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63 Cards in this Set
- Front
- Back
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Tympany
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musical note of higher pitch than resonance; over air-filled viscera
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hyperresonance
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pitch lies between tympany and resonance; at base of left lung
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resonance
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sustained note of moderate pitch; over lung tissue and sometimes over the abdomen
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dullness
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short, high-pitched note with little resonance; over solid organs adjacent to air-filled structures
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appendicitis pain
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initially periumbilical or epigastric; colicky; later becomes localized to RLQ, often at McBurney's point s/s: guarding, tenderness; +iliopsoas and + obturator signs, RLQ skin hyperesthesia; anorexia, nausea, or vomiting after onset of pain; low-grade fever; + Aaron, Rovsing, Markle and McBurney signs |
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peritonitis pain
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onset sudden or gradual; pain generalized or localized to RLQ, often at McBurney's point s/s: shallow respiration; + Blumberg, mark;e and balance signs; reduced or absent bowel sounds, nausea and vomiting; + obturator + iliopsoas signs |
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cholecystitis pain
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sever, unrelenting RUQ or epigastric pain; may be referred to right subscapular area s/s: RUQ tenderness and rigidity, + Murphy sign, palpable gallbladder, anorexia, vomiting, fever, possible jaundice |
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pancreatitis pain
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dramatic, sudden, excruciating LUQ, epigastric, or umbilical pain; may be present in one or both flanks; may be referred to left shoulder and penetrates to back s/s: epigastric tenderness, vomiting, fever, shock; + Grey Turner sign, + Cullen sign: both signs occur 2-3 days after onset |
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Salpingitis pain
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lower quadrant, worse on left s/s: nausea, vomiting, fever, suprapubic tenderness, rigid abdomen, pain on pelvic examination |
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pelvic inflammatory disease pain
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lower quadrant, increases with activity s/s: tender adnexa and cervix, cervical discharge, dyspareunia |
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diverticulitis pain
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epigastric, radiating down left side of abdomen especially after eating; may be referred to back s/s: flatulence, borborygmus, diarrhea, dysuria, tenderness on palpation |
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perforated gastric or duodenal ulcer pain
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abrupt RUQ; may be referred to shoulders s/s: abdominal free air and distention with increased resonance over liver; tenderness in epigastrium or RUQ; rigid abdominal wall, rebound tenderness |
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intestinal obstruction pain
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abrupt, sever, colicky, spasmodic; referred to epigastrium, umbilicus s/s: distention, minimal rebound tenderness, vomiting, localized tenderness, visible peristalsis; bowel sounds absent (with paralytic obstruction) or hyperactive high pitched (with mechanical obstruction) |
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Volvulus pain
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referred to hypogastrium and umbilicus s/s: distention, nausea, vomiting, guarding; sigmoid loop volvulus may be palpable |
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leaking abdominal aneurysm pain
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steady throbbing midline over aneurysm; may penetrate to back, flank s/s: nausea, vomiting, abdominal mass, bruit |
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biliary stones, colic pain
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episodic, severe, RUQ, or epigastrum lasting 15 minutes to several hours; may be lower s/s: RUQ tenderness, soft abdominal wall, anorexia, vomiting, jaundice, subnormal temperature |
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renal calculi pain
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intense; flank, extending to groin and genitals; may be episodic s/s: fever, hematuria; + Kehr sign |
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ectopic pregnancy pain
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lower quadrant; referred to shoulder; with rupture is agonizing s/s: hypogastric tenderness, symptoms of pregnancy, spotting, irregular menses, soft abdominal wall, mass on bimanual pelvic examination; ruptured: shock, rigid abdominal wall, distention; + Kehr and Cullen signs |
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ruptured ovarian cyst pain
