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45 Cards in this Set

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Rebound tenderness, a sign of peritoneal inflammation
Positive Blumberg sign
Pain down the medial thigh to knees; may occur in response to strangulated hernia.
Romberg-Howship sign
Absence of bowel sounds in the RLQ
Dance sign
bluish periumbilical discoloration; is indicative of intraabdominal bleeding
Cullen sign
separation between the left and right side of the rectus abdominis muscle, which may occur in pregnancy
Diastasis recti
Rebound tenderness over McBurney's point in RLQ suggests appendicitis.
McBurney sign
Hypertrophy of the circular muscle of the pylorus leads to obstruction of the pyloric sphincter. Infants present with regurgitation progressing to projectile vomiting.
Obj: small, rounded olive-shaped mass in RUQ, esp. after infant vomits. U/S & surg. consult needed.
Pyloric stenosis in infants
Associated condition: Appendicitis. Pain or distress occurs in the area of pt's heart or stomach on palpation of McBurney's point
Aaron sign
Assos. cond: peritoneal irritation. Fixed dullness to percussion in L & R flank that disappears on change of position.
Ballance
Assos. cond: Intussusception (prolapse,or telescoping of one segment of intestine into another causes intestinal obstruction). Absence of bowel sounds in RLQ. Occurs in infants 3-12mths old. Stool mixed w blood and mucus w red currant jelly appearance.
Obj: sausage-shaped mass may be palpated in R or LUQ, whereas RLQ feels empty.
Diag: air-contrast enema.
Dance sign
Newborn abd. inspection
Abd. inspection of newborn:
- distended or protruding abd. can result from feces, mass, or organ enlargement.
- scaphoid abd. suggests that the abd. contents are displaced into the thorax.
- pulsations in epigastric area are common in newborns and infants.
- distended veins across abd. are an unexpected findings suggestive of vascular obstruction or abd. distention or obstruction.
- spider nevi may indicated liver disease.
- 2 arteries, 1 vein in umbilical cord.
-1 artery- ? congenital anomalies.
- diastasis rectus abdominis, a separation 1 to 4cm wide in midline usually between xyphoid and umbilicus, is a common finding.
Occurs more often if women. Usually appears in late adolescence or early adult life & rarely appears for the first time after 50y/o.
Subj: commonly report a cluster of symptoms, consisting of abd pain, bloating, constipation, & diarrhea. Some experience alternating diarrhea and constipation. Mucus may be present around or within stool. Bouts may occur at times of emotional distress.
Obj: unremarkable exam. Diag. made by: abd pain/discomfort at least 3 days/month during the previous 3 mnts associated with 2 or more of the following:
- relieved by defecation
- onset assoss. w onset in stool frequency, change in stool form or appearance
- altered stool passage (straining&/urgency)
-mucorrhea
IBS
Part of the stomach passes through esophageal hiatus in the diaphragm into chest cavity.
Assosciated w obesity, pregnancy, ascites, use of tight fitting belts and clothes;
Subj: epigastric pain &/ hurtburn that worsens w lying down & is relieved by sitting up or antacids.
- water brash
- dysphagia
- syptoms of incarcereated hernia include sudden onset of vomiting, pain & complete dysphagia.
Obj: unremarkable exam; w sever disease may have erythema of posterior pharynx & edematous vocal cords.
Hiatial hernia w esophagitis
Chronic circumscribed break in duodenal mucosa that scars w healing.
May develop from infections w H.Pylori & increased gastric acid secretion. Occurs more often in men.
Subj: localized epigastric pain that occurs when stomach is empty & is relieved by food and antacids. W upper GI bleeding symptoms include hematemesis & melena; significant blood loss may result in dizziness & syncope.
Obj: anterior wall ulcers may produce tenderness on palpation of the abd.Perforation of duodenum presents w signs of acute abdomen( abd distention, rebound & guarding). Duodenal ulcer - pain on empty stomach. Gastric ulcer - pain w full stomach. Duodenal ulcer pain may awaken pt at 1 to 2 am. Can be relieved by antacids.
Stool guaiac should be perfomed on all pt's w epigastric pain. PUD should be suspected in any pt w dyspepsia/epigastric pain, >50y/o, has associated weight loss, or loss of appetite.
Direct endoscopy.
PUD
Chronic inflammatory disorder that can affect any part of GI tract that produces ulceration, fibrosis, & malabsorption; the terminal ileum & colon are the most common sites.
Cause unknown.
Subj: chronic diarrhea w compromised nutritional status
- other systemic manif, - arthritis, iritis, erythema nodosum
- disease course characterized by unpredictable flares & remissions.
Obj: may have RLQ tenderness
- abd mass may be palpated 2ry to thickened or inflamed bowel
- perianal tags, fistulae, & abscesses may be seen
- cobble stone appearance of intestinal mucosa.
