Chapter 11 - Abdomen

Front 1

What does GERD stand for?

Back 1

Gastroesophageal reflux disease

Front 2

What is the cause of GERD?

Back 2

the esophagus is exposed to gastric acid for prolonged periods due to malfunction of the lower esophageal sphincter OR impaired peristalsis (motion that pushes food down)

Front 3

What bacteria may be present in GERD?

Back 3

Heliobacter Pylori

Front 4

Where is the pain of GERD felt?

Back 4

chest or epigastric

Front 5

What does the pain of GERD feel like?

What is this pain also known as? (2)

Back 5

burning

aka "heartburn" and regurgitation

Front 6

When does GERD typically occur?

Back 6

After meal, especially fatty foods

Front 7

Three factors that aggravate GERD.

Back 7

Lying down

bending over

physical activity

Front 8

Two prescriptions and one OTC someone with GERD can take to feel better.

Back 8

Antacids

selected drugs like: theophylline, or Calcium channel blockers

Front 9

Three things people with GERD should avoid.

Back 9

alcohol avoidance

avoid fatty meals

avoid chocolate

Front 10

Seven associated symptoms you might see in a GERD PT.

Back 10

wheezing

chronic cough

shortness of breath

hoarseness

choking sensation

halitosis

sore throat

Front 11

GERD increases the risk of what two conditions?

Back 11

1. Barrett's esophagus (lining of the esophagus is damaged by stomach acid; changed to a lining similar to the stomach)

2. esophageal cancer

Front 12

Where are peptic ulcers usually located?

Back 12

duodenum or stomach

Front 13

What is the difference between peptic ulcers and dyspepsia?

Back 13

Dyspepsia has similar symtpoms with no ulceration.

Front 14

Bacteria present in peptic ulcers and dyspepsia.

Back 14

H. Pylori

Front 15

Location and radiation of Peptic ulcers/dyspepsia

Back 15

Epigastric, radiates to back

Front 16

What kind of pain might a peptic ulcer/dyspesia PT describe to you?

Back 16

gnawing, burning, aching, pressing, hungerlike

Front 17

How might you distinguish the pain of duodenal ulcers from the pain of gastric ulcers or dyspepsia?

Back 17

the pain:

1. wakes them in the middle of the night

2. occurs, disappears for months and recurs

Front 18

2 Factors that may relieve peptic ulcers/dyspepsia.

Back 18

food, antacids

Front 19

Six associated symptoms you might see in a peptic ulcer/dyspepsia PT.

Back 19

Nausea

vomiting

belching

bloating

heartburn (more indicative of duodenal)

weight loss (more indicative of gastric)

Front 20

Name the age groups that dyspepsia, gastric ulcers and duodenal ulcers are most commonly seen in.

Back 20

Dyspepsia: young, 20-29

gastric ulcers: 50+

duodenal ulcers: 30-60

Front 21

The majority (90-95%) of stomach cancers are what type?

Back 21

adenocarcinoma

Front 22

Name three places that stomach cancer is found.

Back 22

1. cardia (opening near top of stomach for food to pass down; connects esophagus to stomach)

2. distal stomach

3. gastroesophageal junction

Front 23

What might a PT with stomach cancer tell you their pain feels like?

Back 23

persistent, slowly progressive

Front 24

What aggravates stomach cancer pain?

Back 24

food

Front 25

What makes stomach cancer pain from GERD and peptic ulcer/dyspepsia (in terms of what makes it feel better)?

Back 25

Stomach cancer is not relieved by antacids or food

(peptic ulcers/dyspepsia are relieved by both

GERD is relieved by antacids)

Front 26

Name 5 associated symptoms a stomach cancer PT might present with.

Back 26

Anorexia

nausea

early satiety

weight loss

bleeding

Front 27

What age range is stomach cancer common in?

Back 27

50-70

Front 28

What is the cause of acute appendicitis?

Back 28

inflammation of the appendix with distention or obstruction

Front 29

Which two places might a PT with appendicitis point to when asked where they feel pain?

Back 29

pain is poorly localized

general belly button area

right lower quadrant pain

Front 30

1. If an appendicitis PT tell you that they have periumbilical pain, what would you expect that pain to feel like?

2. What if it is in the right lower quadrant?

Back 30

1. mild but increasing cramping

2. steady and more severe than that in the navel region

Front 31

1. How long does the pain of appendicitis located in the periumbilical area last?

2. And in the right lower quadrant?

Back 31

1. 4-6 hours

2. depends on the intervention

Front 32

What causes acute cholecystitis?

Back 32

gallstone obstructing a cystic duct

Front 33

Where would a PT point to for pain if they have acute cholecystitis?

Back 33

right upper quadrant or upper abdomen

Front 34

Where does the pain of acute cholecystitis radiate to?

Back 34

Right scapular area

Front 35

How would a PT describe the pain of acute cholecystitis?

Back 35

Steady, aching pain

Front 36

What two things make the pain of acute appendicitis in the right lower quandrant worse?

Back 36

Movement and cough

Front 37

What might a PT tell you about their pain that clues you in to perforation of the appendix?

Back 37

the pain has temporarily subsided

Front 38

1. Name three associated symptoms that present with the more severe form of appendicitis (right lower quadrant).

2. What can you expect these symptoms will usually be followed by?

Back 38

1. anorexia, nausea, vomiting

2. onset of pain and a low fever

Front 39

When does the pain of acute cholecystisis usually occur?

Back 39

gradual onset

Front 40

What makes acute cholecystitis worse?

Back 40

deep breathing (described as jarring in text)

Front 41

Name four associated symptoms of acute appendicitis.

Back 41

anorexia, nausea, vomiting, fever

Front 42

What causes biliary colic?