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lower quadrant, steady, increases with cough or motion s/s: vomiting, low-grade fever, anorexia, tenderness on pelvic examination |
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splenic rupture pain
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intense; LUQ, radiating to left shoulder, may worsen with foot of bed elevated s/s: shock, pallor, lowered temperature |
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IBS pain (chronic)
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hypogastric pain; crampy, variable, infrequent; associated with bowel function s/s: unremarkable physical examination; pain associated with gas, bloating, distention; relief with passage of flatus, feces |
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Lactose intolerance pain (chronic)
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crampy pain after drinking milk or eating milk products s/s: associated diarrhea; unremarkable physical examination |
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diverticular disease pain (chronic)
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localized pain s/s: abdominal tenderness, fever |
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constipation pain (chronic)
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colicky or dull and steady pain that does not progress and worsen s/s: fecal mass palpable, stool in rectum |
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uterine fibroids pain (chronic)
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pain related to menses, intercourse s/s: palpable myoma(s) |
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hernia pain (chronic)
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localized pain that increases with exertion or lifting s/s: hernia on physical examination |
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esophatitis/GERD pain (chronic)
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burning or gnawing pain in midepigastrium worsens with recumbency and certain food s/s: unremarkable physical examination |
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peptic ulcer pain (chronic)
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burning or gnawing pain s/s: may have epigastric tenderness on palpation |
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gastritis pain (chronic)
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constant burning pain in epigastrium s/s: may be accompanied by nausea, vomiting, diarrhea or fever; unremarkable physical examination |
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Aaron sign
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pain or distress occurs in area of patient's heart or stomach on palpation of McBurney's point Appendicits |
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Ballance sign
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fixed dullness to percussion in left flank and dullness in right flank that disappears on change of position peritoneal irritation |
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Blumberg sign
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rebound tenderness peritoneal irritation or appendicitis |
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Cullen sign
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ecchymosis around umbilicus hemoperitoneum; pancreatitis; ectopic pregnancy |
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Dance sign
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absence of bowel sounds in RLQ intussesception |
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Grey Turner sign
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ecchymosis of flanks hemoperitoneum; pancreatitis |
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Kehr sign
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abdominal pain radiating to left shoulder spleen rupture; renal calculi; ectopic pregnancy |
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markle (heel jar) sign
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patient stands with straightened knew, then raises up on toes, relaxes, and allows heels to hit floor, thus harring body. action will cause abdominal pain if positive. peritoneal irritation; appendicitis |
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McBurney's sign
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rebound tenderness and sharp pain when McBurney's point is palpated appendicitis |
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Murphy sign
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abrupt cessation of inspiration on palpation of gallbladder cholecystitis |
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Romberg-howship sign
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pain down the medial aspect of the thigh to the knees strangulated obturator hernia |
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rovsing sign
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RLQ pain intensified by LLQ abdominal palpation peritoneal irritiation; appendicitis |
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acute diarrhea