- fistula formation, sometimes extending to the skin, is common
Crohn's disease
Chronic inflammatory disorder of the colon & rectum that produces mucosal friability & areas of ulceration.
Unknown etiology.
Active chronic ulcerative colitis predisposes individuals to deleloping colon CA.
Subj: bloody, frequent watery diarrhea, as many as 20 to 30 diarrheal stools/day.
- may exhibit weight loss, fatigue & general debilitation
- may remain in remission for years
Obj: generally do not have fistulae or perineal disease
- contrast radiograph shows loss of normal mucosal pattern
- sclerosing cholangitis may occur w cholestatic pattern of elevated transminases
- pathology shows mucosal edema w ulcerations and bleeding
Ulcerative Colitis
Subj: RUQ pain w radiatin around the midtorso to R scapular region; pain is abrupt and severe & lasts 2-4 hrs.
- may have associated symptoms including fever,jaundice & anorexia
- w chronic - fat intolerance, flatulence, nausea, anorexia, & nonspecific abd pain
Obj: + Murphy's sign-
- involuntary guarding or rebound tenderness may be present
- some may have full palpable GB in RUQ
- chronic - GB isnt palpable d/t GB fibrosis
Cholecystitis
Insulin resistance is important factor; NAFLD is associated w metabolic syndrome (obesity, high triglicerides, diabetes).
Higher prevalence in Hispanics
Nonalcoholic Fatty Liver Disease (NAFLD)
80% causes by chronic alcohol use.
Subj: epigastric mild to severe "knifelike" pain that radiates to the back. Associated w n/v, abd distention, fever, & anorexia
Obj: diffuse abd tenderness to palpation, abd distention
- decreased bowel sounds r/t an ileus
- in severe necrotizing pancreatitis, Cullen, & Grey-Turner signs
- fever, tachy, dyspnea d/t diaphragmatic irritation
- Amylase & Lipase elevated
Chronic pancreatitis - steatorreha
Pancreatitis
Symptoms include pain in LUQ w radiatin to L shoulder (Kehr sign).
Obj: LUQ pain w palpation, signs of peritoneal irritation may be seen (involuntary guarding, rebound tenderness)
Dx is made by paracenthesis or CT
Spleen laceration/rupture;
Inflammation of capillary loops of renal glomeruli.
Most common cause - post-strep infection & immune mediated (IgA nephropathy).
Subj: Peripheral or periorbital edema.
- tea-colored urine or gross hematuria
- nausea, malaise, flank pain
Obj: edema, Htn, oliguria
- microscopic hematuria occurs in all affected patients
Acute Glomurolenephritis
Dilation of renal pelvis & calyses d/t obstruction of urine flow anywhere from urethral meatus to kidneys.
Subj: w acute- may c/o intermittent, severe pain (renal colic) w n/v
- most are asymptomatic & hydronephrosis is found radiologic screening
- w 2ry infection may report abd pain, flank pain, hematuria, fever
Obj: most - unremarkable PE
In severe cases, kidneys may be palpable during abd exam, costovertebral angle tenderness may be present.
- w lower urinary tract obstruction distended bladder may be palpable
Hydronephrosis
Gram - bacilli (E.coli & Klebsiella) & Enterococcus faecalis the most common pathogens
Obj: fever and CVA tenderness distinguish pylo from UTI
- lab: pyuria & bacturia
Pylonephritis
Symptoms of pylo persist > 72hrs of appropriate antib. therapy: chills, fever, dysuria, flank pain
Obj: CVA tenderness, pyuria, bacturia
Imaging: U/S, CT, MRI
Renal abscess
Distal intestinal obstruction caused by thick inspissated impacted meconium in lower intestine.
May be 1st manif of systic fibrosis
Subj: - failure to pass meconiu in first 24 hrs after birth
- symptoms r/t distal intestinal obstruction (vomiting & abd distention)
Obj: abd distention; complicated cases - volvulus, signs of shock- tachy & hypotension
Uncompl. cases are treated w hyperosmolar enemas (Gastrographin) under fluoroscopic guidance;
Meconium Illeus
Inflammatory disease of GI mucosa associated w prematurity & gut immaturity.
Most common GI emergency in neonates.Varying degrees of mucosal or transmural intestinal necrosis occur, most commonly in distal ileum & proximal colon.
Subj: inability to tolerate feedings, abd distention, vomiting, bloody stools
Obj: Temp instability & subtle signs of distress, lethargy, abd distention, apnea, resp distress.
Plain abd x-ray may show pneumatosis intestinalis (air in the bowel wall). Often fatal.
Necrotizing enterocolitis
Solid malignancy of embryonal origin in peripheral sympathetic nervous system.
Unknown cause.
