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186 Cards in this Set
- Front
- Back
A glistening, taut appearance on the abdomen suggests ___ |
ascites
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A bluish periumbilical discoloration (Cullen sign) suggests ____
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intraabdominal bleeding
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What can produce striae?
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pregnancy, weight gain, Abdominal tumor or ascites
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What color are the striae of Cushing Disease?
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remain purplish
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A pearl-like, enlarged umbilical node may signal _____
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intraabdominal lymphoma
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The presence of scarring should alert you to the possibility of _____
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internal adhesions.
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Contuor common in well-muscled, athletic adults
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FLAT
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contour is characteristic of young children
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rounded or convex
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Why would a adult have a rounded or convex contour?
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result of subcutaneous fat or poor muscle tone from inadequate exercise.
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Contour of thin adults?
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scaphoid or concave
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inflammation, swelling, or bulges of the umbilicus may indicate
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hernia
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Distention from the umbilicus to the symphysis can be caused by ___, ___, ___, ___
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ovarian tumor, pregnancy, uterine fibroids, or a distended bladder.
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distention of the upper half, above the umbilicus, can mean ___, ___, __
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carcinoma, pancreatic cyst, or gastric dilation.
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Asymmetric distention or protrusion may indicate ___, ___, ___, ___, ___
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hernia, tumor, cysts, bowel obstruction, or enlargement of abdominal organs.
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You are with a patient whose abdomen is significantly distended and whose bowel sounds are hypoactive or even absent. There is no particular pain and you feel no masses. The reflexes are hypoactive. You know that the patient is on diuretics for treatment of hypertension. DX?
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Think hypokalemia. Diuretics/distention/deficiency of K+. Steroids can do the same thing.
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Protrusion of the navel indicates an
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umbilical hernia.
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hernia contains a bit of fat and is felt as a small, tender nodule, midline of the epigastrium
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hernia of the linea alba
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A nonreducible hernia in which the blood supply to the protruded contents is obstructed is _____
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strangulated and requires immediate surgical intervention.
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Diastasis recti is often caused by
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pregnancy or obesity. The condition is of little clinical significance.
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Male respiration movement
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abdominal respiration
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Female respiration movement
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costal movement.
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Limited abdominal motion associated with respiration in adult males may indicate
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peritonitis or disease
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rippling movement across a section of the abdomen
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peristalsis
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What does the presence of peristalsis in an adult mean
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intestinal obstruction
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Marked pulsation may occur as the result of _____
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increased pulse pressure or abdominal aortic aneurysm.
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frequency of bowel sounds?
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5 to 35 per minute
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Loud prolonged gurgles are called
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borborygmi (stomach growling)
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Increased bowel sounds may occur with ___, ___, ___
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gastroenteritis, early intestinal obstruction, or hunger
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High-pitched tinkling sounds suggest
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intestinal fluid and air under pressure, as in early obstruction.
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Decreased bowel sounds occur with ___,___
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peritonitis and paralytic ileus
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Describe a friction rub of the liver or spleen
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high pitched and are heard in association with respiration.
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What do friction rubs of the abdomen indicate
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inflammation of the peritoneal surface of the organ from tumor, infection, or infarct.
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Describe the sound of a venous hum
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soft, low pitched, and continuous
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A venous hum occurs with ____
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increased collateral circulation between portal and systemic venous systems.
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A distended bladder produces
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dullness in the suprapubic area.
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Sound over air-filled viscera
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Tympany
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Sound of the base of the lung
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Hyperresonance
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Sound Over lung tissue and some times over the abdomen
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Resonance
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Sound Over solid organs adjacent to air-filled structures
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Dullness
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A lower liver border that is more than 2 to 3 cm (¾ to 1 inch) below the costal margin may indicate ___ due to ___
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organ enlargement or downward displacement of the diaphragm because of emphysema or other pulmonary disease.
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upper border of the liver usually begins at the
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fifth to seventh intercostal space.
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Dullness of the liver extending above the fifth intercostal space suggests
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upward displacement from abdominal fluid or masses.
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Vertical span of the liver is usually ?
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6 to 12 cm (2½ to 4½ inches).
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Errors in estimating liver span can occur when ____
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the dullness of pleural effusion or lung consolidation obscures the upper liver border, leading to overestimation of size.
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What can obscure the dullness of the lower liver border, leading to underestimation of liver size.
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gas in the colon may produce tympany in the right upper quadrant
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The usual liver span at the midsternal line is
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4 to 8 cm (1½ to 3 inches). Spans exceeding 8 cm suggest liver enlargement.