Back 42

Cystic duct or common bile duct is suddenly obstructed by a gallstone.

Front 43

1. Where would a PT with biliary colic point to for their pain? (two possible spots)

2. Where would it radiate to?

Back 43

1. epigastric OR right upper quadrant

2. radiates to right scapula and shoulder

Front 44

How would a PT likely describe the pain of biliary colic to you?

Back 44

steady, aching

Front 45

What is the "timing" for the pain of biliary colic?

Back 45

a recurrent pain that has a rapid onset over a few minutes, lasts for one to several hours and then gradually subsides

Front 46

Name four associated symptoms that biliary colic may present with.

Back 46

anorexia, vomiting, nausea, restlessness

Front 47

what is acute pancreatitis?

Back 47

acute inflammation of the pancreas

Front 48

1. Where is the pain of acute pancreatitis felt?

2. Where does it radiate to?

Back 48

1. epigastric

2. to the back or other parts of the abdomen

Front 49

What is the pain of acute pancreatitis like?

Back 49

steady

Front 50

What is the "timing" of the pain of acute pancreatitis?

Back 50

acute onset that is persistent

Front 51

What make the pain of acute pancreatitis worse?

Back 51

lying supine

Front 52

What makes the pain of acute pancreatitis better?

Back 52

leaning forward with the trunk flexed

Front 53

Name four associated symptoms of acute pancreatitis.

Back 53

nausea, vomiting, abdominal distention, fever

Front 54

What past medical history and social history items might indicate an increased risk for acute pancreatitis?

Back 54

history of previous attacks, alcohol abuse and gallstones

Front 55

What is the cause of chronic pancreatitis?

Back 55

fibrosis of the pancreas, caused by recurrent inflammation

Front 56

Where would a PT with chronic pancreatitis feel their pain?

Where would it radiate to?

Back 56

epigastric, radiating to back

Front 57

How does the pain of chronic pancreatitis feel?

Back 57

steady, deep

Front 58

Name two factors that make chronic pancreatitis worse.

Back 58

alcohol, fatty, heavy meals

Front 59

What position might you find a chronic pancreatitis PT in that is trying to lessen the pain?

Back 59

learning forward with the trunk flexed

Front 60

Name three associated symptoms of chronic pancreatitis.

Back 60

1. pancreatic enzyme insufficiency

2. diarrhea with fatty stool (steatorrhea)

3. diabetes mellitus

Front 61

The majority (95%) of pancreatic cancers are what kind?

Back 61

adenocarcinomas

Front 62

Where is the pain of pancreatic cancer felt?

Where does it radiate to?

Back 62

epigastric, radiates to the back

Front 63

How would a PT with pancreatic cancer most likely describe the pain?

Back 63

steady, deep, persistent pain

Front 64

What position might alleviate the pain of pancreatic cancer?

Back 64

learning forward with trunk flexed

Front 65

Name six associated symptoms of pancreatic cancer.

Back 65

anorexia

nausea

vomiting

weight loss

jaundice

depression

Front 66

What is acute diverticulitis?

Back 66

inflammation of the colonic diverticulum (a saclike mucosal outpouching through the colonic muscle)

Front 67

Where is the pain of acute diverticulitis felt?

Back 67

lower left quadrant

Front 68

What does the pain of acute diveritculitis feel like?

Back 68

may be cramping at first, but then becomes steady

Front 69

What is the onset of acute diverticulitis usually like?

Back 69

gradual

Front 70

Name 3 possible associated symptoms of acute diverticulitis.

Back 70

fever, constipation, brief diarrhea

Front 71

Name two causes of obstruction of the bowel lumen in acute bowel obstruction. Also, name their locations.

Back 71

<---

1. adhesions (scar tissue) or hernias in the small bowel

2. cancer or diverticulitis in the colon

Front 72

A PT with acute bowel obstruction in the small bowel would localize their pain to where?

Back 72

periumbilical or upper abdomen

Front 73

A PT with acute bowel obstruction in the colon would localize their pain to where?

Back 73

lower abdominal or generalized

Front 74

Regardless of the location of the obstruction, the pain in acute bowel obstruction will likely be described as?

Back 74

cramping

Front 75

What is the onset of acute bowel obstruction pain in both the small bowel and colon?

Back 75

paroxysmal - sudden attack or increase of symptoms

Front 76

Which kind of the acute bowel obstruction (small bowel or colon) pain is decreased as bowel motility is impaired?

Back 76

small bowel

Front 77

Which kind of the acute bowel obstruction (small bowel or colon) pain is generally milder?

Back 77

colon

Front 78

Based on the associated symptoms, how might you differentiate between small bowel or colon acute bowel obstruction?

Back 78

Note: Obstipation = complete or severe constipation

The symptoms occur in opposite order:

small bowel presents with: vomiting of BILE and MUCUS or FECAL material early, then obstipation develops

colon: Obstipation occurs early, there is not likely to be vomiting but if there is it's a late symptom

Front 79

What causes mesenteric ischemia?

Back 79

A thrombosis or embolus is blocking blood supply to the mesentery (called acute arterial occlusion)

OR

the blood supply is reduced from hypoperfusion

Front 80

Where would a PT with mesenteric ischemia probably tell you the pain is?

Back 80

periumbilical at first, then more diffuse

Front 81

What might a PT with mesenteric ischemia describe their pain as?

Back 81

cramping at first, then steady

Front 82

What is the onset of mesenteric ischemia?

Back 82

abrupt, then persistent

Front 83

Name four associated symptoms of mesenteric ischemia.

Back 83

Vomiting, diarrhea (can be bloody), constipation, shock

Front 84

Do you see mesenteric ischemia in younger aged PTs or older?

