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30 Cards in this Set

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What are the steps to the abdomenal exam?
Inspect skin
Ausculate bowel
Percuss bowel
Palpate bowel
Palpate liver
Palpate kidney
Palpate spleen
Pump back for kidney
GU exam
Peptic Ulcer Dz
1. Cause
2. Location
3. Quality of pain
4. Timing
5. Aggravating
6. Eleviating
7. Assoc symptoms (compare Dypepsia, Gastric and Duodenal ulcers)
1. Cause - H. Pylori
2. Location: epigastric and can radiate to back
3. Quality of pain: variable
4. Timing: intermittent
5. Aggravating: variable
6. Eleviating: antacids and food can relieve
7. Assoc symptoms: nausea, vomiting, heartburn, weightloss (Dyspepsia: more common in 20-29yo; Gastric Ulcer in >50; Duodenal ulcer in 30-60yo.
Stomach Cancer:
1. Cause
2. Location
3. Quality of pain
4. Timing
5. Aggravating
6. Eleviating
7. Assoc symptoms
1. Cause: neoplasm
2. Location: epigastric
3. Quality of pain: variable
4. Timing: history of pain is shorter than peptic ulcer and pain is persistant and slowly progressive
5. Aggravating: food
6. Eleviating: not relieved by antacids
7. Assoc symptoms: anorexia, weight loss, nausea
Pancreatitis: (Acute)

1. Cause
2. Location
3. Quality of pain
4. Timing
5. Aggravating
6. Eleviating
7. Assoc symptoms
1. Cause: inflammation of pancreas
2. Location: epidgastric and can radiate to back or other parts of abdomen
3. Quality of pain: steady
4. Timing: acute and persistant
5. Aggravating: lying supine (face up)
6. Eleviating: leaning forward with trunk flexed
7. Assoc symptoms: nausea, vomiting, abdominal distention, fever.
What medication should you ask patient about if you suspect peptic ulcer disease?
NSAID's
Compare duodenal ulcers to gastric ulcers based on their elleviating and aggrevating factors:
Duodenal: relief with food
Gastric: worse with food
Compare duodenal ulcers to gastric ulcers based on their onset of symptoms:
Duodenal: worse before meal
gastric: worse during meal
How do you diagnose a peptic ulcer?
Using gastroscopy, take biopsy,
Treatment for a peptic ulcer?
amoxicillin, clarithromycin and a proton pump inhibitor such as omeprazole.
Cholecystitis
1. Cause
2. Location
3. Quality of pain
4. Timing
5. Assoc symptoms
1. Cause: inflammation of gallbladder due to impaction of gallstone.
2. Location: right upper quadrant and can radiate to scapular area
3. Quality of pain: steady and aching
4. Timing: gradual onset
5. Assoc symptoms: nausea, vomiting, fever
Acute Diverticulitis:
1. Cause
2. Location
3. Quality of pain
4. Timing
5. Assoc symptoms
Acute diverticulitis
1. Cause: inflammation of a colonic diverticuli (sac like mucosal outpouching through the colonic muscle)
2. Location: left lower quadrant
3. Quality of pain: may be cramping or steady
4. Timing: gradual onset
5. Assoc symptoms: fever, constipation, and may be an initial brief diarrhea
What lab findings would suggest choledocholithiasis?
Increase in alk phos
Increase in conjugated bilirubin
Increase in cholesterol in the blood
What tests (nonlab) would you order if you suspect choledocholithiasis?
Ultrasound to see enlargement of common bile duct
What is Murphy's sign?
Hook thumb underneath ribs in the midclavicular line on the right side. If patient can't inspire without pain = postive which could mean cholithiasis (NOT cholidocothiasis; would be negative)
What tests would you do if you suspect acute diverticulitis?
CT scan
CBC
What is the treatment for acute diverticulitis?
Broad spectrum antibiotics (Levofloxacin)

Advise a high fiber diet (after healed)
Acute Appendicitis:
1. Cause
2. Location
3. Quality of pain
4. Timing
5. Aggrevate
6. Elleviate
7. Associated symptoms
1. Cause: inflammation of appendix
2. Location: poorly localized periumbilical pain followed by right lower quadrant pain
3. Quality of pain: cramping at first then steady and severe
4. Timing: lasts 4-6 hrs
5. Aggrevate: cough, movement
6. Elleviate: none
7. Associated symptoms: anorexia and nausea, low fever
Presence of melena (black tarry stools) causes:
1. peptic ulcer
2. gastritis
3. esophageal varices
4. Mallory-weiss tear
Lab findings in a patient with appendicitis:
elevation of neutrophilic white cells
What tests should you order if you suspect appendicitis? (nonlab)
ultrasound
CT scan
Antibiotics to administer when you suspect appendicitis?
metronidazole
Where is their tenderness in an appendicitis?
McBurney's point
What are the signs and symptoms of Crohn's disease?
Soft and loose stools free of blood (or less blood than ulcerative colitis).

The onset is chronic and may wake patient up at night.

Cramping periumbilically or in right lower quadrant, or diffuse, low fever, weight loss.

More common in people with Jewish descent.
What are the signs and symptoms of Ulcerative colitis?
Soft to watery stool with blood. Diarrhea may wake person up. Cramping lower abdomenal pain with anorxia and fever.
What are the signs and symptoms of Irritable bowel syndrome?
Loose stools that may show mucus but not blood. Also can have hard stools with constipation.

Often worse in the morning (diarrhea rarely wakes you up)

Lower abdominal pain.
Acute secretory infection causing diarrhea is caused by: (2)
1. Staph aureus (gram + in grape clusters) - Clindamycin
2. Clostridium perfringens (gram pos rod)
3. toxic E. Coli
4. Vibria cholerae
5. Giardia lamblia
Acute inflammatory infection causing diarrhea?
1. Salmonella - gram neg rod (amphicellin)
2. Shigella - gram neg rod (amphicillin)
3. Yersinia (gram neg rod)
4. Campylobacter
5. E.coli (most common in travel)) - gram neg (Amoxicillin)
6. Entamoeba histolytica
If patient has diarrhea what must you NOT forget to ask?
travel!!!
Prophylaxis treatment for those travelling to prevent diarrhea:
bismuth subsalicylate (2 tablets, 4 times daily)
What could it be?
Blood in stool (3)
1. ulcerative colitis
2. Crohn's
3. Hemorrhoids