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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