Back 84

older aged

Front 85

What is oropharyngeal dysphagia caused be?

Back 85

motor disorders that affect the pharyngeal muscles

Front 86

What is the "timing" of oropharyngeal dysphagia

Back 86

acute or gradual onset and variable progression depending on the underlying disorder

Front 87

What makes the pain of oropharyngeal dysphagia worse?

Back 87

trying to swallow

Front 88

In PTs with oropharyngeal dysphagia, what might happen when they attempt to swallow?

Back 88

Aspiration into the lungs or regurgitation into the nose

Front 89

What are three conditions that can cause oropharyngeal dysphagia?

Back 89

stroke, bulbar palsy, other neuromuscular conditions

Front 90

What causes the pain in esophageal dysphagia?

Back 90

"mechanical narrowing"

Front 91

In esophageal dysphagia:

if the mechanical narrowing is in the mucosal rings and webs, what is the "timing" of the pain?

Back 91

intermittent

Front 92

In esophageal dysphagia:

if the mechanical narrowing is in the mucosal rings and webs, what factor may aggravate the pain?

Back 92

solid foods

Front 93

In esophageal dysphagia:

if the mechanical narrowing is in the mucosal rings and webs, what might alleviate the pain?

Back 93

regurgitation of the bolus of food

Front 94

In esophageal dysphagia:

if the mechanical narrowing is due to an esophageal stricture, what is the "timing" of the pain?

Back 94

intermittent, may become slowly progressive

Front 95

In esophageal dysphagia:

if the mechanical narrowing is due to an esophageal stricture, what factor may aggravate the pain?

Back 95

solid food

Front 96

In esophageal dysphagia:

if the mechanical narrowing is due to an esophageal stricture, what might alleviate the pain?

Back 96

regurgitation of the bolus of food

Front 97

In esophageal dysphagia:

if the mechanical narrowing is due to an esophageal stricture, what might you see in the PT's PMH/CHS?

Back 97

long history of heartburn and regurgitation

Front 98

In esophageal dysphagia:

if the mechanical narrowing is due to esophageal cancer, what is the "timing" of the pain?

Back 98

may be intermittent at first, then progressive over months

Front 99

In esophageal dysphagia:

if the mechanical narrowing is due to esophageal cancer, what may aggravate the pain?

Back 99

solid foods, and then eventually liquids

Front 100

In esophageal dysphagia:

if the mechanical narrowing is due to esophageal cancer, what may alleviate the pain?

Back 100

regurgitation of the bolus of food

Front 101

In esophageal dysphagia:

if the mechanical narrowing is due to esophageal cancer, what are three associated symptoms?

Back 101

pain in the chest

pain in the back

weight loss (late-stage)

Front 102

What is the timing of the pain of diffuse esophageal spasm?

Back 102

intermittent

Front 103

What factors may aggravate diffuse esophageal spasm?

Back 103

solid or liquids

Front 104

What factors may alleviate diffuse esophageal spasm?

Back 104

1. nitroglycerin

2. repeated swallowing

3. straightening the back/raising the arms

4. Valsavla maneuver

<--- straining down against closed glottis

Front 105

What does the pain of diffuse esophageal spasm mimic?

How long does it last?

Back 105

chest pain like angina pectoris or myocardial infarction

lasts minutes to hours

Front 106

What is the "timing" of scleroderma pain?

Back 106

intermittent; may progress slowly

Front 107

What factors may aggravate scleroderma?

Back 107

solids or liquids

Front 108

what is diffuse esophageal spasm?

Back 108

contractions of the esophagus are of normal amplitude but they are uncoordinated, simultaneous, or rapid

Front 109

what is scleroderma?

Back 109

connective tissue disorder that affects the skin; wall of the blood vessels; in this case, internal organs, such as the gastrointestinal tract

Front 110

what factors might alleviate scleroderma?

Back 110

1. repeated swallowing

2. straightening the back/raising the arms

3. Valsavla maneuver

<--- straining down against closed glottis

Front 111

what are the associated symptoms of scleroderma?

Back 111

heartburn, other symptoms assocated with scleroderma (scleroderma is systemic)

Front 112

What is achalasia?

Back 112

increased pressure in lower esophageal sphincter (LES), diminished or absent peristalsis distal esophagus, and lack of a coordinated relaxation when swallowing

Front 113

what is the "timing" of achalasia?

Back 113

intermittent, may progress slowly

Front 114

what aggravates achalasia?

Back 114

solids or foods

Front 115

what alleviates achalasia?

Back 115

1. repeated swallowing

2. straightening the back/raising the arms

3. Valsavla maneuver

<--- straining down against closed glottis

Front 116

what are three symptoms associated with achalasia?

Back 116

regurgitation at night when lying down

nocturnal cough

chest pain after eating

Front 117

Name three lifestyles habits that can affect bowel movements and lead to constipation.

Back 117

1. inadequate time or setting for defecation

-ignoring the defecation reflex leads to inhibition of the defecation reflex; can be due to hectic schedules, unfamiliar surroundings, bed rest

2. False expectations of bowel habits

-expectations of what is considered "regular" or more frequent stools than the person's norm; can be due to beliefs, treatments, ads for laxatives

3. diets deficient in fiber

-leads to decreased fecal bulk; can be due to debilitation or constipating drugs

Front 118

Three patterns of irritable bowel syndrome.

Back 118

1. diarrhea-predominant

2. constipation-predominant

3. mixed

Front 119

What is Irritable Bowel Syndrome? What is it caused by?

