like alcohol, citrus, chocolate, coffee, onions, pepperming or positions like lying down.

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31
Q

RLQ conditions

A
  • appendicitis
  • peptic ulcer disease
  • ruptured ovarian follicle
  • ectopic pregnancy
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32
Q

LLQ conditions

A
  • Accompanied by diarrhea –> diverticulitis
  • Diffuse abdo pain, distention, nausea, emesis –> obstruction
  • Severe diffuse abdo pain with guarding and rigidity on exam–> peritonitis
33
Q

Chronic lower abdo pain can be caused by….

A

Change in bowel habits –> colon cancer
Intermittent pain for 12 weeks in preceding 12 months with relieve from defecation, change in bowel habits, change in stool formation –> IBS

34
Q

Indigestion

A

General distress associated with eating that may have many meanings
- Pregnancy
- DKA
- Adrenal insufficiency
- Hypercalcemia
- Uremia
- Liver disease
- Emotional state
- Adverse drug reactions

35
Q

Nausea and vomiting

A
  • W/obstipation (severe constipation with inability to pass gas/stool) –> obstruction
  • hematemesis – brownish black, possibly coffee ground emesis –> esophageal or gastric varices?
36
Q

What can cause early satiety?

A
  • Gastroparesis
  • anticholinergic medications
  • gastric outlet obstruction
  • gastric CA
37
Q

Dysphagia

A
  • Xerostomia – insufficient saliva
  • Can be structural (esphageal stricture), neurologic (stroke, parkinson’s), muscular (muscular dystrophy, myasthenia gravis)
38
Q

Diarrhea

A
  • Acute – less than 14 days, usually foodborne caused by infection
  • Persistent – 14-30 days
  • Chronic – more than 30 days (IBS, crohns, UC, C Diff)
39
Q

Jaundice

A

Yellowish discoloration of the skin and sclera caused by elevated levels of bilirubin from the breakdown of hemoglobin

40
Q

Carotenemia

A

(orange pigment in carrots) increased carotene in the blood causes discoloration of skin but not sclera or mucous membranes

41
Q

Peptic ulcer disease

A

Mucosal ulcer in the stomach or duodenum >5mm (H.pylori/NSAIDS)

Epigastric pain that may radiate to the back
o Gnawing, burning, aching, hunger like pain – 20% have no symptoms

Duodenal ulcer – pain at night
o Relief with food and antacids (duodenal)

42
Q

Gastroesophageal reflux disease (GERD)

A

Prolonged exposure of the esophagus to gastric acid due to impaired esophageal motility of excess relaxation of sphincter muscle
o Chest or epigastric pain that burns
o Happens after meals,
o Happens with spicy foods, lying down, bending over
o Better with PPIs and antacids

43
Q

Symptoms associated with GERD

A
  • Wheezing
  • Chronic cough
  • SOB
  • Hoarseness
  • Choking sensation
  • Dysphagia
  • Halitosis
  • Sore throat
44
Q

Symptoms associated with PUD

A
  • N&V
  • Belching
  • Bloating
  • Heartburn
  • dyspepsia
45
Q

Special assessment techniques for Appendicitis

A
  • McBurney’s point tenderness RLQ
  • Rovsing sign - rebound tenderness in LLQ
  • Psoas sign - raise right thigh against hand, causes pain in RLQ
  • Obturator - flex right thigh at hip, bend knee, rotate leg internally - pain RLQ
  • Rectal exam - right sided rectal tenderness
  • Pelvic exam - palpable inflamed appendix
46
Q

Diverticulitis

A

Acute inflammation of colonic diverticula, outpouching usually in sigmoid or descending colon
- LLQ pain
- diarrhea (with hx constipation then diverticulitis )
- Cramping then steady pain
- Gradual onset
- Better with analgesia, bowel rest, ABX

47
Q

Symptoms associated with diverticulitis

A
  • Anorexia
  • Fever
  • Diarrhea
  • Urinary symptoms
48
Q

Biliary colic

A

Intermittent obstruction of the cystic duct by a gallstone
o Intermittent pain that resolves
o RUQ or epigastric pain, may radiate to shoulder
o Rapid onset, lasts hours and subsides gradually
o Worse with large fatty meals

