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188 Cards in this Set
- Front
- Back
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Rectus abdominis muscles become more prominent with what actions?
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When pt raises the head and shoulders from the supine position
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How do you normally examine the abdomen? (clockwise/counter-clockwise)
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Clockwise rotation
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What organs are normally sheltered to palpation by the rib cage and dome of the diaphragm?
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Stomach, liver, and spleen
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The lower margin of the liver, the liver edge, is often palpable where?
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At the right costal margin
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The gallbladder is where in respect to the liver?
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Inferior surface of the liver
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What stony, hard structure in the midline is often misidentified as a tumor?
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The xiphoid process
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Where is the spleen, with respect to the stomach?
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The spleen is lateral and behind the stomach
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Which is more superior: the kidney or the spleen?
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Spleen is higher
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Where can you normally feel the pancreas?
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You can't, suckafool
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Which ribs protect most of the spleen?
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9, 10, 11 (not 12 bitch)
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The anterior edge of what sacral vertebrae is often mistaken for a tumor?
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S1
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What palpable findings are normal in the right lower quadrant?
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No palpable findings. Just bowel loops and the appendix, but you shouldn't be able to feel these.
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A distended bladder can be felt where?
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Above the symphysis pubis
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Bladder expansion stimulates contraction of what muscle and what type of muscle is it?
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The detrusor muscle, which is smooth muscle
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You can voluntarily inhibit detrusor contractions of the bladder until the capacity of the bladder exceeds what volume threshold?
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400-500mL
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Define the costovertebral angle
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The angle formed by the lower border of the 12th rib and the transverse processes of the upper lumbar vertebrae
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Abdominal pain alone accounted for more than how many office visits in 2004?
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More than 13 million
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Abdominal pain alone accounted for how many emergency-room visits in 2003?
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7 million
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Visceral pain in the RUQ can indicate what?
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Liver distention against its capsule in alcoholic hepatitis
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Visceral pain is caused by what?
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When hollow organs contract unusually forcefully or are distended or stretched. Stretching of organ capsules also produces pain
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Visceral periumbilical pain that gradually turns to parietal pain in the RLQ indicates?
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Appendicitis. Distention of the appendix that becomes inflammation of the adjacent parietal peritoneum.
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Epigastric pain comes from?
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The stomach, duodenum, or pancreas
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Periumbilical pain comes from?
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The small intestine, appendix, or proximal colon
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RUQ/epigastric pain comes from?
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The liver or biliary tree
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Suprapubic or sacral pain comes from?
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The rectum
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Visceral periumbilical pain that gradually turns to parietal pain in the RLQ indicates?
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Appendicitis. Distention of the appendix that becomes inflammation of the adjacent parietal peritoneum.
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Epigastric pain comes from?
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The stomach, duodenum, or pancreas
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Periumbilical pain comes from?
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The small intestine, appendix, or proximal colon
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RUQ/epigastric pain comes from?
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The liver or biliary tree
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Suprapubic or sacral pain comes from?
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The rectum
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Hypogastric pain comes from?
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The colon, bladder, or uterus
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Describe parietal pain
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A steady, aching pain usually more severe than visceral pain and more precisely localized over the involved structure. It is typically aggravated by movement or coughing so pts usually prefer to lie still.
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Duodenal or pancreatic pain refers to where?
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The back
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Biliary tree pain refers to where?
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Right shoulder or the right posterior chest
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Pleurisy or MI refers to where?
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Epigastric area
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The prevalance of recurrent upper abdominal discomfort or pain in the US and other Western countries is approximately what?
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25%
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What neuropeptides mediate interconnected symptoms of pain, bowel dysfunction, and stress?
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Neuropeptides like 5-hydroxytryptophan and substance P
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What percentage of patients in ERs have nonspecific pain and what percentage of those need surgery, and usually for what?
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40-45% have nonspecific pain, 15-30% need surgery, usually for appendicitis, intestinal obstruction, or cholecystitis.
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Doubling over with cramping, colicky pain indicates what?
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Renal stone
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Sudden knifelike epigastric pain occurs in?
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Gallstone pancreatitis
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Epigastric pain can occur with what?
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Gastritis or GERD
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RUQ and upper abdominal pain signifies what?