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small area of splenic dullness from the ____
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sixth to the tenth rib
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Where do you percuss for gastric air bubbles
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left lower anterior rib cage and left epigastric region
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Which has a lower tympany pitch, the gastric bubble vs intestine
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gastric bubble
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Light palpation is particularly useful in identifying ___ and ___
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muscular resistance and areas of tenderness
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light palpation produces sense of resistance. 2 things
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large mass or distended structure
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Rigidity of the abdomen is common from __
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peritoneal irritation.
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What are the 6 areas of cutaneous hypersensitivity on the abdomen?
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Gallbladder, Left side of Stomach, Kidney, Cecum and appendix, Ovary and tube, and Ureter
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How do you ID peritoneal irritation through cutaneous hypersensitivity?
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Lift a fold of skin away from underlying muscle or, B, stimulate the skin with a sharp point or a broken tongue blade.
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Deep palpation is necessary to thoroughly delineate ___ and ___
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abdominal organs and to detect less obvious masses
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Deep pressure may also evoke tenderness in the healthy person over __, ___, ___, ___
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cecum, sigmoid colon, aorta, and in the midline near the xiphoid process.
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soft, rounded, boggy mass in the cecum and in the ascending, descending, or sigmoid colons
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presence of feces in the colon, often mistaken for an abdominal mass,
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Other structures that are sometimes mistaken for masses in the abdomen
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lateral borders of the rectus abdominis muscles, the uterus, aorta, sacral promontory, and common iliac artery
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What is the point of the scratch test for the abdomen?
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auscultation to detect the differences in sound transmission over solid and hollow organs. Place the stethoscope over the liver and with the finger of your other hand scratch the abdominal surface lightly, moving toward the liver border. When you encounter the liver, the sound you hear in the stethoscope will be intensified.
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How do you detect liver tenderness if the liver is not palpable?
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indirect fist percussion. Place the palmar surface of one hand over the lower right rib cage, and then strike your hand with the ulnar surface of the fist of your other hand
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Where do you palpate the gallbladder?
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below the liver margin at the lateral border of the rectus abdominis muscle
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palpable, tender gallbladder indicates
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cholecystitis
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palpable, NONtender gallbladder indicates
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common bile duct obstruction
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What is Murphy sign for?
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inflamed gallbladder
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The percussion note over an enlarged spleen
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dull because the spleen displaces bowel
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The percussion note over an enlarged kidney is
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resonant because the kidney is deeply situated behind the bowel.
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A prominent lateral pulsation on Aorta suggests
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aortic aneurysm
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Direction of Aorta pulse
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Anterior
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Absence of the abdominal reflex may indicate
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pyramidal tract lesion.
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protuberant abdomens or flanks that bulge in the supine position
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Ascites
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What is the auscultatory change in a healthy person over the pelvic border?
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percussion note is first dull and then changes sharply to a loud note at the pelvic border. ascites the percussion note changes above the pelvic border at the fluid level.
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The sudden onset of severe epigastric pain is, of course, unsettling. If that pain is continuous, unrelieved, and radiating (often) to the groin and back, think ___
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acute pancreatitis.
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Dx when vomitus smells like Fetid
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gastrointestinal obstruction
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Dx when vomitus smells like Kerosene
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hydrocarbon ingestion
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Dx when vomitus smells like Violets
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sometimes from turpentine
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Dx when vomitus smells like Garlic
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arsenic
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Patients with an organic cause for abdominal pain are generally
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not hungry think appendicitis or intraabdominal infection.
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Pain not directed to the navel but goes immediately to a fixed point
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significant physical importance.
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What is Apley rule?
