Phys. Dx. 2 Exam 3

Front 1

Hernia

Back 1

any protrusion of a viscus through a normal (umbilicus) or abnormal opening
usually in inguinal area

Front 2

2 types of hernias

Back 2

internal (diaphragmatic/hiatal)- portion of the stomach protrudes through the diaphragm
external- umbilical, epigastric, inguinal, femoral, obturator, incisional, spigelian- protrusion of intestine covered by the peritoneum through a weak point in the abdominal wall into an extra abdominal space

Front 3

hernia symptoms (internal and external)

Back 3

internal- GERD, substernal chest pain, belching (increase after large meal or with reclining)
external- pain (may indicate icschemia or tearing) and mass

Front 4

hernia risk factors

Back 4

weak abdominal muscles
chronic increase in intra-abdominal pressure (straining, coughing, lifting, pregnancy)

Front 5

hernia terms

Back 5

reducible- contents of the hernial sac can be easily replaced
irreducible/incarcerated- contents cant be replaced, need to monitor for possible complications
strangulated- blood supply has been compromised. emergency.

Front 6

umbilical hernias

Back 6

most often seen in infants (resolves when abdominal muscles start to strengthen as mobility increases)
most resolve by age 2
monitor for compromise by monitoring bowel movements

Front 7

femoral hernias

Back 7

most often in females
intenstine covered by peritoneum through femoral ring
impulse in area of interest during valsalva indicates hernia

Front 8

inguinal hernias

Back 8

indirect- passes through the deep inguinal ring, inguinal canal, and superficial inguinal ring and may descend into the scrotum (complete). Incomplete indirecct- doesnt fall into scrotum
direct- occurs through the posterior wall of the canal in the region of the superficial ring. rarely descends and more problematic.

Front 9

direct hernia exam features

Back 9

middle aged and elderly men (55% B/L)
above inguinal ligament; directly behind and through external ring
rarely scrotal involvement
impulse at side of finger in inguinal canal

Front 10

indirect hernia exam features

Back 10

all ages and 30% B/L
above inguinal ligament; hernial sac enters inguinal canal at internal ring and exits at external ring
common scrotal involvement
impulse location at tip of finger in inguinal canal

Front 11

femoral hernia exam features

Back 11

least common, more common in women
below inguinal ligament
mass is below the canal

Front 12

anorectal disease risk factors

Back 12

genetics
diet
IBD
chronic constipation or diarrhea
chronic increase in intra-abdominal pressure
STD's (causing anal tissue damage)
butt sex

Front 13

colorectal cancer risk factors

Back 13

age over 40
family/personal history of colon problems
diet high in beef and animal fats, low in fiber
exposure to carcinogens

Front 14

anorectal symptoms

Back 14

mass, lesions, swelling, itching, pain
change in bowel habits
bleeding (first sign of colorectal cancer is occult blood)

Front 15

pruritis types

Back 15

generalized- diffuse skin disorder, chronic renal or hepatic disease
intense- lymphoma or Hodgkins
GI disorders- prurutis ani, anal rectal lesions, parasites, skin irritation, local infection

Front 16

anorectal bleeding

Back 16

melena- slow upper GI bleed --> black, dark, sticky stool
hematochezia- bright red blood in stool

Front 17

anorectal exam positions

Back 17

lithotomy- supine w/ knees bent and thighs apart
sims- side lying
supported flexion

Front 18

anorectal exam- canal stuff

Back 18

lower half of canal sensitive to pain
upper half relatively insensitive to pain
99% of polyps develop above pectinate line and are'nt painful
internal hemorrhoids are not painful, external ones are

Front 19

pilonidal cyst and sinus

Back 19

dot superior to butt crack
probably congenital
could have opening of a sinus tract
tuft of hair or halo of erythema could be present
usually asymptomatic except for slight drainage

Front 20

internal hemorrhoids (prolapsed)

Back 20

enlargements of the normal vascular cushions above the pectinate line
not usually palpable
may cause bright red bleeding during shitting

Front 21

external hemorrhoids (thrombosed)

Back 21

dilated veins originating below the pectinate line covered w/ skin
usually asymptomatic unless thrombosis occurs--> local pain increasing w/ shitting and sitting
tender mass is visible on ass hole

Front 22

anal fissure

Back 22

very painful ulceration of the anal canal mostly posterior
accompanied by a swollen "sentinel" skin tag just below it
sphincter is spastic and exam is painful

Front 23

anorectal fistula

Back 23

inflammatory tract or tube that opens at one end into the anus or rectum and at the other end into the skin surface or another skin surface
usually preceded by an abscess
(kind of like an extra hole around the butt hole- hole from butthole canal to surface)

Front 24

prolapse of the rectum

Back 24

more common in infants
rectal mucosa coming through the anus appearing as a doughnut of red tissue.