Back 119

functional change in the frequency or form of bowel movements without known pathology; possibly due to change in intestinal bacteria

Front 120

What are the diagnostic critera of irritable bowel syndrome with respect to:

1. how long the abdominal pain has been present

2. how long the accompanying symptoms have been present

3. what symptoms and how many must be present

Back 120

1. pain must have onset of 3 months or longer

2. accompanying symptoms must have been present for 6 month or longer

3. 2/3 symptoms of the following must be present:

-improvement w/defecation

-onset with change in stool frequency

-onset with change in stool form/appearance

Front 121

Name three types of mechanical obstructions of the bowels.

Back 121

1. cancer of the rectum or sigmoid colon

2. fecal impaction

3. obstructing lesions

Front 122

Why does the bowel become obstructed in cancer of the rectum or sigmoid colon?

Back 122

progressive narrowing of the bowel lumen from adenocarcinomas

Front 123

where is fecal impaction usually located?

Back 123

in the rectum

Front 124

What are some associated symptoms of sigmoid colon cancer?

Back 124

change in bowel habits, diarrhea, abdominal pain, bleeding, occult blood in stool

Front 125

what are some symptoms specific to rectal cancer?

Back 125

tenesmus - feeling of constantly needing to pass stool

pencil-shaped stools

weight loss

Front 126

what are some symptoms associated with fecal impaction?

Back 126

rectal fullness

abdominal pain

diarrhea around the impaction

Front 127

What types of patients would you most likely find fecal impaction?

Back 127

debilitated

bedridden

elderly

Front 128

Name four types of lesions that can cause a mechanical obstruction of the bowel.

Back 128

1, diverticulitis

2. volvulus - tangled intestine

3. itussusception - part of intestine slides back into another section of intestine

4. hernia

Front 129

Name some symptoms associated with lesions that obstruct the bowel, ex. volvulus, intussusception, hernia, diverticulitis

Back 129

colicky abdominal pain

abdominal distention

red blood stools in intussusception

Front 130

The pain of painful anal lesions can cause what to occur?

Back 130

spasm of the external sphincter and voluntary inhibition of the defecation reflex.

Front 131

Name three associated symptoms with painful anal lesions.

Back 131

anal fissures

painful hemorrhoids

perirectal abcesses

Front 132

Name three kinds of drugs that can cause constipation.

Back 132

opiates

anticholinergics

antacids with calcium or aluminum

Front 133

Why do neurologic disorders cause constipation?

Back 133

interfere with the autonomic innervation of the bowel

Front 134

what are some associated symptoms of constipation from depression?

Back 134

fatigue

anhedonia

sleep disturbances

weight loss

(basically the typical depression symptoms)

Front 135

what are some neurologic disorders that can cause constipation?

Back 135

spinal cord injuries

multiple sclerosis

Hirschsprung's disease - missing nerve cells in the muscles of part or all of a baby's colon

Front 136

Name three metabolic conditions that can cause constipation.

Back 136

pregnancy

hypothyroidism

hypercalcemia

Front 137

Name the two types of diarrhea lasting NO LONGER THAN 14 days.

Back 137

secretory infection (non-inflammatory)

inflammatory infection

Front 138

secretory infection diarrhea is caused by?

Back 138

viral infections, bacterial toxins

(S. aureus, B. cereus, C. perfringens, toxigenic E.coli, vibrio cholerae, cryptosporidium, Giardia lamblia, rotavirus)

Front 139

what kind of stool does secretory infection diarrhea cause?

Back 139

water, without blood, pus or mucus

Front 140

name the associated symptoms of secretory infection diarrhea.

Back 140

nausea

vomiting

diarrhea

periumbilical cramping

pain

slightly elevated temperature

Front 141

name three risks for secretory infection diarrhea.

Back 141

travel

common food source

epidemic

Front 142

what is the cause of inflammatory infection diarrhea?

Back 142

colonization or invasion of inestinal muscosa

(nonthyphoid Salmonella, Shigella, Yersinia, Camplylobacter, enteropathic E. coli, entamoeba, histolytica, C. difficile)

Front 143

what is the stool in inflammatory infection diarrhea like?

Back 143

watery, with blood, pus or mucus

Front 144

what are the associated symptoms of inflammatory infection diarrhea?

Back 144

lower abdominal cramping, pain and often rectal urgency aka tenesmus, fever

Front 145

what are some of the causes of inflammatory infection diarrhea?

Back 145

travel

contaminated food or water

frequent anal intercourse

Front 146

what are some drugs that cause diarrhea?

Back 146

magnesium-containing antacids

antibiotics

antineoplastic agents - aka anticancer

laxatives

Front 147

Name two types of diarrheal syndromes that can cause diarrhea to last 30 days or more.

Back 147

Irritable bowel syndrome

cancer of the sigmoid colon

Front 148

what are two possible characteristics of the stool in PTs with irritable bowel syndrome?

Back 148

loose, 50% with mucus, small to moderate volume OR

small, hard stools with constipation

can be mixed patterns

Front 149

when is diarrhea in irritable bowel syndrome the worst? (time of day)

Back 149

worse in the morning

rarely at night

Front 150

What are the associated symptoms of irritable bowel syndrome?

Back 150

crampy lower abdominal pain, abdominal distention, flatulence, nausea, urgency to defecate, relieves symptoms

Front 151

Who is at risk for irritable bowel syndrome?

Back 151

young and middle-aged adults

Front 152

what is the stool like in cancer of the sigmoid colon?

Back 152

blood-streaked

Front 153

what are some associated symptoms of cancer of the sigmoid colon?

Back 153

change in usual bowel habits, cramply lower abdominal pain, constipation

Front 154

what group is at risk for sigmoid colon cancer?

Back 154

middle-aged and older adults, especially 55+

Front 155

What is ulcerative colitis?

