Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
270 Cards in this Set
- Front
- Back
Name the three central regions of the abdomen from top to bottom (9 region names)
|
Epigastric, Umbilical, Suprapubic (or hypogastric)
|
|
Which ribs protect the spleen?
|
9, 10, and 11th
|
|
The bladder can accommodate about ___ mL of urine, but may be overridden until what capacity is exceeded?
|
normally 300 mL, can go to 400-500mL
|
|
What are the three broad categories of abdominal pain?
|
Visceral pain, parietal pain, and referred pain
|
|
What is visceral pain?
|
Pain caused by forceful contraction or distention/ stretch of hollow abdominal organs (intestine, biliary tree).
|
|
Visceral pain in the RUQ may result from ____ in patients with ___
|
liver distention against its capsule in alcoholic hepatitis
|
|
Adjectives such as "gnawing, burning, cramping, or aching" describe ____pain
|
visceral
|
|
visceral periumbilical pain may signify _____.
|
early acute appendicitis, progresses to RLQ pain with inflammation of peritoneum
|
|
Describe parietal pain.
|
Originates from inflammation of the peritoneum. Typically worse with movement
|
|
What type of pain is typically more severe, more easily localized, and aggrivated by movement?
|
Parietal
|
|
Pain of ____ may be referred to the back. Pain of the ____ may be referred to the R shoulder or post. chest.
|
1. duodenal or pancreatic origin = back
2. pain of the biliary tree = R shoulder or posterior chest |
|
Pain from pleurisy or AMI may be referred to the ____
|
epigastric area
|
|
Studies suggest that neuropeptides like ____ and ___ mediate interconnectd symptoms of pain, bowel dysfunction, and stress.
|
Substance P, 5-hydroxytryptophan
|
|
In the ER< 40-50% of patients have ___ but 14-30% need surgery for ___
|
1. non-specific pain
2. intestinal obstruction, appendicities, or cholecystitis |
|
A patient presents doubled over with cramping type colicky pain. You suspect ____
|
Renal stone
|
|
A patient presents with sudden, knifelike epigastric pain suggestive of ____
|
gallstone pancreatitis
|
|
Epigastric pain occurs with ___ or ___, RUQ pain signifies ___
|
1. Gerd, Gastritis
2. cholecystitis |
|
Why does establishing the severity of pain not really help us?
|
Sensitivity to pain varies widely and diminishes in eldterly, and people have very different pain thresholds
|
|
Angina from inferior wall CAD may present as _____, but can be distinguished by assessing ____
|
"heartburn", but worse on exertion and relieved by rest
|
|
What is dyspepsia?
|
chronic or recurrent discomfort or pain in upper abdomen
|
|
What is discomfort?
|
subjective negative feeling that is not painful (bloating, heartburn, nausea, upper abd. fullness, etc)
|
|
When bloating, nausea, or belching occur alone they ___ (do/NOT) meet criteria for dyspepsia.
|
DO NOT
|
|
What is aerophagia?
|
Swallowing air
|
|
____ may occur with bloating from IBS or swallowing air.
|
belching
|
|
Define functional (non-ulcer) dyspepsia?
|
3 month hx of non-specific upper abdominal discomfort or nausea not attributable to structural abnormality or peptic ulcer.
|
|
Multifactorial causes of non-ulcer dyspepsia include:
|
1. delayed gastric emptying
2. H. Pylori 3. psychosocial problems |
|
A patient with GERD is likely to experience what symptoms? How often?
|
1. heartburn, acid reflux, or regurgitation
2. more than once a week |
|
What are the diagnostic criteria for GERD?
|
1. heartburn, acid reflux, or regurgitation >1/week
2 Or mucosal damage on endoscopy |
|
Risk factors for GERD include:
|
1. reduced salivary flow
2. Delayed gastric emptying. 3. Some medications 4. Hiatal hernia |
|
____ is described as a rising retrosternal pain or discomfort that is worse in association with certain positions or foods.
|
Heartburn
|
|
What foods typically aggrivate heartburn?
|
alcohol, chocolate, citrus fruits, coffee, onions, peppermint.
|
|
What body positions aggrivate heartburn?
|
bending over, exercising, lifting, or laying supine.
|
|
A patient with GERD may also experience _____respiratory symptoms, or ____ symptoms.
|
1. atypical (wheezing, cough, aspiration pneumonia)
2. pharyngeal (hoarseness, chronic sore throat) |
|
Dysphagia is ____
Odyphagia is ____ |
dysphagia = difficulty swallowing
odyphagia = painful swallowing |
|
What type of GERD patients warrant endoscopy? What are you looking for with endoscopy?