Front 25

rectal polyps

Back 25

can be on a stalk (pedunculated) or lie on the mucosal surface (sessile)

Front 26

rectal shelf

Back 26

metastases from any source producing a "blockade or shelf" of the anal canal

Front 27

prostate gland

Back 27

lies anterior to anterior rectal wall
bilobed heart shaped 2.5- 4 cm
normal- hard rubber ball
< 1 cm of protrusion into rectal wall

Front 28

abdominal pain

Back 28

visceral- dull, diffuse (appendix)
somatic- sharper, well-localized (peritoneum)
referred- shared pathways (kidney stones, pancreatitis and gall bladder issues can cause back pain)

Front 29

relieving abdominal pain

Back 29

belching- stomach, relieves gastric distension
eating- stomach/duodenum, peptic ulcer
vomiting- stomach/duodenum, from pyloric obstruction
leaning forward- retroperitoneal structures (pancreas, kidney)
knee flex- peritonitis
right thigh flex- appendicitis
left thigh flex- diverticulitis (psoas muscles)

Front 30

patterns of pain referral

Back 30

acute cholecystitis- right shoulder pain
appendicitis- umbilical pain
splenic infarct- left lower axillary border of rib pain
pleuritic pain- right side below rib pain

Front 31

Ulcerative colitis vs. Crohn's

Back 31

UC- bloody diarrhea is classic, malabsorption, abdominal pain, bloating, fissures in rectum, rectal disease but no anal disease
Crohn's- blood specs in stool, fistulas, abscess and perforations, no rectal disease, but anal disease present

Front 32

anorexia shit

Back 32

complex psychiatric disorder
polyphagia- excessive eating (diabetes assoc.)
weight loss more than 10 lbs or 5% of body weight w/out diet modification is bad
hepatitis can lead to anorexia (or if smoker, can cause loss of smoking desire)

Front 33

alternating diarrhea and constipation

Back 33

could be colon cancer or IBS

Front 34

acute diarrhea

Back 34

associated with medications (ie antibiotics) or infections

Front 35

stool tests

Back 35

wrights or methylene blue- pus
occult blood- guiac test
sudan black B- fat
alkalinization with NaOH- laxative abuse
stool culture- bacterial pathogens

Front 36

pencil shaped poo

Back 36

associated with cancer of the rectum or sigmoid colon

Front 37

Protuberant or distended abdomen

Back 37

Fat
fetus
flatulance
fatal growth (cancer)
fluid (ascites)
feces (intestinal obstruction)

Front 38

dysphagia

Back 38

difficulty swallowing
oropharyngeal (transfer) dysphagia- occurs after a stroke
esophageal (mechanical or motility)
motility/motor problem occurs with solids/liquids
mechanical problem occurs only with solids

Front 39

causes of jaundice

Back 39

viral hepatitis (most common)
alcoholic, drug induced, or metastatic liver disease
choledocholithiasis, cholecystitis
pancreas carcinoma

Front 40

terrys nails

Back 40

white nail bed
associated with liver cirrhosis, CHF, and hyperbilirubinemia

Front 41

Osler-Weber-Rendu syndrome

Back 41

lesions on tongue and lips
repeated small bleeds can lead to anemia

Front 42

Peutz-Jeghers syndrome

Back 42

clue lesions on lips, oral mucosa, and sometimes palms
polyps throughout intestines and 100% lifetime risk of cancer

Front 43

caput medusae

Back 43

portal venous hypertension leads to pronounced dilation of periumbilical veins

Front 44

sister mary joseph's nodule

Back 44

intra abdominal metastasis to the umbilicus
adult with enlarged, discolored umbilicus
belly button cancer

Front 45

movement w/ respiration

Back 45

females have more costal breathing
men and children are more abdominal (efficient)