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Cholecystitis
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Is sensitivity to pain diminished or augmented in older patients?
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Diminished
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"Indigestion" that is precipitated by exertion and relieved by rest may indicate?
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Angina from inferior wall coronary artery disease
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Define dyspepsia
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Chronic or recurrent discomfort or pain centered in the upper abdomen
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Define discomfort
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A subjective negative feeling that is nonpainful
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Name some symptoms of discomfort
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Bloating, nausea, upper abdominal fullness, and heartburn
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Bloating may occur due to?
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Inflammatory bowel disease or aerophagia
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Define functional (nonulcer) dyspepsia
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A 3-month history of nonspecific upper abdominal discomfort or nausea not attributable to structural abnormalities or peptic ulcer disease. Causes may include delayed gastric emptying, gastritis from H. pylori, and psychosocial factors
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How does GERD present?
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Like heartburn, acid reflux, or regurgitation.
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How do you diagnose GERD?
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Endoscopy or symptoms of heartburn, acid reflux, or regurgitation
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What are the risk factors for GERD?
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Reduced salivary flow, delayed gastric emptying, selected medications, and hiatal hernia
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Define Heartburn
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A rising, retrosternal burning pain or discomfort occurring weekly or more often. Aggravated by alcohol, chocolate, citrus fruits, coffee, onions, peppermints, bending over, exercising, lifting, or lying supine.
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Patients that present with atypical respiratory symptoms such as cough, wheezing, ad aspiration pneumonia or pharyngeal symptoms, such as hoarseness and chronic sore throat may have what?
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GERD
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What's the difference between dysphagia and odyophagia?
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Difficulty swallowing is dysphagia. Pain with swallowing is odyophagia.
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What are some GI alarm symptoms?
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dysphagia, odyophagia, recurrent vomiting, evidence of GI bleed, weight loss, anemia, or risk factors for gastric cancer
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What is Barrett's esophagus?
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When the squamocolumnar junction is displaced proximally and replaced by intestinal metaplasia, increasing the risk of esophageal cancer 30-FOLD.
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Approximately what percent of pts with GERD will present with no disease upon endoscopy?
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50%
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In women, RLQ pain may indicate what?
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Ectopic pregnancy, ruptured ovarian follicle, or pelvic inflammatory disease
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Cramping pain radiating to the RLQ or LLQ may indicate what?
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Renal stone
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LLQ pain with a palpable mass may be a what?
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Diverticulitis
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Diffuse abdominal pain with absent bowel sounds and firmness, guarding, or rebound on palpation indicates what?
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Small or large bowel obstruction
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Change in bowel habits with a mass lesion indicates what?
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Colon cancer
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What are the symptoms of irritable bowel syndrome?
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Intermittent pain for 12 weeks of the preceding 12 months with relief from defecation, change in frequency of bowel movements or change in form of stool, without structural or biochemical abnormalities
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What is retching?
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Involuntary spasm of the stomach, diaphragm, and esophagus
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Raising esophageal or gastric contents without nausea or retching is called what?
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Regurgitation
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Vomiting and pain indicate?
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Small bowel obstruction
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Fecal odor in the vomitus indicates?
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Small bowel obstruction or gastrocolic fistula
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Is a small amount of yellowish or greenish bile normal in gastric juice?
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Yes, it is common and has no special significance
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Brownish or blackish vomitus with a "coffee grounds" appearance suggests what?
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Blood altered by gastric acid. Can results from esophageal or gastric varices, gastritis, or peptic ulcer disease
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Symptoms of blood loss such as syncope and lightheadedness rarely appear until you've loss how much blood?
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500mL
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For abdominal fullness after a light or moderate meal, consider what?
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Diabetic gastroparesis, anticholinergic medications, gastric outlet obstruction, gastric cancer
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For early satiety, consider what?
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Hepatitis
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What is the sensation of a lump in the throat or the retrosternal area unassociated with swallowing called?
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I dunno. NOT dysphagia though.
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What are the indications for oropharyngeal dysphagia?
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Drooling, nasopharyngeal regurgitation, cough from aspiration
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Gurgling or regurgitation of undigested food can occur in what?
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Structural conditions such as Zenker's diverticulum
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If a pt points below the sternoclavicular notch for dysphagia, what kind of dysphagia is it?