|
- patients with uncomplicated GERD unresponsive to empiric therapy
- patietns older than 55 - those with "alarm symptoms" -looking for esophagitis, peptic strictures, or barrett's esophagus |
|
What are "alarm symptoms"?
|
difficulty swallowing, odyophagia, recurrent vomiting, GI bleeding, weight loss, anemia, or risk factors for gastric cancer.
|
|
In what condition does squamous columnar jucntion et displaced proximally and replaced y intstinal metaplasia.
|
Barret's esophagus
|
|
Approximately _____ of patients with GERD will have no disease on endoscopy.
|
50%
|
|
RLQ pain or pain that migrates from the periumbilical region along with _____ is most likely to predict appendicitis.
|
abdominal wall rigidity on palpation
|
|
What are some other causes of RLQ pain or abdominal wall rigidity (not appy), esp in women?
|
PID, ruptured ovarian follicle, ectopic pregnancy
|
|
Cramping pain radiating to the LLQ may be ____
|
a renal stone
|
|
LLQ pain with a palpable mass may be ____
|
Diverticulitis
|
|
Diffuse abdominal pain with absent bowel sounds and firmness, guarding, or rebound on palpatin indicate ____
|
small or large bowel obstruction
|
|
Changes in bowel habits with mass lesion indicates ___-
|
colon cancer
|
|
Irritable Bowel Syndrome is characterized by what criteria?
|
- intermittent pain for 12 weeks of the previous 12 months
- change in frequency of bowel movments - relieve of pain with defecation - change in form of stool -*without structural or biochemical abnormalities* |
|
What is retching?
|
Involuntary spasm of hte stomach, diaphragm, and esophagus that precedes and culminates in vomiting
|
|
What is regurgitation?
|
not vomiting, but raising esophageal or gastric contents without vomiting or nausea
|
|
Regurgitation occurs in ___, ___, and ____
|
GERD, esophageal stricture, and esophageal cancer
|
|
Fecal odor of emesis occurs in _____ or ____
|
small bowel obstruction or gastrocolic fistula
|
|
Blood in emesis witha brown, balck "coffee ground" appearance indicates _______
|
blood processed by gastric juices
|
|
Symptoms of blood loss such as lightheadedness or syncope depend on rate and volume and are rare until blood loss exceeds _____.
|
500mL
|
|
Indicators of ____ include:
drooling, nasopharyngeal regurgitation, cough |
Oropharyngeal dysphagia
|
|
Gurgling or regurgitation of undigetsed food occur in structural conditions like _____
|
Zenker's diverticulum
|
|
Where does the pain from esophageal dysphagia occur?
|
Below the sternoclavicular notch
|
|
If a person is having dysphagia associated with solid foods, consider conditions like ____ or ___
|
Esophageal stricture, web, or Schatzki's ring
|
|
If a person is having difficulty swallowing solids and liquids, what type of disorder is more likely?
|
a motility disorder.
|
|
What is the normal volume of flatus passed daily in some patients?
|
up to 600mL
|
|
Acute diarrhea is usually caused by ___/ Chronic diarrhea is usually _____ in origin.
|
1. infection
2. non-infectious (Crohn's, ulcerative colitis, etc) |
|
High volume, frequent wattery stools are usualyy from the ____. Small volume stools with tenesmus (diarrhea with mucus, pus, or blood) occur in _____
|
1. small intestine
2. rectal inflammatory conditons |
|
______ diarrhea usually has pathologic significance.
|
Nocturnal
|
|
Describe steatorrhea
|
Frothy, fatty, floating, Feces
|
|
Chronic diarrhea is defined by the presence of ___
|
1. 12 weeks of the prior 6 months with at least two of the following: fewer than 3 bowel movenets, 25% or more defecations with straining, lumpy or hard stools, or manual facilitation.
|
|
Thin, pencil-like stools occur in ___
|
an obstructing "apple-core" lesion of the sigmoid colon
|
|
Melena may appear with as little as ____ upper GI bleeding. Hematochezia if more than _____ mL of blood, especially lower GI.
|
1. 100mL
2. 1000mL |
|
What is obstipation?
|
No passage of feces OR gas... signifies intestinal obstruction
|
|
Jaundice may be ___ or ___ .
|
Intrahepatic (damage to hepatoytes or impaired excretion due to damaged intrahepatic bile ducts), or extrahepatic (bile duct obstruction)
|
|
Dark urine from bilirubin indicates ___
|
impaired excretion of bilirubin into GI tract
|
|
What is an acholic stool?
|
stool that doesn't contain bile
|
|
Involuntary urinating or lack of urinary awareness suggests what types of defecits?
|
Cognitive or neurosensory
|
|
Stress incontinence arises from ___
|
decreased intraurethral pressure
|
|
_____ accompanies acute urinary retention.
|
Pain of sudden overdistention.
