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63 Cards in this Set

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Sudden onset of persistent, severe or escalating abdominal pain, writhing in pain unable to find a position that offers any comfort, usually requiring emergency hospital or surgical intervention
Surgical abdomen
What is the pain of surgical abdomen most likely due to?
Inflammation, perforation, obstruction, infarction or rupture of intra-abdominal organ.
Name some conditions associated with surgical abdomen.
Appendicitis, acute cholecystitis, Pancreatitis, perforated ulcer or peritenitis, kidney stone, intestinal obstruction, strangulated hernia
Name symptoms associated with gastrointestinal involvement.
Difficulty swallowing, loss of appetite, indigestion, nausea, vomiting, abdominal pain, diarrhea, constipation, yellow or black colored stool &/or mucus or blood in stool
Name symptoms associated with genitourinary involvement.
Painful urination, increased, decreased or absent frequency, cloudy, reddish-brown or red urine; discharge, hesitancy or diminished force; infertility or other sexual concerns
Name symptoms suggesting gynecologic involvement.
Pain before, during or after menstruation; heavy, light or absent menstrual flow; vaginal discomfort or discharge; infertility or other sexual concerns.
What organs are located in the right upper quadrant of the abdomen?
Hepatic flexure of the colon, liver, gallbladder, right adrenal gland, right kidney and small intestines.
What organs are located in the left upper quadrant of the abdomen?
Splenic flexure of the colon, stomach, body of the pancreas & spleen, left adrenal gland, left kidney, small intestines and abdominal aorta.
What organs are located in the lower right quadrant of the abdomen?
Cecum & appendix, ight ovary & fallopian tube, right ureter and small intestines.
What organs are located in the left lower quadrant of the abdomen?
Sigmoid colon, left ovary & fallopian tube, left ureter and small intestines.
What organs are located in the super pubic region?
Penis & testicles or vagina & uterus, urinary bladder & urethra
Rule-of-thumb which states that the further away from the navel that a patient points to an area of pain, the more likely it is organic in nature.
Apley's Rule
Pain resulting from diseased chest or abdominal organs may manifest at a site distant from the distressed organ; for instance, irritation to the underside of the diphragm may cause shoulder pain.
Referred pain
Abdominal pain that radiates to the left shoulder = splenic rupture, kidney stone or ectopic pregnancy
Kehr's sign
Pain coming in waves usually originates in ___________.
Hollow organs
Pain that is constant in nature usually originates in _____ or the _______.
Solid organs, peritoneum
Name the specific order exam procedures of the abdomen are typically performed in.
1. Inspection
2. Auscultation
3. Percussion
4. Light & Deep Palpation
Name 2 reasons why it is important to perform abdomen procedures from least invasive to most invasive.
1. It is possible that deep palpation or even percussion may damage a distended appendix, pleen or aorta.
2. Percussion & deep palpation may alter the normal frequency of the peristaltic sounds.
How should the patient be placed for an abdominal exam?
The patient should be supine on the exam table, draped appropriately with abdomen exposed from the xiphoid to the pubic hair line. To relax the abdominal muscles, have the patient's arms at their side & knees bent.
What things should you look for when inspecting the abdomen?
Assess for abnormal skin tone, texture, contour, pulsations & peristalsis. There should be uniform skin tone & texture; there should be neither signs of inflammation, pallor, cyanosis or jaundice nor any rashes, lesions, vascular markings, stretch marks or scras.
Bluish discoloration around the umbilicus suggests intraabdominal hemorrhage
Cullen's Sign
Name the 9 "f's" that are possible causes of abdominal distention.
Fat, Fetus, full bladder, flatulent, feces, fluid, fibroids, fatal tumor or false pregnancy.
A benign red mark or dot that is common to the trunk with aging. No clinical significance.
Cherry angiomas
What is the normal range of clicks and gurgles heard via auscultation for peristalsis?
from 5-35 per minute
_______ are abnormal, pulsed, blowing sounds produced by turbulence when blood flows through a narrowed artery.
Bruits
Bruits can be caused by stenosis (usually atherosclerosis or clot), compression ( from a normal or abnormal structure) or from turbulence; there fore a bruit could also be caused by an _________
Aneurysm
_____________ are continuous, murmur-like sounds common above the right clavicle in children and pregnant women. They are usually considered harmless.
Venous hums
What kind of percussive notes are normal in the abdomen?
Tympanic with occasional dull notes
What do large areas of dullness suggest in the abdomen?
an enlarged organ, tumor or fluid in the abdomen. Remember that feces or a full bladder are commonly mistaken for masses.
Where is the lower border of the liver normally located?
No more than 1/2 " below the costal margin
Where would you percuss for the gastric air bubble?
In the 6th & 7th intercostal spaces on the left
How do you palpate the liver?
Slide under the right rib cage with your left hand and lift upward or have the patient lie on their fist; with sides of the right hand palpate along & under the right costal margin attempting to feel the lower liver border.
_______ is positive when percussion or palpation at McBurney's point ( half way between the navel and the right ASIS) causes discomfort in the epigastric area; it suggests appendicitis.