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frequent liquid or loose stools lasting less than 4 weeks duration patho: most commonly, viral and self-limited in those without signs or symptoms or other organ involvement; international travelers may acquire foodborne infection (entertoxigenic E.coli, salmonella, shigella or entamoeba histolytica); camping or well water exposes individuals to giardia and campylobacter through untreated water; cryptosporidium is a potential cause from contaminated water in urban areas of the United States; salmonella or campylobacter jejuni from undercooked poultry; undercooked beef or unpasteurized milk may contain E. coli; raw shellfish is a potential source of Norwalk virus; consider food poisoning if diarrhea develops in two or more persons following ingestion of the same food subj: usually abrupt onset that lasts less than 2 weeks; abdominal pain; N/V; fever; tenesmus (feeling of incomplete defecation); vomiting within several hours of injesting a particular food suggests food poisoning; bloody diarrhea may occur with organisms such as campylobacter and shigella obj: diffuse abdominal tenderness; examination can mimic peritoneal inflammation with right lower quadrant pain or guarding; if severe, may have findings consistent with moderate to sever dehydration, particularly in infants, children, and older adults (e.g. tachycardia, hypotension, and altered mental status) |
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GERD
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backward flow of gastric contents, which are typically acidic, into the esophagus patho: caused by relaxation or incompetence of the lower esophageal sphincter; delayed gastric emptying is a predisposing factor subj: heartburn or acid indigestion (burning chest pain, localized behind the breastbone that moves up towards the neck and throat); bitter or sour taste of acid in the back of the throat; hoarseness; infants and toddlers exhibit back arching, fussiness with feeding, or regurgitation and vomiting; can be severe enough to cause weight loss and failure to thrive; can precipitate an acute asthma exacerbation or cause chronic respiratory problems from aspiration and esophageal bleeding obj: generally unremarkable examination; with severe disease may have erythema of the posterior pharynx and edematous vocal cords |
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IBS
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disorder of intestinal motility patho: common - occurs in about one in five Americans, more often in women; usually begins in late adolescence or early adult life and rarely appears for the first time after 50 years of age subj: commonly report a cluster of symptoms, consisting of abdominal pain, bloating, constipation, and diarrhea; some experience alternating diarrhea and constipation; mucus may be present around or in the stool; bouts may occur at times of emotional stress obj: generally unremarkable examination; diagnosis is typically made after excluding other potential causes; Rome III diagnostic criteria requires recurrent abdominal pain or discomfort at least 3 days per month during the previous 3 months associated with two or more of the following: relieved by defecation, onset associated with change in stool frequency, onset associated with change in stool form or appearance supporting symptoms include: altered stool passage (straining and/or urgency), mucorrhea |
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Hiatal hernia with esophagitis
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part of the stomach passes through the esophageal hiatus in the diaphragm into the chest cavity patho: very common - occurs most often in women and older adults; associated with obesity, pregnancy, ascites, and the use of tight-fitting belts and clothes, muscle weakness is a predisposing factor subj: epigastric pain and/or heartburn that worsens with lying down and is relieved by sitting up or antacids; water brash (mouth fills with fluid from the esophagus); dysphagia; most are asymptomatic and discovered incidentally; symptoms of incarcerated hernia include sudden onset of vomiting, pain, and complete dysphagia obj: generally unremarkable examination; with sever disease may have erythema of the posterior pharynx and edematous vocal cords |
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duodenal ulcer (duodenal peptic ulcer disease)
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chronic circumscribed break in the duodenal mucosa that scars with healing patho: may develop from infection with helicobacter pylori and increased gastric acid secretion (e.g. zollinger-ellison syndrome); occurs approximately twice as often in men as in women subj: localized epigastric pain that occurs when the stomach is empty and is relieved by food or antacids; with upper gastrointestinal bleeding, symptoms include hematemesis and melena. significant blood loss may result in dizziness and syncope. obj: anterior wall ulcers may produce tenderness on palpation of the abdomen; ulcers occur on both the anterior and posterior walls of the duodenal bulb. anterior ulcers are more likely to perforate, whereas posterior ulcers are more likely to bleed; perforation of the duodenum presents with sings of an acute abdomen (abdominal distention, rebound, and guarding); with significant bleeding, may show hypotension and tachycardia |
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crohn disease