|
|
Painful urination accompanies ___ or ___
|
cystitis or urethritis
|
|
In sudden overdistention of the bladder, pain is _____ whereas in chronic bladder distention it is usually ____
|
1. agonizing
2. painless |
|
Where is prostatic pain typically felt?
|
in the perineum and the rectum
|
|
Urinary ____ suggests bladder infection or irritation.
|
Urgency
|
|
What is the rough definition of polyuria?
|
Significant increase in 24-hour urine volume, roughly exceeding 3 liters
|
|
Up to 30% of older patients are concerned about what urinary problem?
|
Incontinence
|
|
Stress incontinence with increaed intra-abdominal pressure suggestes ____
|
decreased contractility of urethral sphincter or poor support of bladder neck
|
|
Urge incontinence suggests
|
detrussor overactivity
|
|
Overflow incontinence suggests
|
the bladder cannot be emptied until bladder pressure exceeds the urethral pressure - anatomical obstruction or neuro problems
|
|
Functional incontinence may arise from ____
|
impaired cognition, musculoskeletal problems, immobility
|
|
What is the difference between gross and microscopic hematuria?
|
Gross = visible to naked eye
Microscopic = requires microscope |
|
Renal or ureteral colic is caused by ____
|
sudden obstruction of a ureter
|
|
According to bates, the cuttoffs for "risky" or "hazardous" drinking are:
|
women: 3+ drinks/ occasion, 7+ drinks per week
men: 4+ drinks/ occasion, 14+ drinks/week |
|
Hepatitis A is transmitted via ____
|
fecal-oral contamination, often by contaminated food or water.
|
|
Hepatitis B can be transmitted via:
|
sexual contact, percutaneous or mucosal exposure to blood, travel to endemic areas
|
|
Approximately __% of otherwise healthy persons infected with Hep B are ____
|
95% self limited
|
|
Most Hep B patients are ____ until ____
|
asymptomatic until developing advanced liver disease
|
|
Hepatitis C is present in about ___% of US adults, but between ___ and ___% in high-risk groups.
|
2%, up to 50-90% in high risk
|
|
The third most common cancer in adults accounting for almost 10% of cancer deaths is ___
|
colorectal cancer
|
|
When assessing the skin, you may see pink-purple straie that suggest ____
|
Cushing Disease
|
|
Dilated veins in the abdomen may be seen in ___ or ___
|
hepatic cirrhosis or inferior vena cava obstruction
|
|
Assymetry of the abdomen could be due to ___
|
enlarged organ or mass
|
|
Peristaltic waves may be visible or increased in ____
|
intestinal obstruction
|
|
What would you suspect if you noted an increased abdominal pulsation?
|
Aortic aneurysm or increased pulse pressure
|
|
What order should the abdominal exam be done in?
|
Inspection, Auscultation, Percussion, Palpation,
|
|
Why should you listen to abdominal sounds before percussion or palpation?
|
Those maneuvers may alter frequency of bowel sounds
|
|
What is the normal frequency of clicks/gurgles in bowel sounds?
|
5-34/ min
|
|
What is borborygmi?
|
Prolonged gurgles of hyperperistalsis (stomach growling!)
|
|
A bruit in the abdomen that has both __and ___ components is highly sugestive of renal artery stenosis as the cause of ___
|
1. both systolic and diastolic
2. HTN |
|
Abdominal bruits confined to ____ are relatively normal and may not indicate disease.
|
Systole
|
|
Friction rubs in the abdomen may suggest what?
|
liver tumor, gonococcal disease around the liver, or splenic infarction
|
|
A protruberant abdomen that is tympanitic throughout suggests ___
|
intestinal obstruction
|
|
Dullness (percussion) in bilateral flanks should prompt further assessment for ____
|
Ascites
|
|
In situs inversus, you would expect to hear ___ on the right and ___ on the left during percussion.
|
1. tympany on the right
2. dullness in LUQ |
|
Involuntary rigidity during light palpatin typically persists despite relaxation maneuvers and indicates ____
|
peritoneal inflammation
|
|
Abdominal masses may be categorized several ways:
|
1. physiologic (pregnant uterus)
2. inflammatory (diverticulitis) 3. vascular (AAA) 4. neoplastic (carcinoma) 5. obstructive (bladder or bowel distention) |
|
Abdominal pain and tenderness, especially when associated with muscle spasm (cough) suggest _____
|
inflammation of parietal perineum.
|
|
When assessing for rebound tenderness, you should press down _____ and withdraw ___.
|
1. firmly and slowly
2. quickly *look for pain induced or increased by release** |
|
Rebound tenderness suggests _____
|
Peritoneal inflammation
|
|
The span of liver dullness is _____ if the liver is enlarged
|
Increased
|
|
When would liver dullness be decreased?