49
Q

Ulcerative colitis

A
  • Muscosal inflammation from the recutm to colon with microperforations and possibly polyps
  • Frequent diarrhea, watery, bloody
  • Abrupt onset, recurrent, persistent, may awaken at night
50
Q

Symptoms associated with ulcerative colitis

A
  • Cramping with urgency
  • Fever
  • Fatigue
  • Weakness
  • abdo pain
51
Q

Hepatitis A

A
  • Fecal oral spread or contaminated food
  • HVA vaccine at age 1
  • Immune globulin single dose for treatment
  • Not fatal unless other liver conditions
52
Q

Hepatitis B

A
  • Spread through body fluids
  • Most cases self limited pt develops immunity
  • Chronic infection in diabetic and immunosuppressed patients
  • Vaccination & antiviral treatment
53
Q

Hepatitis C

A
  • Most prevalent bloodborne pathogen in the US
  • IV drug use, needlestick injuries, transfusion/transplantation prior to 1992
54
Q

Inflammatory bowel disease (IBS)

A

o Characterized by bloating
o Increases the risk for colorectal cancer
- Intermittent pain for 12 weeks in preceding 12 months with relieve from defecation, change in bowel habits, change in stool formation

55
Q

Hepatomegaly

A

o Enlarged liver
o A palpable liver edge does not indicate hepatomegaly

56
Q

Colon cancer and screening recommendations

A

For adults 50 to 75. All of these are options:

o Colonoscopy every 10 years
o Stool based test annually
o Sigmoidoscopy every 5 years
o Flexible sigmoidoscopy every 10 years

57
Q

Structures of the RUQ

A

Gallbladder
Pylorus
Duodenum
Hepatic flexure of colon
Head of pancreas

58
Q

Structures of the LUQ

A

Spleen
Splenic flexure of colon
Stomach
Body and tail of pancreas

59
Q

Structures of the LLQ

A

Sigmoid colon
Descending colon
Left ovary

60
Q

Structures of the RLQ

A

Cecum
Appendix
Ascending colon
Terminal ileum
Right ovary

61
Q

Obstipation

A

Severe constipation that prevents passage of stool and gas, indicates bowel obstruction, is a medical emergency.

62
Q

Diarrhea

A

lose or watery stool for at least 75% of the stools being passed

63
Q

Constipation

A
  • Less than 3 BM per week,
  • at least 25% involve straining or feeling incomplete emptying,
  • lumpy or hard,
  • requires manual facilitation to pass
64
Q

Acute abdominal pain causes

A
  • appendicitis
  • cholecystitis
  • GERD
  • INtestinal obstruction
  • UTI
  • Peritonitis
65
Q

Chronic abdominal pain causes

A
  • IBS
  • IBD
  • GERD
  • PUD
  • Cancer
66
Q

Melena

A

Black tarry stools

67
Q

Hematochezia

A

bright red bloody stools

68
Q

Pencil thin stools

A

colon cancer

69
Q

Mucus in stools

A

Adenoma, infection, IBD, IBS

70
Q

Black stool

A
  • ate licorice
  • taking bismuth?
  • bleeding in UGI tract?
71
Q

Pale, white, clay colored stools

A

bile duct may be blocked

72
Q

Yellow stool

A

Too much fat, malabsorption, celiac disease

73
Q

Red stools

A
  • ate red things
  • hemorrhoids
  • bleeding LGI tract
74
Q

Symptoms of Viral hepatitis

A

Affects the liver and may cause
- n/v
- abdo pain
- dark urine
- light colored stools

75
Q

What is proctitis?

A

Inflammation of the last 6” of the cololn

76
Q

Risk factors for proctitis

A
  • unsafe sex practices
  • inflammatory bowel disease
  • radiation therapy

Concerns for
- anemia, fistulas

77
Q

Risk factors for anorectal cancer

A
  • age
  • adenomatous polyps
  • IBD
  • family history
78
Q

Anorectal cancer screening guidelines

A

USPSTF

50-75
- colonoscopy every 10 years
- FIT annually
- FIT/DNA every 3 years

79
Q

Cause of Anal Cancer?

A

HPV infection

At risk
- immunocomprimised
- HIV
- medication
- prior transplants
- homosexual men

Treatment is chemo and radiation

NR509 - Advanced Assessment (9 decks)

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