Back 155

inflammation of the mucosa and submucosa of rectum and colon

Front 156

what are two kinds of Inflammatory Bowel Disease?

Back 156

ulcerative colitis

crohn's disease of the small bowel or colon

Front 157

two kinds of crohn's disease.

Back 157

crohn's of the small bowel: aka regional enteritis

crohn's of the colon: granulomatous colitis

Front 158

what is crohn's disease?

Back 158

chronic inflammation of the bowel wall, usually in a skip pattern involving the terminal ileum and/or proximal colon

Front 159

what is the stool like in crohn's (small bowel/enteritis) and in crohn's (colon/granulomatous colitis)

Back 159

small bowel/enteritis: small, soft to loose or watery and free of blood

colon/granulomatous colitis: blood in stool, less bleeding than in ulcerative colitis

Front 160

Is crohn's chronic and/or recurrent?

Back 160

both chronic and recurrent

Front 161

What are the associated symptoms of crohn's in small bowel/enteritis and colon/granulomatous colitis?

Back 161

small bowel/enteritis: crampy around the navel or right lower quadrant

colon/colitis: diffuse with pain and anorexia, low fever, weight loss

may also present with perianal fistulas

Front 162

what is distinct about the stool in ulcerative colitis?

Back 162

there is blood in the soft to watery stool

Front 163

who is at risk for ulcerative colitis? and what does it put those who have it at risk for?

Back 163

those at risk: young people

puts them at risk for: colon cancer

Front 164

who is at risk for crohn's disease?

what does it put them at risk for?

Back 164

those at risk: young people, late teens, also in middle age, people of jewish descent

at risk for: colon cancer

Front 165

Name three conditions that can be classified as "voluminous diarrhea."

Back 165

Malabsorption syndrome

osmotic diarrhea

secretory diarrhea

Front 166

What is malabsorption syndrome?

Back 166

defective transport/absorption by intestinal epithelium

impaired luminal digestion

epithelial defects at brush border

Front 167

Name three types of malabsorption disorders that are caused by defective absorption by intestinal epithelium

Back 167

crohn's

celiac disease

surgical resection

Front 168

name a type of malabsorption disorder that is caused by impaired luminal digestion.

Back 168

pancreatic insufficiency

Front 169

name a type of malabsorption disorder that is caused by epithelial defects of brush border.

Back 169

lactose intolerance

Front 170

what are some of the characteristics of the stool in malabsorption syndromes?

Back 170

bulky, soft, light yellow to gray, mush, greasy or oily, frothy, especially foul-smelling, usually floats

Front 171

Name some associated symptoms of malabsorption syndrome.

Back 171

anorexia, weight loss, fatigue, abdominal cramping, abdominal distention, symptoms associated with the nutritional deficiencies brought on by malabsorption

Front 172

In malabsorption syndrome what nutritional deficiency leads to bleeding?

Back 172

vitamin K

Front 173

In malabsorption syndrome what nutritional deficiency leads to bone pain and fractures?

Back 173

vitamin D

Front 174

In malabsorption syndrome what nutritional deficiency leads to glossitis?

Back 174

vitamin B

Front 175

In malabsorption syndrome what nutritional deficiency leads to edema?

Back 175

protein

Front 176

Two causes of osmotic diarrhea

Back 176

lactose intolerance

and

abuse of osmotic purgatives

Front 177

what is lactose intolerance?

Back 177

lack of the intestinal enzyme lactase

Front 178

what types of stool are produced by osmotic diarrhea and secretory diarrhea?

Back 178

watery, large volume

Front 179

What makes lactose intolerance worse? better?

Back 179

worse: ingestion of milk

better: fasting

Front 180

what does the pain associated with lactose intolerance feel like?

Back 180

crampy, abdominal pain, abdominal distention and flatulence

Front 181

What percentage of the African American, Asian, Native American, Hispanic and Caucasian population are lactose intolerant?

Back 181

African Americans, Asians, Native Americans and Hispanics: over 50%

Caucasians: 5-20%

Front 182

what is melena?

Back 182

black, sticky, shiny, tarry stool

Front 183

In melana, occult blood test results are positive or negative?

Back 183

positive

Front 184

How much blood is lost into the GI tract for an adult to produce melena? Where is it lost from?

Back 184

at least 60 mL

usually lost from the esophagus, stomach, or duodenum.

Front 185

How long does it take for blood lost from esophagus, stomach or duodenum to be excreted?

Back 185

7-14 hours.

Front 186

If transit time from esophagus, stomach or duodenum is more than 7-14 hours, what is the likely source of the blood?

Back 186

jejunum, ileum or ascending colon

Front 187

what is a common cause of melena in newborns?

Back 187

swallowing blood during birth

Front 188

Name four causes of melena.

Back 188

GERD/peptic ulcers

gastritis/stress ulcers

esophageal or gastric varices

reflux esophagitis/Mallory-Weiss tear in mucosa due to vomiting

Front 189

Black, non-sticky stools are negative or positive for occult blood tests?

Back 189

negative, no pathologic significance

Front 190

Name some causes of black non-sticky stools.

Back 190

ingestion of iron, bismuth salts, licorice or even chocolate cookies

Front 191

If a PT comes to you with:

melena

has recently ingested aspirin

had recent bodily trauma

increased ICP

what might you consider as the diagnosis?

Back 191

gastritis or stress ulcers

Front 192

If a PT comes to you with:

melena

cirrhosis of the liver

what might you consider as the diagnosis?

Back 192

<---

esophageal - enlarged veins in the lower part of esophgus

(or gastric varices)

Front 193

If a PT comes to you with:

melena

recent alcohol consumption

states that they've been violently retching and vomiting

what might you consider as the diagnosis?