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The farther from the navel the pain, the more likely it will be organic in origin
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People with organic abdominal pain keep their eyes ___ on palpation
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OPEN
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Initially periumbilical or epigastric; colicky; later becomes localized to RLQ, often at McBurney point
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Appendicitis
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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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Appendicitis
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Onset sudden or gradual; pain generalized or localized, dull or severe and unrelenting; guarding; pain on deep inspiration
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Peritonitis
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Shallow respiration; + Blumberg, Markle, and Ballance signs; reduced or absent bowel sounds, nausea and vomiting; + obturator and iliopsoas tests
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Peritonitis
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Severe, unrelenting RUQ or epigastric pain; may be referred to right subscapular area
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Cholecystitis
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RUQ tenderness and rigidity, + Murphy sign, palpable gallbladder, anorexia, vomiting, fever, possible jaundice
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Cholecystitis
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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
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Pancreatitis
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Epigastric tenderness, vomiting, fever, shock; + Grey Turner sign; + Cullen sign: both signs occur 2 to 3 days after onset
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Pancreatitis
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Pain Lower quadrant, worse on left
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Salpingitis
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Nausea, vomiting, fever, suprapubic tenderness, rigid abdomen, pain on pelvic examination
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Salpingitis
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Pain Lower quadrant, increases with activity
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Pelvic inflammatory disease
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Tender adnexa and cervix, cervical discharge, dyspareunia
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Pelvic inflammatory disease
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Pain Epigastric, radiating down left side of abdomen especially after eating; may be referred to back
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Diverticulitis
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Flatulence, borborygmus, diarrhea, dysuria, tenderness on palpation
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Diverticulitis
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Pain Abrupt RUQ; may be referred to shoulders
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Perforated gastric or duodenal ulcer
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Abdominal free air and distention with increased resonance over liver; tenderness in epigastrium or RUQ; rigid abdominal wall, rebound tenderness
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Perforated gastric or duodenal ulcer
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Abrupt, severe, spasmodic; referred to epigastrium, umbilicus
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Intestinal obstruction
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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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Intestinal obstruction
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Pain Referred to hypogastrium and umbilicus
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Volvulus
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Distention, nausea, vomiting, guarding; sigmoid loop volvulus may be palpable
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Volvulus
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Steady throbbing midline over aneurysm; may radiate to back, flank
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Leaking abdominal aneurysm
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Nausea, vomiting, abdominal mass, bruit
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Leaking abdominal aneurysm
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Pain Episodic, severe, RUQ, or epigastrium lasting 15 min to several hours; may be referred to subscapular area, especially right
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Biliary stones, colic
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RUQ tenderness, soft abdominal wall, anorexia, vomiting, jaundice, subnormal temperature
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Biliary stones, colic
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Pain Intense; flank, extending to groin and genitals; may be episodic
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Renal calculi
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Fever, hematuria; + Kehr sign
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Renal calculi
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Pain Lower quadrant; referred to shoulder; with rupture is agonizing
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Ectopic pregnancy
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Hypogastric tenderness, symptoms of pregnancy, spotting, irregular menses, soft abdominal wall, mass on bimanual pelvic examination; ruptured: shock, rigid abdominal wall, distention; + Kehr, Cullen signs
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Ectopic pregnancy
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Pain Lower quadrant, steady, increases with cough or motion
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Ruptured ovarian cyst
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Vomiting, low-grade fever, anorexia, tenderness on pelvic examination
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Ruptured ovarian cyst
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Pain Intense; LUQ, radiating to left shoulder; may worsen with foot of bed elevated
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Splenic rupture
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Shock, pallor, lowered temperature
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Splenic rupture
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Hypogastric pain; crampy, variable, infrequent; associated with bowel function
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Irritable bowel syndrome
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Crampy pain after eating milk or milk products
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Lactose intolerance
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Localized pain Abdominal tenderness, fever
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Diverticular disease
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Colicky or dull and steady pain that does not progress and worsen; Fecal mass palpable, stool in rectum
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Constipation
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Pain related to menses, intercourse; Palpable myoma(s)
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Uterine fibroids
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Burning gnawing pain in mid-epigastrium, worsens with recumbency; Negative physical examination
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Esophagitis/gastroesophageal reflux disease
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Burning or gnawing pain; May have epigastric tenderness on palpation
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Peptic ulcer
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Constant burning pain in epigastrium; May be accompanied by nausea, vomiting, diarrhea, or fever
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Gastritis
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What can produce a Quality and Onset of Abdominal Pain: Burning
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Peptic ulcer
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Quality and Onset of Abdominal Pain: Cramping
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Biliary colic, gastroenteritis
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Quality and Onset of Abdominal Pain: Colic
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Appendicitis with impacted feces; renal stone
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Quality and Onset of Abdominal Pain: Aching
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Appendiceal irritation
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Quality and Onset of Abdominal Pain: Knifelike
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Pancreatitis
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Quality and Onset of Abdominal Pain: Ripping, tearing
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Aortic dissection
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Quality and Onset of Abdominal Pain: Gradual onset
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Infection
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Quality and Onset of Abdominal Pain: Sudden onset
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Duodenal ulcer, acute pancreatitis, obstruction, perforation
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sudden, dramatic change from mild, even vague abdominal pain that is there but not particularly distressing to a sudden onset of severe abdominal tenderness in the hypogastric area, particularly on the involved side. Rigidity and rebound may come on early or late
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Ectopic Pregnancy
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rigidity, a positive psoas sign, fever, or rebound tenderness are physical examination findings that increase the likelihood of
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appendicitis
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What is rebound tenderness test for?