|
if liver is small or free air is present belwo the diaphragm (perforated hollow viscous).
|
|
COPD could cause liver dullness to be displaced in what direction.
|
Downward (low diaphragm)
|
|
What is the normal liver span?
|
6-12cm in midclavicular line
4-8cm in midsternal line |
|
Mild tenderness with liver palpation is __
|
likely normal
|
|
Firmness or hardness of the liver, or blunting of the edges suggests ___-
|
abnormality
|
|
On inspiration, the liver is palpable about _____ below the right costal margin in the midclavicular line.
|
3cm.
|
|
Obstructed, distended gallbladder may form ______
|
an oval mass and merge with the edge of the liver (dull to percussion)
|
|
If percussion dullness is present when percussing the spleen, palpation can correctly detect presence or absense of splenomegally _____ of the time
|
80%
|
|
What is Traube's Space?
|
left lower anterior chest wall between lungs and costal margin.
|
|
Besides splenomegaly, what may cause dullness on percussion of Traube's space?
|
fluid or solids in the stomach or colon
|
|
What is the splenic percussion sign?
|
Percuss the lowest interspace in the left axillary anterior line (usually tympanic). Then ask pt to take a deep breath and percuss again to see if it remains tympanic (normal) - indicates normal spleen size
|
|
A positive splenic percussion sign indicates___
|
splenomegaly
|
|
If the spleen is palpable, splenomegaly is ____ times more likely.
|
8
|
|
When laying on the right side, an enlarged spleen would be palpable where?
|
2cm below the L costal margin on deep inspiration
|
|
If you cannot palpate a kidney, what does it mean?
|
That's normal
|
|
Causes of kidney enlargement include ____
|
hydronephrosis, cycsts, tumors
|
|
What does bilateral kidney enlargement suggest?
|
polycystic kidney disease
|
|
In patients over 50, how would you assess the width of the aorta?
|
by pressing deeply in the upper abdomen with one hand on each side of the aorta.
|
|
In >50 patients, what is a normal aorta width?
|
up to 3cm (average is 2.5cm)
|
|
Risk factors for AAA include;
|
age >65, smoking hx, male, 1* relative with history of AAA repair
|
|
Screening by palpation followed by ___ for AAA decreases mortality.
|
ultrasound
|
|
Rupture of AAA may be signaled by ____, and is 15x more likely when the AAA is greater than ___cm
|
1. pain
2. 4 |
|
A protruberant abdomen with bulging flanks suggests
|
ascitic fluid
|
|
What are some causes of ascites?
|
1. increased hydrostatic pressure in cirrhosis
2. CHF 3. constrictive pericarditis 4. inferior v.c. or portal obstruction 5. decreased osmotic pressure in nephrotic syndrome 6. malnutrition 7. ovarian cancer |
|
In ascites, dullness _____ whereas tympany shifts toward the ___
|
1. shifts toward the more dependent side
2. top |
|
A positive fluid wave, shifting dullness, and peripheral edema make the diagnosis of ____ very likely
|
Ascites
|
|
The pain of appendicitis classically begins ____ then shifts to ___ and is worse with ___
|
1. periumbilical
2. RLQ 3. coughing |
|
Localized tenderness anywhere in the RLQ, even flank, may indicate ___
|
appendicitis
|
|
Why would right-sided rectal tenderness occur in appendicitis?
|
inflamed adnexa or inflamed seminal vesicle due to peritoneal inflammation
|
|
What is Rovsing's sign?
|
Pain in the RLQ during LLQ palpation
|
|
Rovsing's sign is highly suspicious of ___
|
appendicitis
|
|
Irritation of the psoas muscle, as identified by the psoas sign, may be caused by ___
|
inflammation secondary to an inflamed appendix
|
|
Positive psoas and obturator signs are indicative of ___
|
an inflamed appendix
|
|
What is cutaneous hyperesthesia?
|
Pick up small skin folds along the abdominal wall. If tender, may suggest appendicits
|
|
How is Murphy's Sign performed?
|
Hook Left thumb or fingers of R hand under costa margin. Have pt take a deep breath and note degree of tenderness.
|
|
A sharp increase in tenderness with stop in inspiratory effort while palpating the RUQ is a _____ sign, and suggestive of ____
|
1. positive murphy's sign
2. acute cholecystitis |
|
_____ are hernias in the abdominal wall exclusive of groin hernias.
|
Ventral hernias
|
|
How can you try to see the bulge of a hernia if you suspect it but are unable to readily see it?
|
Have patietn lie supine and raise head and shoulders off the table.
|
|
How can you distinguish an abdominal mass from a mass in the abdominal wall?
|
Ask patient to raise head and shoulders off the table, or strain down, then feel for the mass again. Abdominal wall masses will remain palpable, intra-abdominal mass is usually obscured by muscle
|
|
What does the following indicate?