Back 193

Mallory-weiss tear to esophagus

Front 194

Hematochezia, what is it? And where does it usually originate from?

Back 194

red blood in the stool originating from the colon, rectum or anus

Note: can originate from jejunum or ileum, but less frequently

Front 195

What condition invovles large loss of blood into the stool, more than a liter?

Back 195

Upper gastrointestinal hemorrhage

Front 196

Why does the blood stay red in hemtochezia as opposed to the black color in melena?

Back 196

Short transit time through the intestinal tract leaves little time for the iron in the hemoglobin to oxidate and turn black.

The longer the transit time through the GI tract - the darker the stool will be.

Front 197

Name some causes of hemetochezia.

Back 197

1. Colon cancer

2. Adenomatous hyperplastic polyps (pictured)

3. Diverticula of the colon

4. Inflammatory conditions of the colon/rectum (crohn's, ulcerative colitis, etc.)

5. Ischemic colitis

6. Hemorrhoids

7. Anal fissures

Front 198

What is ischemic colitis?

Back 198

Blood flood to the colon is reduced by blocked artieries.

Front 199

What finding would correlate with ischemic colitis in your physical exam of the abdomen upon palpation?

Back 199

abdomen is soft to palpation

Front 200

A PT presents with:

hematochezia

lower abdominal pain

fever

and a soft abdomen upon palpation

What might you consider as a diagnosis?

Back 200

ischemic colitis

Front 201

What are some signs and symptoms of hemorrhoids and anal fissures?

Back 201

blood on the toilet paper

blood on the surface of the stool

blood dripping into the toilet

Front 202

What is a cause of reddish but not bloody stool?

What symptoms might lead you to rule this out as having a non-pathologic origin?

Back 202

ingestion of beets

pink urine preceding the reddish stool

Front 203

What are some mechanisms of increased frequency to urinate? (Think changes to structure rather than disease)

Back 203

1. decreased capacity of the bladder

2. increased sensitivity to stretch due to inflammation

3.decreased elasticity of wall of the bladder

4. decreased inhibition of bladder contractions

5. impaired emptying of bladder leaving some residual urine in bladder

Front 204

What are some causes of increased frequency to urinate?

Back 204

Infection

stones

tumor/foreign body in the bladder

scar tissue

motor disorders of the nervous system (stroke)

Front 205

If a PT presents with burning on urination, urgency to urinate and hematuria would you expect his condition to arise from:

a) infection, stones, tumor

b) scar tissue

c) motor disorder of the nervous system

Back 205

both a) and b) are possible:

a) infection, stones or a tumor

b) scar tissue

Front 206

If a PT presents with increased frequency to urinate accompanied by neurologic symptoms like weakness and paralysis

would you expect his condition to arise from:

a) infection, stones, tumor

b) scar tissue

c) motor disorder of the nervous system

Back 206

c) motor disorder of the nervous system

Front 207

Name some mechanisms that could cause the bladder to not empty fully.

Back 207

partial obstruction of the bladder neck or proximal urethra

loss of peripheral nerve supply to the bladder

Front 208

What can cause an obstruction in the bladder neck or proximal urethra?

Back 208

benign prostatic hyperplasia

<---

urethral stricture

lesions of the bladder or prostate

Front 209

If a PT presents to you with:

increased frequency of urination, hesistancy in starting the urinary stream, straining to void, reduced size and force of the stream and dribbling at the end

what diagnosis might you consider?

Back 209

an obstruction in the bladder of the neck or proximal urethra

Front 210

What condition is associated with a nerve disease that affects the sacral nerves and nerve roots and causes frequency to urinate?

Back 210

diabetic neuropathy

Front 211

Name some causes for nocturia wigh high output volumes.

Back 211

1.polyuria in general

2. decreased concentrating ability by kidneys and a loss of the normal decrease in nocturnal urinary output

3. excessive fluid intake before bedtime

4. fluid-retention/edematous states that accumlate during the day and excrete when the PT lies down at night

Front 212

Name some conditions that cause edematous states leading to nocturia.

Back 212

Heart failure

nephrotic syndrome

hepatic cirrhosis w/ascited

chronic venous insufficiency

Front 213

Name two kinds of nocturia.

Back 213

Hight-volume nocturia

low-volume nocturia

Front 214

Name a cause of low-volume nocturia.

Back 214

Insomnia in which the PT is up at night without a real urge to urinate

Front 215

Name four mechanisms of polyuria.

Back 215

1. antidiuretic hormone (ADH) deficiency

2. renal unresponsiveness to ADH

3. solute diuresis

4. excessive water intake

Front 216

what is solute diuresis?

Back 216

increased urination caused by the presence of certain substances in the small tubes of the kidneys

ex. electrolytes, nonelectrolytes

Front 217

A deficiency in antidiuretic hormone caused by a disorder of the posterior pituitary and hypothalamus is called?

Back 217

diabetes insipidus

Front 218

A condition in which the kidneys are unresponsive to antidiuretic hormone is called?

Back 218

nephrogenic diabetes insipidus

Front 219

What are some causes of nephrogenic diabetes insipidus?

Back 219

hypercalcemic and hypocalcemic nephropathy

lithium toxicity

Front 220

In addition to polyuria what other associated factors would lead you to consider a diagnosis that is either diabetes insipidus or nephrogenic diabtetes insipidus?

Back 220

severe and persistent thirst/polydipsia

nocturia

Front 221

Name an electrolyte the can cause solute diuresis . And some causes of the imbalance.

Name a nonelectrolyte that can cause solute diuresis. And some causes of the imbalance.