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chronic inflammatory disorder that can affect any part of the gastrointestinal tract that produces ulceration, fibrosis, and malabsorption; terminal ileum and colon are the most common sites patho: cause is unknown but is thought to occur from an imbalance between proinflammatory and intiinflammatory mediators subj: chronic diarrhea with comprised nutritional status; other systemic manifestations may include arthritis, iritis, and erythema nodosum; disease course characterized by unpredictable flares and remissions obj: may have RLQ tenderness; abdominal mass may be palpated secondary to thickened or inflamed bowel; perianal skin tags, fistulae, and abscesses may be seen; extraintestinal examination findings include erythema nodosum and pyoderma gangrenosum, as well as arthritis involving the large joints; colonoscopy and pathology show characteristic cobblestone appearance of the mucosa; fistula and abscess formation, sometimes extending to the skin, is common as well as perianal skin tags |
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ulcerative colitis
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chronic inflammatory disorder of the colon and rectum that produces mucosal friability and areas of ulceration patho: cause unknown, but immunologic and genetic factors have been implicated; active chronic ulcerative colitis predisposes an individual to developing colon cancer subj: bloody, frequent, watery diarrhea, with as many as 20-30 diarrheal stools per day; may exhibit weight loss, fatigue, and general debilitation; may range from mild to severe, depending on the degree of colon involvement; may remain in remission for years after an acute phase of the illness; sclerosing cholangitis (inflammation, scarring and destruction of bile ducts) may present with fatigue and juandice obj: generally do not have fistulae or perianal disease; contrast radiographs typically show loss of the normal mucosal pattern; schlerosing cholangitis may occur with a cholestatic pattern of elevated transaminase levels; endoscopic findings show mucosal edema with ulcerations and bleeding |
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stomach cancer
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arises from epithelial cells of the mucosal membrane patho: most commonly found in lower half of the stomach; in early stages, the growth is confined to the mucosa and submucosa, as disease progresses, the muscular layer of the stomach becomes involved; metastases, local and distant, are common subj: may have vague and nonspecific symptoms, including loss of appetite, feeling of fullness, weight loss, dysphagia, and persistent epigastric pain obj: may have midepigastric tenderness, hepatomegaly, enlarged supraclavicular nodes, and ascites; an epigastric mass may be palpable in the late stages of disease |
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diverticular disease
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patho: diverticula are saclike mucosal outpouchings through colonic muscle; may involve any part of the gastrointestinal tract; the sigmoid is the most commonly affected location; cause unknown, but may be caused by colonic dysmotility, defective muscular structure, and defects in collagen and aging subj: most patients are asymptomatic; with diverticulitis (when diverticula become inflamed), may experience left lower quadrant pain, anorexia, nausea, vomiting, and altered bowel habits (usually constipation); pain usually localizes to the site of inflammation obj: may have abdominal distention and be tympanic to percussion with decreased bowel sounds and localized tenderness; lower GI bleeding may occur |
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colon cancer (colorectal cancer)
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patho: may involve the recutm, sigmoid, proximal and descending colon; second most common cancer in the United States subj: symptoms depend on cancer location, size, and presence of metastases; may describe abdominal pain, blood in the stool, or a recent change in the frequency or character of stool; earliest sign may be occult blood in the stool, which can be detected by fecal occult blood testing obj: few early examination findings; if disease has progressed, may have palpable abdominal mass in right or left lower quadrants or show signs of anemia from occult blood loss (e.g. pallor and tachycardia); rectal cancer may be palpable by digital rectal examination |
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hepatitis
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inflammatory process characterized by diffuse or patchy hepatocellular necrosis patho: most commonly caused by viral infection, alcohol, drugs, or toxins; acute viral hepatitis is caused by at least five distinct agents; hep D occurs only in those infected with Hp B, either as a coinfection in acute Hep B or as a superinfection in chronic Hep B; Hep E is a self-limited type that may occur after a natural disaster because of fecal-contaminated water or food subj: some are asymptomatic; others report jaundice, anorexia, abdominal pain, clay-colored stools, tea-colored urine, and fatigue; obj: liver function tests are abnormal; examination findings may include jaundice and hepatomegaly; with severe or progressive disease, may develop cirrhosis with its associated examination findings |
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cirrhosis