"Abdomen flat, no bowel sounds heard. Firm and boardlike, increased tenderness, guarding, and rebound in R midquadrant. Liver percusses to 7cm in midclavicular line. Edge not felt. Spleen and kidneys not felt. No palpable masses. No CVA tenderness. |
Peritonitis from possible appendicitis
|
|
Clinical estimates of liver size should be based on both ___ and ___ though even these techniques are far from perfect
|
palpation AND percussion
|
|
What finding (liver) is commonly found in patients with COPD. The liver edge may be readily palpable, but percussion reveals a low upper edge and vertical span of the liver is normal.
|
Downward displacement of liver by a low diaphragm
|
|
In lanky people, liver tends to be _____ so that the right lobe is easily palpable. This is called ____
|
Elongated, called Riedel's lobe
|
|
What is Reidel's lobe?
|
Elongation of the right lobe of the liver - not pathological
|
|
___ may produce an enlarged liver with a firm, non-tender edge.
|
Cirrhosis
|
|
An enlarged liver with a smooth, TNEDER, edge suggests ___
|
inflammation (hepatitis), or venous congestion (R side CHF)
|
|
Enlarged liver that is firm or hard with irregular edges or surface suggests ____. Liver may or may not be tender, may have 1+ nodules
|
Malignancy
|
|
Local causes of peritoneal inflammation include (4)
|
1. acute cholecystitis
2. acute pancreatitis 3. Acute Appendicitis 4. Acute diverticulitis |
|
In acute cholecystitis, signs are maximal in _____. Check for ___
|
1. RUQ,
2. Murphy's sign |
|
In ____ epigastric tenderness and rebound tenderness are usually present, but abdominal wall is soft.
|
Acute pancreatitis
|
|
In ____ RLQ signs are typical but may be absent early.
|
Acute appendicitis
|
|
___ most often involves the sigmoid colon and resembles Left-sided appendicitis
|
Acute diverticulitis
|
|
When unilateral _____ pain may mimick cholecystitis or appendicitis. Rebound tenderness aren't as common, chest signs are usually present.
|
Acute pleurisy
|
|
Frequently bilateral, the tenderness of -______ is usually maximal just above inguinal ligaments. Rebound tenderness and rigidity may be present. motion of the uterus causes pain.
|
Acute salpingitis
|
|
What is salpingitis?
|
Inflammation of the fallopian tubes
|
|
Bowel sounds may be ___, ___, or ___
|
decreased, normoactive, increased
|
|
Bowel sounds would be ____ in diarrhea or early intestinal obstruction.
|
Increased
|
|
Bowel sounds would be ____ or ___ in ileus or peritonitis.
|
Decreased or absent (listen 1-2 full minutes or longer)
|
|
High-pitched tinkling bowel sunds suggst ___
|
intestinal fluid and air under tension in a dilated bowel
|
|
Rushes of high-pitched bowel sounds coinciding with abdominal cramping suggest ___
|
intestinal obstruction
|
|
A -____ suggests carcinoma of the liver or alcoholic hepatitis
|
Hepatic bruit
|
|
____ with both systolic and diastolic components suggest partial occulsion of the aorta or large arteries.
|
Aortic bruit
|
|
A venous hum indicates ___
|
increased collateral circulation between portal and systemic venous systems (hepatic cirrhosis)
|
|
Grating sounds that vary with respiration are ____
|
friction rubs
|
|
Friction rubs indicate ____.
|
Inflammation of surface of an organ
|
|
When a systolic bruit accompanies a hepatic friction rub, suspect ____
|
Liver carcinoma
|
|
What may cause peritoneal inflammation resulting in a friction rub?
|
liver caner, chlaymidial or gonococceal perihepititis, recent liver biopsy, splenic infarct
|
|
What is the most common cause of a protruberant abdomen?
|
Fat
|
|
What is a pannus?
|
An "apron" of fatty tissue may extend below inguinal ligaments
|
|
More serious causes of intestinal gas production include ___
|
intestinal obstruction and paralytic ileus.
|
|
Abdominal distention from gas becomes more marked in ___ than ___ obstruction
|
1. colonic
2. small bowel |
|
An abdominal tumor would be ___ to percussion
|
Dull
|
|
Occasionally, a markedly ____ may be mistaken for an abdominal tumor.
|
Distended bladder
|
|
In large, solid abdominal tumors, bowels may be displaced in what direction?