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Esophageal dysphagia
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How do you differentiate between structural and motility problems with the esophagus?
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Trouble with solid foods indicate a structural problem, like a structure, web, or Schatzki's ring, or neoplasm. Solids and liquids indicate a motility disorder.
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What is Schatzki's ring?
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Narrowing of the lower portion of the esophagus
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What should you consider in odynophagia?
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esophageal ulceration from radiation, caustic ingestion, infection from candida, cmv, hsv, or hiv.
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Gurgling or regurgitation of undigested food can occur in what?
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Structural conditions such as Zenker's diverticulum
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If a pt points below the sternoclavicular notch for dysphagia, what kind of dysphagia is it?
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Esophageal dysphagia
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How do you differentiate between structural and motility problems with the esophagus?
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Trouble with solid foods indicate a structural problem, like a structure, web, or Schatzki's ring, or neoplasm. Solids and liquids indicate a motility disorder.
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What is Schatzki's ring?
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Narrowing of the lower portion of the esophagus
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Gurgling or regurgitation of undigested food can occur in what?
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Structural conditions such as Zenker's diverticulum
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What should you consider in odynophagia?
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esophageal ulceration from radiation, caustic ingestion, infection from candida, cmv, hsv, or hiv.
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If a pt points below the sternoclavicular notch for dysphagia, what kind of dysphagia is it?
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Esophageal dysphagia
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How do you differentiate between structural and motility problems with the esophagus?
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Trouble with solid foods indicate a structural problem, like a structure, web, or Schatzki's ring, or neoplasm. Solids and liquids indicate a motility disorder.
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What is Schatzki's ring?
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Narrowing of the lower portion of the esophagus
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What should you consider in odynophagia?
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esophageal ulceration from radiation, caustic ingestion, infection from candida, cmv, hsv, or hiv.
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What is the normal minimum for bowel movements per week?
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2 bowel movements
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If a pt has excessive flatus of about 600mL, what should you consider?
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Aerophagia, legumes or other gas-producing foods, intestinal lactase deficiency, IBS
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Define diarrhea
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Stool volume greater than 200 grams in 24 hours
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Differentiate between acute and chronic diarrhea
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Acute lasts 2 weeks or less and is usually due to infection. Chronic is 4 weeks or more and noninfectious (Crohn's/UC).
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High-volume frequent watery stools are usually from where?
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Small intestine
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Small-volume stools with tenesmus or diarrhea with mucus, pus, or blood occur in?
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Rectal inflammatory conditions
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Steatorrhea can be caused by what?
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Celiac sprue, pancreatic insufficiency, and small bowel bacterial overgrowth
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Diarrhea is common with what meds?
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Penicillins, macrolides, magnesium-based antacids, metformin, and herbal/alternative meds
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Constipation is defined how?
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Present for at least 12 weeks of the prior 6 months with fewer than 3 bowel movements per week, 25% or more defecations with either straining or sensation of incomplete evacuation, lumpy or hard stools, or manual facilitation
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Apple-core lesions occur where?
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Sigmoid colon, and produce thin, pencil-like stool
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What is obstipation?
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No passage of feces or gas. Indicates intestinal obstruction
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Differentiate between melena and hematochezia
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Melena are black, tarry stools from an upper GI bleed of about 100mL. Hematochezia is red or maroon-colored and comes from a lower GI bleed of more than 1000mL
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Blood on the surface of toilet paper occurs with?
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Hemorrhoids
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Mechanisms of jaundice include?
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Increased production of bilirubin, decreased uptake of bilirubin by hepatocytes, decreased ability of the liver to conjugate bilirubin, and decreased excretion of bilirubin into the bile, resulting in absorption of conjugated bilirubin back into the blood
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Gilbert's syndrome can cause what?
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Hereditary cause of hyperbilirubinemia due to reduced activity of glucorunyltransferase, which conjugates bilirubin.
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What can cause impaired excretion of conjugated bilirubin?
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viral hepatitis, cirrhosis, primary biliary cirrhosis, drug-induced cholestasis, ORAL CONTRACEPTIVES, METHYL TESTOSTERONE, and chlorpromazine
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Gallstones or pancreatic carcinomas can obstruct what duct?