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diffuse hepatic process characterized by fibrosis and alteration of normal liver architecture into structurally abnormal nodules patho: progression of liver disease to cirrhosis can happen over weeks to years; signs and symptoms occur as a result of decreased liver synthetic function, decreased detoxification capabilities, or portal hypertension; most common causes in the U.S. are Hep C and alcoholic liver disease; less common causes include autoimmune hepatitis, primary biliary cirrhosis, Wilson disease, hemochromatosis, althp=antitrypsin deficiency, and sarcoidosis. subj: some are asymptomatic; others report jaundice, anorexia, abdominal pain, clay-colored stools, tea-colored urine and fatigue; may describe prominent abdominal vasculature, cutaneous spider angiomas, hematemesis, and abdominal fullness obj: on examination, the liver is initially enlarged with a firm, non-tender border on palpation, as scarring progresses, the liver size is reduced and it generally cannot be palpated; neurologic examination abnormalities may be seen; with progressive disease, portal hypertension and ascites may occur; muscle wasting and nutritional deficiencies may be evident in late-stage disease; may have abnormal laboratory values (e.g., liver function tests and coagulopathy) |
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primary hepatocellular carcinoma
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patho: frequently arises in the setting of cirrhosis, approximately 20-30 years after liver injury or disease onset, however about 25% have no prior risk factors for cirrhosis; most patients die from tumor progression with the median survival time from diagnosis around 6 months; can metastasize to the lungs, portal vein, periportal nodes, bone, and brain; widespread vaccination for hep A and B and routine screening for Hep B and C may reduce the incidence subj: symptoms may include jaundince, anorexia, fatigue, abdominal fullness, clay-colored stools, and tea-colored urine obj: on examination, hepatomegaly with a hard, irregular liver border may be palpated; liver nodules may be present and palpable, and the liver may be tender or nontender; examination findings related to cirrhosis may be seen |
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cholelithiasis
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stone formation in the gallbladder occurs when certain substances reach high concentration in bile and produce crystals patho: crystals mix with mucus and form gallbladder sludge, over time the crystals enlarge, mix, and form stones; main substances involved in gallstone formation are cholesterol (>80%) and calcium billirubinate; chronic disease can result in fibrosis and gallbladder dysfunction and predispose to gallbladder cancer subj: many patients are asymptomatic; symptoms may include indigestion, colic, and mild transient jaundice obj: condition commonly produces episodes of acute cholecystitis |
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cholecystitis
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inflammatory process of the gallbladder most commonly due to obstruction of the cystic duct from cholelithiasis, which may be acute or chronic patho: with cystic duct obstruction, the gallbladder becomes distended, and blood flow is compromised, leading to ischemia and inflammation; acute cholecystitis has associated stone formation (cholelithiasis) in 90% of cases, causing obstruction and inflammation; acute cholecystitis without stones (acalculous) results from any condition that affects the regular emptying and filling of the gallbladder, such as immobilization with major surgery, trauma, sepsis, or long-term parenteral neutrition; chronic cholecystitis refers to repeated attacks of acute cholecystitis in a gallbladder that is scarred and contracted subj: primary symptom is right upper quadrant pain with radiation around the midtorso to the right scapular region; pain is abrupt and severe and lasts for 2-4 hours; may have associated symptoms including fever, jaundice, and anorexia; with chronic cholecystitis may exhibit fat intolerance, flatulence, nausea, anorexia, and nonspecific abdominal pain obj: in acute cholecystitis, classic examination finding is marked tenderness in the right upper quadrant or epigastrium; involuntary guarding or rebound tenderness may be present; some may have a full palpable gallbladder in the RUQ; some may have subtle examination findings, including diffuse abdominal pain, whereas others may have an unremarkable examination; in chronic cholecystitis, a palpable gallbladder is typically not appreciated due to gallbladder fibrosis |
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nonalcoholic fatty liver disease (NAFLD)
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spectrum of hepatic disorders not associated with excessive alcohol intake, ranging from steatosis to cirrhosis and hepatocellular carcinoma subj: hepatic cell inflammation and injury thought to result from accumulation of triglycerides in the liver; genetic and environmental factors are likely to contribute to disease development; insulin resistance is an important factor, as such NAFLD is associated with the metabolic syndrome (obesity, hypertriglyceridemia, and diabetes); currently the most common cause of chronic liver disease in the U.S.; occurs fairly equally in males and females, but ethnic differences include a higher prevalence in Hispanic individuals subj: most patients are asymptomatic but some describe right upper quadrant pain, fatigue, malaise, and jaundice obj: usually identified after discovering abnormal liver function tests, most will have elevated transaminases with aspartate aminotransferase (AST) and alanine aminotransferase (ALT) being two to three times the upper limits of normal; other than an elevated BMI (overweight or obese by criteria), the physical examination is typically unremarkable; about half of patients have hepatomegaly; in more severe disease, patients may have jaundice and ascites; magnetic resonance spectroscopy (MRS) and liver biopsy are most sensitive diagnostic techniques |