|
To the periphery
|
|
Ascitic fluid seeks the _____ in the abdomen, and produces bulging flanks that are dull to percussion
|
lowest
|
|
Localized bulges in the abdominal wall include ___ and __
|
ventral hernias and subcutaneous tumors like lipomas
|
|
What are the most common forms of ventral hernias?
|
umbilical, incisional, and epigastric
|
|
__ is a protrusion through a defective ring, and is most common in infants. In infants it typically closes spontaneously in 1-2 years
|
Umbilical hernia
|
|
__ is a protrusion through a postoperative scar.
|
Incisional hernia
|
|
What type of incisional hernia is at greatest risk for complication?
|
a small defect through which a large hernia has passed
|
|
___ is a small, midline protrusion through a defect in the linea alba between the xiphoid and umbilicus
|
Epigastric hernia
|
|
___ are common, benign, fatty tumors. They may be small or large, usually soft and lobulated
|
Lipoma
|
|
___ is a separation of the two rectus abdominis muscles, through which abdominal contents form a iline ridge when the patient raises their head and shoulders.
|
Diastasis recti
|
|
What is a diastasis recti?
|
Separation of the two rectus abdominis muscles through which abdominal contents form a midline ridge when the patient raises head and shoulders
|
|
When is a diastasis recti usually seen?
|
Repeated pregnancy, obesity, chronic lung disease
|
|
What are the clinical consequences of a diastasis recti?
|
None
|
|
What is the mechanism of the problem of stress incontinence?
|
urethral sphincter is weakened so that transient increases in intra-abdominal pressure raise bladder pressure to levels that exceed urethral resistance
|
|
The major cause of stress incontienence of women is ___
|
weakness of the pelvic floor with inadequate muscular support of the bladder and proximal urethra. (childbirth, surgery)
|
|
In men, stress incontinence may follow ___
|
prostatic surgery
|
|
Momentary leakage of small amounts of urine with coughing, laughing, or sneezing in an upright position, or a desire not to urinate describe symptoms of ___
|
stress incontinence
|
|
What are physical signs of stress incontinence?
|
Bladder not detected on abdominal exam, may be demonstrable, atrophic vaginitis may be present
|
|
In ___ detrusor contractions are stronger than normal and overcome the normal urethral resistance. The bladder is typically small.
|
Urge incontinence
|
|
List the mechanisms of urge incontinence: (3)
|
1. decreased cortical inhibition of detrusor contraction from stroke, tumors, dementia, and spinal lesions,
2. hyperexcitability of sensory pathways as in bladder infection, tumor, or fecal impaction 3. deconditioning of voiding reflexes as in frequent voluntary voiding at low volumes |
|
Name the symptoms of urge incontinence:
|
1. incontinence preceeded by an urge to void (moderate volume)
2. urgency 3. if acute inflammation is present, may have pain 4. possibly "pseudo-stress incontinence" (10-20sec after stresses such as change position, coughing, laughing etc) |
|
Physical signs of ___ include: bladder not detectible on abdominal exam, cortical inhibition is decreased, mental deficits or motor signs of NS are often present, sensory pathways are hyperexcitable with signs of local pelvic problems or fecal impaction
|
Urge incontinence
|
|
In ___ detrusor contractions are insufficient to overcome urethral resistance and the bladder is typically large, despite efforts to void
|
Overflow incontinence
|
|
Obstruction of the bladder outlet as in BPH or tumor, weakneass of detrusor muscle due to peripheral nerve disease, or impaired bladder sensation that interrupts the reflex arc can cause what?
|
Overflow incontinence
|
|
Symptoms of overflow incontinence include:
|
1. continuous dripping of dribbling incontinence
2. decrease force of urinary stream 3. prior symptoms of partial urinary obstruction or other symptoms of peripheral nerve disease |
|
Describe physical signs of overflow incontinence.
|
- enlarged bladder often found on exam and may be tender
- prostatic enlargement, - motor signs of peripheral nerve disease - decrease in sensation - diminished or absent reflexes |
|
____ is a functional inability to get to the toilet in time because of impaired health or environmental conditions.
|
Functional incontinence
|
|
Sedatives, tranquilizers, anticholinergics, sympathetic blockers, and potent diaretics may cause ____
|
Incontinence secondary to medications
|
|
Incontinence only in the early morning or on the way to the toilet suggests ___
|
functional incontinence
|
|
___ refers to a demonstrable ulcer usually in the duodenum or stomach
|
Peptic ulcer
|
|
What bacteria often causes peptic ulcers or dyspepsia?