Front 46

visible pulsations in abdomen

Back 46

normal in thin people or children, otherwise may be associated with AAA or solid mass overlying aorta

Front 47

visible peristalsis

Back 47

unusual unless in neonates
left to right indicates pyloric outlet obstruction
right to left- transverse colon obstruction

Front 48

abdominal auscultation

Back 48

listen for 30 seconds to 3 minutes
abnormal if sounds absent or loud and high pitched
paralytic ileus- no sounds for 2 minutes

Front 49

abdominal sounds

Back 49

succussion splash- distension of stomach or colon due to obstruction
peritoneal friction rub- inflammation of the peritoneal surface of a visceral structure like hepatic or splenic disease
venous hum- increased circulation between portal and systemic venous systems, as in hepatic cirrhosis

Front 50

abdominal percussion

Back 50

spleen cant be palpated
shifting dullness- ascites
normal sound is tympani except for liver (dull)

Front 51

splenomegaly

Back 51

dullness in the area between the anterior axillary line and mid axillary line suggests this

Front 52

tests for ascites

Back 52

fluid wave
shifting dullness (dullness on sides and tympani in midline)

Front 53

abdominal palpation

Back 53

light then deep
board like rigidity is classic for peritonitis
palpate painful quadrant last
liver, spleen, kidneys, AA, gallbladder (murphys sign)

Front 54

scratch test

Back 54

used to determine livers edge
perform if liver appears enlarged

Front 55

liver palpation

Back 55

displaced downward- COPD
smooth, large, and nontender edge- cirrhosis
smooth, large, and tender edge- hepatitis or venous congestion (portal venous htn)
irregular, enlarged, firm, tender or nontender- malignancy

Front 56

splenic enlargement

Back 56

spleen isnt palpable until 3x normal size
enlarges toward umbilicus and inferiorly

Front 57

kidney enlargement

Back 57

hydronephrosis, cysts, tumors
B/L enlargement- polycystic disease
back pain common w/ kidney enlargement

Front 58

Murphy's tap/punch

Back 58

light tap producing a vibration that irritates the kidney
Murphy's sign is for gallbladder

Front 59

special tests

Back 59

iliopsoas- appendicitis
obturator- appendicitis or peritonitis
rovsing- tenderness
blumberg's- rebound tenderness
McBurney- appendicitis
Ballottment- free floating abdominal mass

Front 60

renal calculi

Back 60

abdominal pain that radiates into the inguinal/genital area

Front 61

Peptic ulcer and dyspepsia

Back 61

cant be differentiated by signs and symptoms
same symptoms but dyspepsia does not ulcerate
helicobacter pylori is often present
epigastric, may radiate to the back

Front 62

cancer of the stomach

Back 62

a malignant neoplasm
epigastric

Front 63

acute pancreatitis

Back 63

an accute inflammation of the pancreas
epigastric, may radiate to the back or other parts of the abdomen; may be poorly localized

Front 64

chronic pancreatitis

Back 64

fibrosis of the pancreas secondary to recurrent inflammation
epigaastric, radiating through to the back

Front 65

pancreatic cancer

Back 65

a malignant neoplasm
epigastric and in either upper quadrant; often radiates to the back

Front 66

acute cholecystitis

Back 66

inflammation of the gallbladder, usually from obstruction of the cystic duct by a gallstone
right upper quadrant or upper abdominal; may radiate to right scapula

Front 67

biliary colic

Back 67

sudden obstruction of the cystic duct or common bile duct by a gallstone
epigastric or right upper quadrant; may radiate to right scapula and shoulder

Front 68

acute diverticulitis

Back 68

acute inflammation of a colonic diverticulum, a saclike mucosal outpouching through the colonic muscle
left lower quadrant

Front 69

acute appendicitis

Back 69

acute inflammation of the appendix
poorly localized periumbilical pain followed by right lower quadrant pain

Front 70

acute mechanical intestinal obstruction

Back 70

bowel lumen obstruction from adhesions/hernias or cancer/diverticulitis
small bowel: periumbilical or upper abdominal
colon: lower abdominal or generalized

Front 71

mesenteric ischemia

Back 71

blood supply to the bowel and mesentery blocked from thrombosis or embolus, or reduced from hyperfusion
periumbilical to diffuse