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chronic pancreatitis
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chronic inflammatory process of the pancreas, characterized by irreversible morphologic changes resulting in atrophy, fibrosis, and pancreatic calcifications patho: most common cause is chronic alcohol use, other causes include congenital structural abnormalities of the pancreas, hereditary pancreatitis, cystic fibrosis, medication-induced disease, and autoimmune pancreatitis subj: symptoms may include constant, unremitting abdominal pain, weightloss, and steatorrhea obj: examination findings are similar to those in acute pancreatitis, however with chronic disease, there is greater likelihood pf pseudocyst formation; with advanced disease, some may exhibit signs of malnutrition with decreased subcutaneous fat and temporal wasting; pancreatic enzyme levels (amylase and lipase) are elevated, and glucose intolerance may be seen |
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spleen laceration/rupture
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patho: most commonly injured organ in abdominal trauma because of it's location; mechanism of injury can be either blung or penetrating, but it's more often blunt (e.g. MVA) subj: symptoms include pain in the upper left quadrant with radiation to the left shoulder (positive Kehr sign); depending on degree of blood loss, may have symptoms of hypovolemia (e.g. lightheadedness, syncope) obj: examination is remarkable for left upper quadrant pain with palpation, signs of peritoneal irritation may be seen (involuntary guarding or rebound tenderness); diagnosis is made by paracentesis or computed tomography; depending on the degree of blood loss, patients may present with hypotension and decreasing hematocrit |
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acute glomerulonephritis
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inflammation of the capillary loops of the renal glomeruli patho: results from immune complex deposition or formation; many causes, most common include infection (poststreptococcal) and immune-mediated (IgA nephropathy) subj: symptoms usually nonspecific and include nausea and malaise, flank pain may be reported as well as headache secondary to hypertension; some patients report tea-colored urine or gross hematuria; about 85% of affected children develop peripheral and periorbital edema obj: may have an unremarkable examination and normal blood pressure; examination findings may include edema, hypertension, and oliguria; microscopic hematuria occurs in all affected patients (red blood cells casts are seen on urine microscopy) |
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hydronephrosis
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dilation of the renal pelvis and calyces due to an obstruction of urine flow anywhere from the urethral meatus to the kidneys patho: increasing ureteral pressure results in changes in glomerular filtration, tubular function, and renal blood flow. subj: with acute obstruction, may have intermittent, severe pain (renal colic) with nausea and vomiting; with secondary infection, may report abdominal pain, flank pain hematuria, and fever obj: most will have an unremarkable physical examiniation; in severe cases, the kidneys may be palpable during the abdominal examination, costovertebral angle tenderness may be present; with lower urinary tract obstruction, a distended bladder may be palpable (e.g. posterior urethral valves in a newborn); most are asymptomatic, hydronephrosis is found during radiological screening (e.g. fetal ultrasound) or diagnostic imaging. |
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pyelonephritis
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infection of the kidney and renal pelvis patho: gram-negative bacilli (E.coli and klebsiella) and enterococcus faecalis are the most common pathogens; less common organisms occur in hospitalized patients and/or those with indwelling catheters; risk factors include indwelling catheters, DM, sexual activity, prior history of UTI, vesicoureteral reflux (infants and children) and urinary incontinence (older adults). subj: typically present with fever, dysuria, and flank pain; other symptoms include rigors, polyuria, urinary frequency, urgency, and hematuria obj: most are generally ill-appearling with significant pain or discomfort; fever and costovertebral angle tenderness distinguish pyelonephritis from uncomplicated UTI; on laboratory evaluation, pyuria and bacteriuria are present and confirm he diagnosis |
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renal abscess
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localized infection in the medulla or cortex of the kidney patho: abscesses in the renal cortex are ogten caused by gram -positive organisms (staphylococcus aureus and enterococcus faecalis); medullary abscesses are commonly caused by gram-negative bacilli (E.coli and klebsiella) |