Aaron's Sign
Eliciting ___________ is a means of irritating an intestinal structure and overlying peritoneum without poking directly on a potentially infected structure. At a site distant from the pain press into the abdomen deeply and release quickly; this rebound creates a shock wave across the abdomen.
Positive Blumberg's sign or rebound tenderness
When pain is felt in the lower right quadrant during rebound, it is a positive ________ and it suggests appendicitis.
McBurney's sign
If palpation (not rebound) in the lower left quadrant causes pain in the lower right quadrant it's a positive _________ and again suggests appendicitis.
Rovsing sign
Place your thumb under the right rib cage in the area of the gallbladder, have the patient inhale. Cessation of inspiration because of increased pain suggests cholecystitis or gallbladder cancer and is a positive ________
Murphy's sign
Have patient roll over and dullness appears where tympany was when they were lying on their back. What is this called?
Shifting dullness
Name the various places where a hernia may occur.
Inguinal ring (indirect- internal inguinal ring or direct - external inguinal ring), femoral triangle, umbilical hernia, and hiatal or diaphragmatic.
What is the typical patient profile for acute gastroenteritis?
Anybody; 90% of the time it's due to a viral infection, otherwise it could be due to food poisoning, parasites, excess alcohol, psychological causes or morning sickness in pregnant women.
What are the classic signs of acute gastroenteritis?
Diarrhea, vomiting, nausea and a mild ache around the belly button which worsens with peristalsis.
What are aggravating and alleviating activities of acute gastroenteritis?
worse with eating, better with not eating
What physical findings and diagnostic studies are related to acute gastroenteritis?
physical exam findings: Clicks & gurgles in the high normal range
Diagnostic studies: usually unnecessary; diagnosis via clinical findings
What is the typical biographical profile of a patient with ulcerative colitis?
male or female, young adults
What symptoms are associated with ulcerative colitis?
recurrent bouts of diarrhea (20-30 a day) with associated blood, pus or mucous
What physical findings and diagnostic studies are related to ulcerative colitis?
Physical findings: abdominal pain slight or absent
Diagnostic studies: colonoscopy is diagnostic
What is the typical patient profile of a patient with colon cancer?
Male over 50
What are the symptoms associated with colon cancer?
Insidious onset progressing to colicky abdominal pain, constipation; stools may be pencil-thin or ribbon-like & occasionally diarrhea with mucous or blood.
What physical findings and diagnostic studies are associated with colon cancer?
Physical findings: possible palpable abdominal mass
Diagnostic studies: fecal occult blood test; sigmoidoscopy & colonoscopy
What is the typical patient profile of someone with Gastroesophageal Reflux Disease (GERD)?
Common to middle aged women and older adults; associated with obesity, pregnancy, ascites & tight fitting belts and clothing.
What symptoms are associated with GERD?
The ensuing pain results from acid reflux (heartburn) from the stomach 1-4 hours after eating - night-time substernal & epigastric pain; belching
What is the typical patient profile of someone with Chronic Cholecystitis?
Female, fat, flatulent & forty or more years old
What symptoms are associated with Chronic Cholecystitis?
Extended period of recurrent, vague feelings of indigestion, bloating & flatulence not relieved with antacids.
What physical exam findings and diagnostic studies are related to Chronic Cholecystitis?
Physical Exam: RUQ tenderness & guarding to percussion, fist percussion, palpation & a positive Murphy's sign; possible jaundice
Diagnostic Studies: Cholcystography or ultrasound confirm clinical diagnosis
What is the typical patient profile for someone with a duodenal ulcer?
Adults, women over 50 are liable especially if they have helicobacter pylori infection, use NSAIDS, cigarettes, caffeine or alcohol
What symptoms are associated with a duodenal ulcer?
Chronic or recurrent, mild to severe, burning, gnawing or aching epigastric pain, usually 2-3 hours after eating, or having citrus juice, coffee or aspirin
What is the typical patient profile of someone with acute appendicitis, and what are associated symptoms?
any age or gender; Persistent right-sided acute abdominal pain and tenderness are the most consistent clinical feature (100%); mild fever, nausea & vomiting may occur
What diagnostic studies determine Acute Appendicitis?
Clinical findings & elevated WBC count
What is the typical patient profile of someone with an indirect inguinal hernia (intestines protrude through the inguinal canal)?
Any age male, being overweight &/or a history of frequent coughing, sneezing or straining; prevalent in infants if the path for descending testicles fails to close down.
What are physical exam findings of an indirect inguinal hernia?
A cough induced palpable mass against the doctor's finger inserted in the external inguinal ring; pain & a visible mass eventually ensue
Common to women, symptoms include polyuria, nocturia, dysuria & possible hematuria, backache, chills and fever. Urinalysis confirms
Cystitis
What is the typical patient profile of someone with acute Pyelonephritis?
Kids under 5 years old, sexually active people & elderly women
What symptoms and physical findings are associated with Acute Pyelonephritis?
fever, polyuria, nocturia, dysuria & flank pain; flank is tender on palpation; costovertebral angle tenderness & positive Murphy's punch