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The common bile duct
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Conjugated bilirubin turns the urine what color?
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dark yellowish brown or tea color
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What does acholic mean?
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Deficiency of bile
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Acholic stools are what color?
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Gray or light-colored
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Itching indicates what? (doesn't say where lol)
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Cholestatic or obstructive jaundice
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How do you get the heps?
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A: contaminated water or foodstuffs. B: sexual contact or injection drug use. C: IV drug use or blood transfusion
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Involuntary voiding or lack of awareness suggests?
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Cognitive or neurosensory deficits
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Stress incontinence arises from what?
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Decreased intraurethral pressure
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Gonna speed this up, only flashcarding things I think are the most important stuff now
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Roger that sir
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Characterize the pain of bladder infection, sudden distention, and chronic distention
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dull and pressure-like, agonizing, painless
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What is cystitis?
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Inflammation of the bladder
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Painful urination accompanies?
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Cystitis or urethritis
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Prostatic pain is usually felt where?
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In the perineum and occasionally the rectum
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For dysuria, consider what?
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bladder stones, foreign bodies, tumors, acute prostatitis.
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What causes internal and external burning in women?
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Internal is urethritis. External is vulvovaginitis. Both from being a witch.
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Urinary urgency suggests?
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A bladder infection
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Partial obstruction to urinary outflow in men can cause?
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Hesitancy in starting the stream, straining to void, reduced caliber and force, or dribbling.
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Define polyuria
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24-hour urine volume exceeding 3 liters.
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What percentage of older patients are concerned about urinary incontinence? (I know these are dumbass questions, but they show up on tests so...)
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30%
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What causes stress, urge, and overflow incontinence?
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decreased contractility of the urethral sphincter or poor support of bladder neck, detrusor overactivity, anatomical obstruction or stricture or neurogenic abnormalities
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Red urine can be caused by what?
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Beets. Probably blood also
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Renal pain from distention of the capsule is usually?
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dull, aching, and steady
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What does colicky mean?
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Coming in waves (like peristalsis)
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Alcohol abuse/dependency affects how much of the US population?
|
8.5% or 17.6 million people
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Lifetime prevalence for alcohol is?
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13.5%
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ER and trauma admissions are?
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30% to 40% and 50% (whatever the hell that means)
|
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What are the cutoffs for risky or hazardous drinking?
|
W: 3 drinks per occasion, 7 per week
M: 4 drinks per occasion, 14 per week |
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According to the CDC recommendation in 2006, who should receive vaccination for hep b?
|
adults in high risk settings, primary care and specialty settings, occupations with exposure to blood or other potentially infectious body fluids. ALSO PREGNANT WOMEN AT THEIR FIRST PRENATAL VISIT
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What % of hep b patients are asymptomatic until advanced liver disease?
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70%
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What % of hep b infections are self-limited?
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95%
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Prevalence of hep c for high risk groups reaches what %?
|
50-90%
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What are the important risk factors for Hep C?
|
Transfusion before 1987 and organ transplant before 1992. there are others but I don't care about them
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What is the third most common cancer in both men and women and accounts for almost 10% of all cancer deaths, and rhymes with olorectal cancer?
|
Colorectal cancer, of which 90% of the cases happen after age 50
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|
Look over page 432 again on bullshit screening stuff
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NO!
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Cushing's Syndrome produces?
|
Pink-purple striae
|
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Dilated veins occur in?
|
Hepatic cirrhosis or of inferior vena cava obstruction
|
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A lower abdominal mass can indicate what?
|
Ovarian or uterine tumor
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|
When conducting the abdominal exam, expose where to where?
|
Just above the xiphoid process to the symphysis pubis
|
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When do you have increased peristaltic waves?
|
During intestinal obstruction. (weird right? maybe secondary peristaltic waves)
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Increased aortic pulsation suggests?
|
Aortic aneurysm or increased pulse pressure
|
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Bowel sounds may be altered in?
|
Diarrhea, intestinal obstruction, paralytic ileus, and peritonitis
|
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Normal sounds consist of clicks and gurgles occurring at what rate?
|
5-34 per minute
|
|
What are borborygmi?
|
gurgles of hyperperistalsis (stomach growling)
|
|
Hypertension with both systolic and diastolic bruits over the abdomen is probably due to what?