Back 221

Electrolyte: sodium salts

large saline infusions, potent diuretics, some kidney diseases

Nonelectrolyte: glucose

uncontrolled diabetes mellitus

Front 222

What is a symptom to check for to see if excessive water intake is the cause of your PT's polyuria?

Back 222

the polydipsia tends to be episodic and nocturia is usually absent

Front 223

What is stress incontinence (urinary)?

Back 223

the urethral spinchter is weakened so that it cannot fight the bladder pressure, urethral resistance is more easily exceeded

Front 224

Who often has stress incontinence (urinary)?

Back 224

Women:

-who have a weakness in the pelvic flood and inadequate muscular support of the badder, -usually from childbirth or surgery.

-postmenopausal atrophy of the mucosa

-urethral infection

men :

after prostatic surgery

Front 225

What are the symptoms of stress incontinence (urinary)?

Back 225

momentary leakage of small amounts of urine with coughing, laughing or sneezing

Front 226

What are some physical findings of someone with stress incontinence (urinary)?

Back 226

the bladder is NOT detected in physical exam

PT may exhibit during the exam, especially if sitting upright and has not voided before exam

atrophic vaginitis - thinning, drying and inflammation of the vaginal walls due to your body having less estrogen

Front 227

What is urinary urge incontinence?

Back 227

The detrusor contractions are so strong that they exceed the normal urethral resistance.

Front 228

Name some conditions urinary urge incontinence is caused by.

Back 228

stoke, brain tumor, demetia, spinal cord lesions

(decreased inhibition of detrusor contractions)

bladder infections, tumors, fecal impaction (sensory pathways are hyperexcitable)

deconditioning of voiding reflex due to frequently voiding at low bladder volumes

Front 229

In cases where the urge incontinence is due to a DECREASE in inhibition of detrusor contractions, what are some signs and symptoms you might expect?

Back 229

moderate volume of involuntary urine loss preceded by an urge to void

mental deficits and motor signs of CNS disease are often present

Front 230

What are some clues to tell you that a PT's urge incontinence is probably arising from hyperexcitability of the sensory pathways (ex. bladder infection, tumor, fecal impaction)

Back 230

urgency, frequency and nocturia with small to moderate volumes and acute inflammation or pain while urinating may be present

other local pelvic problems are present

Front 231

What are some clues to tell you if a PT's urge incontinence is likely based off us a deconditioning of the void reflex?

Back 231

they void within seconds after positional changes, or going up/down stairs

Front 232

What is overflow incontinence?

Back 232

the detrusor contractions are insufficient to overcome urethral resistance and the bladder becomes large even after an effort to void

Front 233

What are detrusor contractions?

Back 233

When the bladder is stretched, the parasympathetic nervous system signals to contract the detrusor muscle. This encourages the bladder to expel urine through the urethra

Front 234

What are three causes of overflow incontinence?

Back 234

obstruction of the bladder outlet such as in benign prostatic hyperplasia

weakness of the detrusor muscle due to peripheral nerve disease at sacral level

interruption of the reflex arc from impaired bladder sensation (such as in diabetic neuropathy)

Front 235

How would you narrow down the cause of overflow incontinence to either:

a) obstruction

b) peripheral nerve disease

c) impaired bladder sensation

Back 235

obstruction - continuous dripping

peripheral nerve disease - decreased force of the stream

impaired bladder sensation - PT is diabetic

Front 236

What is functional incontinence?

Back 236

inability to get to the toilet in time because of impaired health or environmental conditions

Front 237

Name some health conditions that cause functional incontinence.

Back 237

problems in mobility such as weakness, arthritis, poor vision

Front 238

Name some environmental factors that cause functional incontinence.

Back 238

unfamiliar settings, distant bathrooms, bed rails, physical restraints

Front 239

In overflow incontinence what is a common physical exam finding?

Back 239

enlarged bladder that is tender

Front 240

Name some drugs that may cause incontinence.

Back 240

sedatives

tranquilizers

anticholinergics

sympathetic blockers

potent diuretics

Front 241

Name this bulge in the abdominal wall.

Define it.

Back 241

Umbilical hernia.

protrusion through a defective umbilical ring, typically in infants but can be in adults.

Front 242

Name this bulge in the abdominal wall.

Define it.

Back 242

Incisional hernia.

protrusion through an operative scar

Front 243

How is an umbilical hernia usually resolved in infants?

Back 243

On its own within 1 to 2 years.

Front 244

When you palpate an incisional hernia what must you determine?

Why is it important to determine this?

Back 244

Detect the length and width.

A large hernia that passing through a small defect has a greater risk for complications than a large defect.

Front 245

Name this bulge in the abdominal wall.

Define it.

Back 245

Epigastric hernia.

Small midline protrusion through a defect in the linea alba. Occurs between the xyphoid process and the umbilicus.

Front 246

How do you palpate an epigastric hernia?

Back 246

With the patient's head and shoulders raised, run your fingerpad down the linea alba to feel it.

Front 247

Name this bulge in the abdominal wall (vs. the normal chest on the bottom).

Define it.

Back 247

Diastasis recti.

Separation of the two rectus abdominus muscles, through which the abdominal contents form a midline ridge when the PT raises his head and shoulders.

Front 248

Name three common causes for diastasis recti.

Back 248

pregnancy

obesity

chronic lung disease

Front 249

Name this bulge in the abdominal wall.

Define it.

Back 249

Lipoma.

Common, benign, soft, lobulated, fatty tumors usually in subcutaneous tissues almost anywhere on the body, including the abdominal wall.

Front 250

How would you palpate a lipoma?

Back 250

Press your finger down on the edge of the lipoma, it should slip out from under.

Front 251

Name this cause of a protruberant abdomen.

Where is it thickened?