|
H. Pylori
|
|
Pain in the epigastric area that radiates to the back, described as "gnawing, aching, or hungerlike", that may be relieved with food or antacids suggests
|
Peptic ulcer or dyspepsia
|
|
Dyspepsia is more common in ages ___, gastric ulcer n ages ___ and duodenal ulcer in ages ___
|
1. dyspepsia = 20-29
2. duodenal = 30-60 3. gastric = 50+ |
|
What parts of the stomach is cancer usually in? What type of cancer is it usually?
|
1. cardia and GE junction, some in distal stomach
2. adenocarcinoma |
|
Describe the pain of stomach cancer. What other symptoms could you expect?
|
Persistant and slowly progressive, worse with food,
Other symptoms: anorexia, nausea, satieity, weight loss, gastric bleeding (ages 50-70) |
|
Epigastric pain that may radiate to back or abdomen, and poorly localized with persistant and acute pain. Worsened by laying supine, relieved with leaning forward is suggestive of
|
Acute pancreatitis
|
|
Biliary colic is caused by
|
sudden obstruction of the cystic duct or common bile duct by a gallstone
|
|
Describe the pain associated with biliary colic
|
Steady, aching (NOT colicky) with rapid onset over a few minutes, lasts upt to several hours and is recurrent)
|
|
Acute mechanical intstinal obstruction presents with pain in the ____ for small bowel or ___ for colon
|
1. periumbilical or upper abdomen
2. lower abdominal or generalized |
|
Paroxysmal pain thatmay decrease as bowel mobility is impaired is suggestive of ___
|
acute, mechanical intestinal obstruction
|
|
Blood supply to the bowel and messentary from thrombosus or embolus or hypoperfusion results in ___
|
mesenteric ischemia
|
|
Periumbilical pain that progresses to diffuse pain; starts as cramping and progresses to steady, and abrupt in onset then persistent suggests
|
Mesenteric Ischemia
|
|
What is oropharyngeal dysphagia
|
difficulty swallowing due to motor disorder affecting pharyngeal muscles (specifics depend on underlying disorder)
|
|
What are the three problems/ mechanisms of esophageal dysphagia?
|
mechanical narrowing of:
- mucosal rings and webs - esophageal stricture - esophageal cancer |
|
Esophageal dysphagia is aggrivated by ___ and relieved by ___
|
aggrivated: solid foods
relieved: regurgitation of food bolus |
|
Motor disorders that cause dysphagia include:
|
diffuse esophageal spasm
scleroderma achalasia |
|
Dysphagia that results in chest pain mimicking angina or MI is likely ____
|
diffuse esophageal spasm
|
|
Life activities that can cause constipation include:
|
1. ingoring the sensation of a full rectum
2. expectations of "regularity or more frequent stools 3. decreased fecal bulk due to low fiber |
|
In ___ a change in the frequency or form of bowel movement without structural or chemical abnormality results.
|
irritable bowel symptoms
|
|
What are symptoms of IBS?
|
small, hard stools with mucus, perioids of diarrhea, intermittent pain for 12 weeks of 12 months relieved by defecation
|
|
Constipation caused by rectal or colon cancer causes ___
|
progressive narrowing of the bowle lumen (diarrhea, abd pain, bleeding, tenesmus)
|
|
__ is a large, firm, immovable fecal mass usually in the rectum
|
Fecal impaction
|
|
Rectal fullness, abd pain, diarrhea around the area, is suggestive of ____ and common in debilitated, bedridden, and elderly
|
Fecal impaction
|
|
Currant Jelly stools (red blood and mucus) along with colicky abdominal pain and distention may suggest____
|
intussusception
|
|
List the major categories of constipation causes:(8)
|
1. life activities/habits
2. IBS 3. Mechanical obstruction 4. Painful anal lesions 5. drugs 6. depression 7. neurological disordesr 8. metabolic conditions |
|
Frequency of urination may be due to:
|
1. decreased bladder capacity
2. impaired emptying of the bladder |
|
Causes of decreased urinary capacity of the bladder include:
|
1 increased bladder sensitivity due to inflammation
2. decreased elasticity 3. decreased cortical inhibition of bladder contractions |
|
Causes of impaired emptying of the bladder with residual urine include:
|
1. partial mechanical obstruction of the bladder neck or urethra
2. loss of peripheral nerve supply to the bladder |
|
Decreased concentrating ability of the kidney with loss of normal decrease in nocturnal urinary output, excessive fluid intake before bed, and fluid retention with dependent edema may cause
|
Nocturia
|
|
Nocturia may be present in two categories:
|
1. with high volumes
2. wiht low volumes |
|
Low-volume nocturia includes:
|
frequency, waking up at night without a real urge (pseudo-frequency) and could be due to insomnia
