Week 9: Abdomen Flashcards Preview

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Flashcards in Week 9: Abdomen Deck (38)
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1

What symptoms are more consistent with GI pain? (13)

1. abdominal pain
2. indigestion
3. nausea
4. vomiting
5. hematemesis
6. anorexia
7. early satiety
8. dysphagia
9. odynophagia
10. change in bowel function
11. diarrhea
12. constipation
13. jaundice

2

What symptoms are more consistent with GU pain? (12)

1. suprapubic pain
2. dysuria
3. urgency
4. frequency
5. hesitancy
6. decreased stream
7. polyuria
8. nocturia
9. incontinence
10. hematuria
11. flank pain
12. ureteral colic

3

What are the screening recommendations for colorectal cancer? 
What are the recommendations for stool based tests vs. direct visualization tests?
What are the recommendations for high risk patients?

USPSTF: colorectal cancer screening in average-risk adults from 50-75

Stool based tests
- FIT annually
- Fecal occult blood testing annually
- FIT DNA every 1 or 3 years
Direct visualization tests
- Colonoscopy every 10 years
- Sigmoidoscopy every 5 years
- Flexible sigmoidoscopy every 10 years with FIT every 3 years

High risk persons: personal hx of colorectal cancer, long-standing IBS - start screening earlier than age 50

4

What are the screening recommendations for alcohol abuse? Hepatitis C?

- Alcohol abuse: all primary care patients
- Hepatitis C: those born between 1945-1965

5

What are the screening recommendations for an abdominal aortic aneurysm? How do you perform this assessment?

Men over 50 who have smoked

Assessment: press deeply into the upper abdomen with one hand on each side of the aorta - should be approx 3 cm wide

6

When auscultating the abdomen, what would be normal findings? What would bruits indicate? Venous hum? Friction rubs? 

Normal bowel sounds occur 5-34x per minute
Bruit: hepatic indicates carcinoma of the liver or cirrhosis; arterial bruits suggest partial occlusion of the aorta or large arteries
Venous hum: indicates increased collateral circulation between portal and systemic venous systems (hepatic cirrhosis)
Friction rubs: inflammation of the peritoneal surface of an organ
Palpation: normal abdominal assessment you should not be able to feel individual organs

7

What should a systolic bruit + hepatic friction rub make you suspect?

carcinoma of the liver

8

How would you describe visceral pain?

- nonspecific and difficult to localize
- Quality: gnawing, burning, cramping, aching
- Occurs when hollow organs contract forcefully or are distended or stretched, or when capsules of solid organs are stretched, can occur with ischemia

9

How would you describe parietal pain?

Parietal pain: steady, aching pain, more precisely localized, will be aggravated by coughing or moving
Example: occurs in peritonitis

10

How would you define referred pain? What is an example?

Referred pain: felt in more distant sites that are innervated at approximately the same spinal levels as the impaired structure

Example: pain from the duodenal or pancreatic origin may be referred to the back

11

What techniques can the FNP use to assess the liver? In the pediatric patient? 

Percussion to determine size and palpation of the liver edge
Percussion is better for assessment in pediatrics than palpation

12

What techniques can the FNP use to assess for ascites? 

Percuss from area of central tympany to area of dullness on supine patient

Test for shifting dullness

13

Define dysphagia, what are some etiologies (3)?

Dysphagia: difficulty swallowing, food seems to not go down right

Etiologies: oropharyngeal dysphagia, esophageal dysphagia (mucosal rings and webs; esophageal stricture, esophageal spasm), motor disorders (diffuse esophageal spasm, scleroderma, achalasia)

14

Define odynophagia, what are some etiologies (7)?

Odynophagia: painful swallowing

Etiologies: esophageal ulceration from ingestion of aspirin or NSAIDS, caustic ingestion, radiation, infection with candida, CMV, HSV, HIV

15

What is the murphy sign and what does it indicate?

deeply palpate the RUQ at the location of the pain, ask the patient to take a deep breath - positive sign if sharp halting in inspiratory effort due to pain from palpation of the gallbladder

Indicates cholecystitis

16

What is the psoas sign and what does it indicate?

place hand above the R knee and ask them to raise the thigh against your hand

Indicates appendicitis (psoas irritation due to appendix inflammation)

17

What is the obturator sign and what does it indicate?

flex the R thigh at the hip, with the knee bent rotate the leg internally at the hip

Indicates appendicitis (obturator irritation due to appendix inflammation)

18

What is the Rovsing sign and what does it indicate?