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peritoneal inflammation
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What is a positive Blumberg sign?
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return to position (rebound) of the structures that were compressed by your fingers causes a sharp stabbing pain at the site of peritoneal inflammation
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What is Ballottement ?
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palpation technique used to assess a floating mass, such as the head of a fetus
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Pain or distress occurs in the area of the patient's heart or stomach on palpation of McBurney point; Appendicitis
What sign? |
Aaron 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
What sign? |
Ballance sign
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Rebound tenderness; Peritoneal irritation; appendicitis
What sign? |
Blumberg sign
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Ecchymosis around umbilicus; Hemoperitoneum; pancreatitis; ectopic pregnancy
What sign? |
Cullen sign
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Absence of bowel sounds in right lower quadrant; Intussusception
What sign? |
Dance sign
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Ecchymosis of flanks; Hemoperitoneum; pancreatitis
What sign? |
Grey Turner sign
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Abdominal pain radiating to left shoulder; Spleen rupture; renal calculi; ectopic pregnancy
What test? |
Kehr sign
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Patient stands with straightened knees, then raises up on toes, relaxes, and allows heels to hit floor, thus jarring body. Action will cause abdominal pain if positive; Peritoneal irritation; appendicitis
What test? |
Markle (heel jar) sign
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Rebound tenderness and sharp pain when RLQ is palpated; Appendicitis
What sign? |
McBurney sign
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Abrupt cessation of inspiration on palpation of gallbladder; Cholecystitis
What sign? |
Murphy sign
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Pain down the medial aspect of the thigh to the knees, Strangulated obturator hernia
What sign? |
Romberg-Howship sign
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Right lower quadrant pain intensified by left lower quadrant abdominal palpation; Peritoneal irritation; appendicitis
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Rovsing sign
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A scaphoid abdomen in infants suggests
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abdominal contents are displaced into the thorax. diaphragmatic hernia In newborns
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In infants, distended veins across the abdomen are an unexpected finding suggestive of ___
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vascular obstruction or abdominal distention or obstruction.
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Spider nevi may indicate
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Liver disease
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Any intestinal structure present in the umbilical cord or protruding into the umbilical area and visible through a thick transparent membrane suggests an
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omphalocele
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Once the umbilical stump has separated, serous or serosanguineous discharge may indicate
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granuloma
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Which is ok and which is not in an infant: 1. Herniation through the rectus abdominis muscles vs 2. Diastasis rectus abdominis
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1. no 2. yes
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Peristaltic waves may sometimes be seen in thin, malnourished infants, but their presence usually suggests an
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intestinal obstruction such as pyloric stenosis.
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The bruit of stenosis has a _____; the bruit of arteriovenous fistula is _____.
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The bruit of stenosis has a high frequency and is soft; the bruit of arteriovenous fistula is continuous.
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In infants and young children, Any increase in spleen size may indicate ___
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blood dyscrasias or septicemia.
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The liver edge may be palpable at ________ in infants and toddlers
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1 to 3 cm below the right costal margin
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A sausage-shaped mass in the left lower quadrant may indicate
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feces in the sigmoid colon associated with constipation
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A midline suprapubic mass suggests
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Hirschsprung disease, in which feces fill the rectosigmoid colon
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A sausage-shaped mass in the left or right upper quadrant may indicate
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intussusception
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almond-shaped mass on after the infant vomits deep palpation in the right upper quadrant immediately after the infant vomits
|
pyloric stenosis
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Almost all other palpable masses in the abdomen of the newborn are
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renal in origin
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In infants and toddler, A distended bladder, felt as a firm, central dome-shaped structure in the lower abdomen, may indicate ___
|
urethral obstruction or central nervous system defects.
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It is normal for a child to use abdominal respiration until what ages?
|
6-7 years old
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Restricted abdominal respiration in young children can be caused by
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peritoneal irritation or an acute abdomen.
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In children, upper edge of the liver should be detected by percussion at the
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sixth intercostal space
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In children, The lower edge of the liver may be palpated either at, or
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1 to 2 cm below, the right costal margin.