|
|
___ is the result of deficient ADH, renal unresponsiveness to ADH, excess water intake, or solute diuresis.
|
Polyuria
|
|
___ refers to passage of black, tarry, stools with tests for occult blood being positive.
|
Melena
|
|
Melena involves loss of at least ___mL of blood into the GI tract, and may be a result of ___
|
60mL
result from peptic ulcer, gastritis, stress ulcers, esophagel or gastric varices, reflux esophagitis, mallory weiss tear. |
|
Ingestion of iron, bismuth salts (pepto-bismol), licorice, or some chocolate cookies can result in ___
|
black, non-sticky, bloodless stools
|
|
Red blood in the stool typically originates in the ___, or may be caused by _____
|
1. colon, rectum, or anus (rarely the jejunum or ileum)
2. Upper GI hemorrhage |
|
___ presents with red blood in stools, lower abd pain, sometimes fever, abdomen soft to palpation.
|
Ischemic colitis
|
|
Red blood on the toilet paper, surface of stool, or dripping into thetoilet is suggestive of ___ or ___
|
hemorrhoids or anal fissures
|
|
Pink urine that precedes reddish stool that is not bloody is suggestive of ____
|
beet ingestion
|
|
Acute diarrhea may be caused by ____ or ___ infections
|
Secretory or inflammatory
|
|
Describe the characteristics of secretory diarrhea (acute).
|
- infection by virous or preformed bacterial toxin,
- stools watery, no blood, pus, or mucus - lasting a few days or longer, especially with lactase deficiency - way be associated with nausea, vomiting, or abd cramping and commonly associated with trave, foodborne illness, or a local epidemic |
|
Describe the characteristics of inflammatory diarrhea (acute).
|
- caused by colonization of intestinal mucosa.
- loose to watery stools may have blood, pus, or mucus - variable duration - may ave abdominal cramping and rectal urgency, fever. -Associated with contaminated food or water, or anal sex |
|
Describe the characteristics of drug induced diarrhea.
|
- action of many drugs cause diarrhea
- loose or watery stools that may be acute, recurrent, or chronic - may have nausea, unlikely to have pain - associated with medication use |
|
Three basic categories of chronic diarrhea are __, __, and __
|
1. diarrheal syndrome
2. inflammatory bowel disease 3. Voluminous diarrhea |
|
What is tenesmus?
|
Frequent feeling of needing to evacuate the bowels
|
|
Two main causes of diarrheal syndrome (chronic) are :
|
1. Irritable bowel syndrome
2. cancer of the sigmoid colon |
|
Two main causes of Inflammatory bowel disease are: (chronic)
|
1. Ulcerative colitis
2. Crohn's disease |
|
Three main causes of Voluminous diarrhea (chronic) are:
|
1. malabsorption syndrome
2. osmotic diarrhea 3. secretory diarrhea from multiple causes |
|
__ occurs with a change in frequency and form of BM without reason, loose stools may have mucus or may be intermittent with constipation and diarrhea, worse in the morning, lower abd. craming and flatulence, affecting young or middle aged adults (esp. women)
|
Irritable bowel syndrome
|
|
Describe characteristics of cancer of the sigmoid colon.
|
- partial obstruction by malignancy causes diarrhea
- may be blood streaked - marked by change in bowel habits, abdominal cramping, constipation intermittently - affects middle aged and older, esp >55yrs |
|
Describe Ulcerative colitis:
|
- diarrhea caused by inflammation of the mucosa and submucosa of rectum and colon with ulceration
- soft or watery stools often contain blood - onset ranges variably, typically recurrent and may wake the pt at night - generalized abd pain, anorexia, weakness, fever, -may involve other inflammatory processes. -Affects young people and increases risk of cancer |
|
Describe crohn's disease
|
-chronic transmural inflammation of the bowel wall in a skip pattern
- small soft or watery stool without gross blood. insidious onset, may be chronic or recurrent and may wake the patient at night. - crampy periumbilical or RLQ pain or may be diffuse with other symptoms. - may present with perianal or perirectal abscesses or fistulas and cause obstruction - common in young people, esp late teens but also middle age. - more common in Jewish & increases risk for colon cancer |
|
Describe diarrhea caused by malabsorption syndrome.
|
- Voluminous diarrhea
- defective absorption of fats, with steatorrhea and may be caused by pancreatic insufficiency, bile salt deficiency or bacterial growth - typically bulky soft light colored and greasy stools. Sometimes frothy and floating with particularly foul smell - may involve anorexia, weight loss, fatigue, distention, abdominal cramping, and fat-vitamin deficiencies |
|
Osmotic diarrhea may be due to
|
lactose intolerance or abuse of osmpotic purgatives
|
|
What are osmotic purgatives?
|
Laxatives
|
|
____ occurs in >50% of African-americans, Asians, Native Americans, and Hispanics but onl 5-20% of Caucasians.
|
Lactose intolerance
|