|
Renal artery stenosis
|
|
When do you get friction rubs?
|
liver tumor, gonococcal infection around the liver, splenic infarction
|
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A protuberant abdomen that is tympanitic throughout suggests what?
|
Intestinal obstruction
|
|
What happens during situs inversus?
|
Organs are reversed. Air bubble on the right and liver dullness on the left
|
|
Involuntary rigidity indicates what?
|
Peritoneal inflammation
|
|
How does you establish the area of peritoneal inflammation?
|
Ask the pt where it hurts when they cough and then map the area with 1 finger palpation
|
|
Where do you measure the liver from?
|
Right MCL
|
|
What happens when you use a heavy stroke to percuss the liver?
|
You underestimate liver size, so use light to moderate percussion instead.
|
|
Liver dullness can be decreased during what?
|
Perforated hollow viscus, meaning free air is present below the diaphragm
|
|
Liver may be displaced downwards when?
|
COPD pushes diaphragm downwards
|
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Normal liver spans are greater in what 2 types of people?
|
Men and taller folks
|
|
Normal liver spans are?
|
6-12cm at R MCL, 4-8cm midsternal
|
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What can falsely increase the size of the liver estimate?
|
Pleural effusion or consolidated lung
|
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How much does the likelihood of hepatomegaly roughly increase when the liver edge is palpable?
|
Roughly doubles
|
|
Describe the normal liver edge
|
soft, sharp, and regular with a smooth surface. Sometimes slightly tender
|
|
On inspiration, the liver is palpable how many cm below the MCL?
|
3cm
|
|
What technique may aid liver palpation in the obese?
|
"hooking technique"
|
|
Where does the spleen expand to when it enlarges?
|
Anteriorly, downward, and medially
|
|
Where is Traube's space?
|
between lung resonance above and the costal margin
|
|
What are the sensitivity and specificity of percussion in measuring splenomegaly?
|
sensitivity 60-80%, specificity 72-94%
|
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What is a positive splenic percussion sign?
|
When the spleen is palpable upon inspiration at the lowest interspace at the anterior axillary line.
|
|
How much more likely is splenomegaly when the spleen is palpable?
|
8 times
|
|
The enlarged spleen is how far below the LCM?
|
2cm
|
|
Preservation of tympany in the LUQ indicates enlarged spleen or kidney?
|
Enlarged kidney
|
|
Causes of kidney enlargement include?
|
Hydronephrosis, cysts, and tumors. Polycystic kidney disease if bilateral enlargement.
|
|
Pain with pressure or fist percussion over the CVA indicates what?
|
Pyelonephritis or a musculoskeletal cause
|
|
What is the normal width of the abdominal aorta?
|
Not more than 3cm
|
|
What are the risk factors for an AAA?
|
Age 65 or older, hx of smoking, male gender, first-degree relative with a hx of AAA repair.
|
|
Suprapubic tenderness is caused by what?
|
Bladder infection
|
|
Rupture of an AAA is 15 times more likely when the AAA is how big?
|
>4cm
|
|
What two tests help diagnose ascites?
|
Tests for shifting dullness and for a fluid wave
|
|
What is ballotte-ing used for?
|
Palpation in an ascitic abdomen
|
|
Right-sided rectal tenderness may be caused by what?
|
An inflamed adnexa or an inflamed seminal vesicle
|
|
What is Rovsing's sign?
|
Rebound tenderness in the LLQ suggestive of appendicitis
|
|
What happens during a positive psoas sign?
|
An inflamed appendix causes irritation of the psoas muscle
|
|
What happens during a positive obturator sign?
|
An inflamed appendix causes irritation of the obturator muscle when the leg is flex and internally rotated.
|
|
What is cutaneous hyperesthesia?
|
Gently picking up folds of skin between your thumb and index finger along the abdominal wall. This maneuver is not normally painful.
|
|
What is Murphy's sign diagnostic of and where do you test for it?
|
Tests for acute cholecystitis and conducted where the lateral border of the rectus muscle meets the costal margin
|
|
How can you tell between an abdominal wall mass and an intra-abdominal mass?
|
Ask the patient to raise their head and shoulders while supine. A mass in the abdominal wall will remain palpable while and intra-abdominal mass will be obscured.
|