Back 251

Fat.

Fat thickens the abdominal wall, the mesentery and omentum.

Front 252

What is a pannus?

Back 252

apron of fatty tissue that may exten below the inguinal ligaments

Front 253

When inspecting a pannus what should you look for?

Back 253

Lift the pannus to look for inflammation in the skin folds or even a hidden hernia.

Front 254

Name this cause of a protruberant abdomen.

What is it caused by?

What would you expect it to sound like when percussed?

Back 254

Gas.

caused by certain foods, or more serious conditions like intestinal obstruction and adynamic (paralytic) ileus.

tympanic percussion note

Front 255

Name this cause of a protruberant abdomen.

What would you expect it to sound like when percussed?

Back 255

a large, solid tumor that is usually rising out of the pelvis

dull to percussion

Front 256

Name some causes of a tumor in the abdomen.

Back 256

ovarian tumors

uterine myomata

Front 257

Name this cause of a protruberant abdomen.

How might you distinguish this from another cause?

Back 257

Pregnancy.

Listen for the fetal heart.

Front 258

Name this cause of a protruberant abdomen.

How might you distinguish this from another cause?

Back 258

Ascitic fluid.

Ascitic fluid seeks the lowest point in the abdomen, if you turn the PT on their side and the fluid shifts to the lowest point.

Front 259

What are you listening for at this spot on the abdomen. (general)

Back 259

bowel sounds

Front 260

Bowel sounds can be described as increased or decreased.

Which would you expect in early intestinal obstruction?

In adynamic ileus and peritonitis?

Back 260

Increased - early intestinal obstruction

decreased - adynamic ileus and peritonitis

Front 261

What is recommended you do before you decide that bowel sounds are absent?

Back 261

sit down and listen at the "x" for 2 or more minutes.

Front 262

If you hear a high-pitched tinkling sound in the bowels what does this suggest?

Back 262

intestinal fluid and air under tension in a dilated bowel

Front 263

If you hear rushes of high-pitcheded sounds in the bowels what does this suggest?

Back 263

intestinal obstruction, especially those that coincide with an abdominal cramp

Front 264

If you hear a soft humming noise with both systolic and diastolic components where indicated, what is this called?

What is this sound caused by?

Ex. of a condition that would cause this?

Back 264

Venous hum.

Caused by increased collateral circulation between portal and systemic venous systems.

hepatic cirrhosis

Front 265

What kind of sound does bruits make?

Back 265

turbulent flow

sound of blood rushing past an obstruction

Front 266

What is a hepatic bruit indicative of?

Back 266

carcinoma of the liver or alcoholic hepatitis

Front 267

What is arterial bruits suggestive of?

Back 267

partial occlusion of the aorta or large arteries

Front 268

Partial occlusion of a renal artery can lead to?

Back 268

hypertension

Front 269

If you hear a grating sound at either of the indicated spots what would you consider is the cause?

What does this sound indicate?

Back 269

friction rub.

inflammation of the peritoneal surface of an organ such as in liver cancer or splenic infarct.

Front 270

When a systolic bruits accompanies a hepatic friction rub what condition is likely?

Back 270

carcinoma of the liver

Front 271

Explain how you would localize the tenderness in a PT's abdomen, deep or superficial?

Back 271

Ask the PT to raise their head and shoulders, if the tenderness persists it is more superficial, whereas if the tendernesss is from a deeper lesion it will be protected by the tightened muscles and the pain will decrease.

Front 272

If a PT is concerned about pain in these structures and states that the discomfort is dull and you find that there is no muscular rigidity or rebound tenderness what would you conclude?

Back 272

That these structures are normally tender to deep palpation and that this is normal.

Front 273

A PT experiencing abdominal pain and tenderness in the area denoted by the red line (unilaterally or bilaterally) with rebound tenderness and rigidity what diagnosis might you consider further?

Back 273

acute pleurisy

Front 274

If a PT states that they are experiencing pain in the red areas of the picture and you find that they hve rebound tenderness and motion of the uterus causes pain what diagnosis might you consider?

Back 274

acute salpingitis

Front 275

What condition is likely when a PT tells you they have pain in the red area and upon palpation you find that it hurts when they breathe in (Murphy's sign.)

Back 275

acute cholecystitis

Front 276

What condition is likely when the pain is "almost like a left-sided appendicitis?"

Back 276

acute diverticulitis

Front 277

If a PT states that they have a severe amount of pain in their whole abdomen and you see guarding (boardlike muscle rigidity) what condition would you consider?

Back 277

generalized peritonitis

Front 278

Does a palpable liver always indicate hepatomegaly?

Back 278

No, more often it results from a change in consistency (soft to firm).

Front 279

Explain the significance of palpating a liver that seems to extend far past the lower costal margin than normal BUT, is determined by percussion to be normal dimensions for a liver.

Back 279

Downward displaced liver

It is likely a low diaphragm, the upper border is also low (due to the low diaphragm) so the bottom liver edge is past the costal margin, common in COPD.

Front 280

An elongation in the right lobe that is easily palpable is called?

What does this finding suggest?

Back 280

Riedel's Lobe

It is a normal variation, typically in those who are lanky in build, it is not an increase in liver volume or size.

Front 281

If you palpate a smooth, non-tender, large liver what would you consider as a possible diagnosis?

What if it is tender?

Back 281

Cirrhosis may produce an enlarged liver with a firm, non-tender liver.

Tender: suggests inflammation such as in hepatitis, venous congestion of right-sided heart failure

Front 282

An enlarged liver that is firm or hard and has irregular edges suggests what?

Would you expect the liver to be tender or non-tender?

Back 282

Hepatocellular carcinoma

The liver may be tender or non-tender.