referred rebound tenderness to the RLQ when pressing on the LLQ

Indicates appendicitis

19

What is rebound tenderness and what does it usually indicate?

pain expressed by the patient after the examiner presses down on an area of tenderness and suddenly removes the hand

Indicates peritonitis

20

What are the characteristics of appendicitis?
Location, quality, timing, aggravating factors, relieving factors, associated symptoms and setting

Location: poorly localized periumbilical pain, usually RLQ

Quality: mild but increasing, possibly cramping; steady and more severe

Timing: continues to worsen until treatment

Aggravating factors: movement or cough

Relieving factors: Consider perforation if the pain subsides temporarily

Associated symptoms and setting: anorexia, nausea, possibly vomiting, low fever

21

What are the characteristics of cholecystitis?
Location, quality, timing, aggravating factors, relieving factors, associated symptoms and setting

Location: RUQ or epigastrium pain, may radiate to R shoulder or interscapular area

Quality: steady, persistent, aching

Timing: Gradual onset, course longer than in biliary colic

Aggravating factors: prior history of biliary colic symptoms

Relieving factors: N/A

Associated symptoms and setting: anorexia, nausea, vomiting, fever

22

What are the characteristics of pancreatitis? (Acute vs. chronic)
Location, quality, timing, aggravating factors, relieving factors, associated symptoms and setting

Location: epigastric pain may radiate to the back or other areas of the abdomen

Quality: sharp, knife-like pain; steady, progressive and severe

Timing: acute or chronic

Aggravating factors: movement; alcohol, medication

Relieving factors: hydration, bowel rest

Associated symptoms and setting: nausea, vomiting, abdominal distention; pancreatic enzyme insufficiency, diarrhea with steatorrhea, DM

23

What are the characteristics of diverticulitis?
Location, quality, timing, aggravating factors, relieving factors, associated symptoms and setting

Location: LLQ, pelvic

quality: may be cramping at first, then steady

timing: often gradual onset

aggravating factors: N/A

relieving factors: analgesia, bowel rest, abx

associated symptoms and setting: fever, diarrhea, urinary symptoms, anorexia, tender underlying mass

24

What are the characteristics of obstruction?
Location, quality, timing, aggravating factors, relieving factors, associated symptoms and setting

Location: generalized abdominal pain, nonspecific

quality: cramping, colicky

timing: progressive, intermittent

aggravating factors: ingestion of food or liquids

relieving factors: bowel rest, hydration

associated symptoms and setting: no passage of flatus or bowel movement, nausea, vomiting, progressive abdominal distention

25

What history and exam findings are consistent with IBS? (Timing and associated symptoms)

timing: worse in the morning, rarely at night; pain for 12 weeks in preceding 12 months

associated symptoms: crampy lower abdominal pain, abdominal distention, flatulence, nausea, urgency, pain relived with defecation, change in frequency and form of BMs

26

What are the characteristics of dyspepsia?
Location, quality, timing, aggravating factors, relieving factors, associated symptoms and setting

Location: epigastric, may radiate straight to the back

quality: variable; epigastric gnawing or burning

timing: intermittent

aggravating factors: variable

relieving factors: food and antacids may bring relief

associated symptoms and setting: nausea, vomiting, belching, bloating, more common in the young (20-29 yrs), postprandial fullness, early satiety

27

What history and exam findings are consistent with peritonitis?

pain, absent bowel sounds, rigidity, percussion tenderness and guarding

28

What history and exam findings are consistent with colon cancer? (3)

- change in bowel habits
- diarrhea, abdominal pain, bleeding and occult blood in stool
- weight loss

29

What are the various presentations of bloody stool and their etiologies? (4)

Melena (black tarry stool): gastritis, GERD, peptic ulcer, stress ulcer, esophageal or gastric varices, reflux esophagitis, Mallory-Weiss tear in esophageal mucosa

Black stool: ingestion of iron, bismuth salts, licorice or chocolate cookies

Stool with red blood: colon cancer, hyperplasia or adenomatous polyps, diverticula of the colon, inflammatory conditions, ischemic colitis, hemorrhoids, anal fissure

Reddish but nonbloody stool: ingestion of beets

30

What are the etiologies for constipation? (7)

1. Life activities and habits
2. Irritable bowel syndrome
3. Mechanical obstruction
4. Painful anal lesions: anal fissures, painful hemorrhoids, perirectal abscesses
5. Drugs
6. Depression
7. Neurologic disorders