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average duration of pregnancy
|
280 days, or 40 weeks.
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What is the McDonald rule?
|
During the second and third trimesters, the McDonald rule can also be used to estimate the duration of the pregnancy from fundal height measurement. divide the height of the fundus (in centimeters) by 3.5; the resultant figure is said to equal the duration of pregnancy in lunar months.
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Standard FM count criteria
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10 times in 1 hour to 10 times in 12 hours
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When should someone worry about FM assessment?
|
occurrence of three or fewer FMs in 2 hours for 2 consecutive days while the woman is at rest in left lateral position signals the need for further evaluation of fetal well-being.
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Assessment of fetal position can be performed using the four steps of the
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Leopold maneuvers
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When do Uterine contractions begin ?
|
third month of gestation (Braxton Hicks contractions)
|
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when are uterine contraction abnormal?
|
more than 4 to 6 uterine contractions per hour before 37 weeks of gestation requires evaluation.
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Symptoms can range from dysphagia to nausea, vomiting, anorexia, and hematemesis; and can include changes in stool frequency, size, consistency, or color.
|
gastrointestinal cancer increases with age
|
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The Fs of Abdominal Distention
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Fat
Fluid Feces Fetus Flatus Fibroid Full bladder False pregnancy Fatal tumor |
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Congenital: Hirschsprung disease Obstruction
Neoplasms Stricture of colon Topical: painful hemorrhoids or fissure Impacted feces Prolapse of the rectum Anorexia and depression Temperature high, dehydration results Endocrine: hypothyroidism Diet, diverticulitis, and drugs |
Causes of Constipation: CONSTIPATED
|
|
Abdominal or anal ""sausage""
Blood from the rectum (red currant jelly) Colic: babies draw up their legs Distention, dehydration, and shock Emesis Face pale" |
Intussusception in Infants: ABCDEF
|
|
" * Involuntary rigidity of abdominal muscles
* Tenderness and guarding * Absent bowel sounds * Positive obturator test (p. 555) * Positive iliopsoas test (p. 555) * Rebound tenderness (Blumberg sign and McBurney sign; see Table 17-6) * Abdominal pain on walking * Positive heel jar test (Markle sign, see Table 17-6) * Right lower quadrant pain intensified by left lower quadrant abdominal palpation (positive Rovsing sign, see Table 17-6) " |
Findings in Peritoneal Irritation
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|
"Area of Pain?
Duodenal ulcer Hepatitis Hepatomegaly Pneumonia Cholecystitis" |
Right Upper Quadrant
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|
"Area of Pain?
Appendicitis Salpingitis Ovarian cyst Ruptured ectopic pregnancy Renal/ureteral stone Strangulated hernia Meckel diverticulitis Regional ileitis Perforated cecum" |
Right Lower Quadrant
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|
"Area of Pain?
Intestinal obstruction Acute pancreatitis Early appendicitis Mesenteric thrombosis Aortic aneurysm Diverticulitis" |
Periumbilical
|
|
"Area of Pain?
Ruptured spleen Gastric ulcer Aortic aneurysm Perforated colon Pneumonia" |
Left Upper Quadrant
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|
"Area of Pain?
Sigmoid diverticulitis Salpingitis Ovarian cyst Ruptured ectopic pregnancy Renal/ureteral stone Strangulated hernia Perforated colon Regional ileitis Ulcerative colitis" |
Left Lower Quadrant
|
|
"Landmarks for Abdominal Examination
Liver and gallbladder Pylorus Duodenum Head of pancreas Right adrenal gland Portion of right kidney Hepatic flexure of colon Portions of ascending and transverse colon" |
Right Upper Quadrant (RUQ)
|
|
"Landmarks for Abdominal Examination
Left lobe of liver Spleen Stomach Body of pancreas Left adrenal gland Portion of left kidney Splenic flexure of colon Portions of transverse and descending colon" |
Left Upper Quadrant (LUQ)
|
|
"Landmarks for Abdominal Examination
Lower pole of right kidney Cecum and appendix Portion of ascending colon Bladder (if distended) Ovary and salpinx Uterus (if enlarged) Right spermatic cord Right ureter" |
Right Lower Quadrant (RLQ)
|
|
"Landmarks for Abdominal Examination
Lower pole of left kidney Sigmoid colon Portion of descending colon Bladder (if distended) Ovary and salpinx Uterus (if enlarged) Left spermatic cord Left ureter" |
Left Lower Quadrant (LLQ)
|