Subj: presents as asymptomatic abd mass in young child
- symptoms may include malaise, loss of appetitie, weight loss, protrusion of one or both eyes. Other symptoms arise from compression of mass or metastasis to adjacent organs.
Obj: firm, fixed nontender, irregular, nodular abd mass that crosses the midline.
- metastases to periorbital region result in ptosis & infraorbital ecchymoses;
- Horner syndrome, ataxia, opsomyoclonus ("dancing eys and dancing feet") may be seen
- radiologic studies may show a calcified mass w hemorrhage into surrounding str-res
Neuroblastoma
Most common intraabdominal tumor of childhood, usually appears at 2-3y/o.
Wilms tumor gene, WTI, is located on chromosome II & regulates normal kidney development; ~20% affected kids have it
- associated w several syndromes: WAGR includes Wilms tumor, aniridia, genitourinary abnormalities, mental retardation
Subj: painless enlargement of abd or abd mass
- some present w abd pain, vomiting, hematuria
Obj: firm, nontender mass deep within the flank, only slightly movable & not usually crossing the midline; sometimes bilat
- Htn may be present
Wilms Tumor (Nephroblastoma)
Primary absence of parasympathetic ganglion cells in a segment of colon, which interrupts intestinal motility
- more common in males
Subj: symptoms begin at birth w failure to pass meconium in the first 24-48 hrs after birth
- other symptoms: failure to thrive, constipation, abd distention, episodes of bilious vomiting and diarrhea
Obj: severe constipation, abd distention & stool palpated in LL abd.
Hirschsprung disease (Congenital Aganglionic Megacolon)
Triad of microangiopathic hemolytic anemia, thrombocytopenia& uremia.
Occurs in younger than 4y/o.
Most common cause - Shiga-like toxin produced by E.Coli.
Risk factors- ingestion of undercooked meator unpasteurized milk.
Subj: most have preceding URI of gastroenteritis w fever, abd pain, vomiting; diarrhea often becomes bloody.
Obj: dehydration, edema, petechiae, hepatosplenomegaly. W severe GI disease may display peritoneal signs (abd distention, involuntary guarding, rebound tenderness)
Hemolytic Uremic Syndrome (HUS)
Ecchymosis of flanks.
Hemoperitoneum, pancreatitis
Grey Turner sign
Abd. pain radiating to L shoulder.
Spleen rupture, renal calculi, ectopic pregnancy
Kehr sign
Pt. stands w straightened knees, then raises up on toes, relaxes, and allows heels to hit the floor, thus jarring body. Action will cause abd. pain if positive.
= Peritoneal irritation, appendicitis
Markle (heel jar) sign
Pt. stands w straightened knees, then raises up on toes, relaxes, and allows heels to hit the floor, thus jarring body. Action will cause abd. pain if positive.
= Peritoneal irritation, appendicitis
Markle (heel jar) sign
RLQ pain intensified by LLQ abd. palpation. = Peritoneal irritation, appendicitis
Rovsing sign
Changes in contour or symmetry of abdomen: consider 9 F's
Fat
Fluid
Feces
Fetus
Flatus
Fibroid
Full bladder
Fatal tumor
False pregnancy
Pain is elicited by inward rotation of the hip with the knee bent so that the obturator internus muscle is stretched.
Obturator sign
Palce you hand of the patient's thigh just above the knee and ask the pt to raise the thih against your hand. This contracts the psoas muscle and produces pain in patients w an inflamed appendix.
Psoas sign
The reflux is elicited by applying firm, sustained hand pressure to the abd in midepigastric region while pt breathes regularly. Observe the neck for elevation of jugular venous pressure (JVP) w pressure of the hand & a sudden drop of the JVP when the hand pressure is released. The reflux is exaggereted in R-sided heart failure.
Hepatojugular reflux
An alternative to palpation/percussion to determine hepatic size. Performed by placing the stethoscope over the liver & then lightly scratching up the abd on the R side, using a fingertip or tongue depressor. The sound shoul intensify over liver.
Scratch test
Hematopoietic malignancies cause elargment of spleen leading to LUQ pain.
Splenomegaly results from an increase in splenic workload by trapping & destroying abnormal blood cells or diverse abnormal circulating organisms.
The pt may c/o early satiety or abd fullness & LUQ pain.
Begin w CBC & Platelet count, which will likely provide most info on how to proceed.
Hypersplenism
Pain worsened by intake. Can be relieved by antacids.
Gastric ulcer
Sudden onset of severe lower abd pain, n/v in a young male should alert NP to the possibility of testicular torsion.
Lower abd pain
A complant of fatigue, weakness, weight loss, or change in bowel or bladder habits is worrisome, and a malignancy should be suspected.
Change in bowel habits
Most obvious sign is emenorrhea followed by spotting and sudden onset of severe lower abd pain. Backache may be present. There is tenderness on pelvic exam, & a pelvis mass may be palpated. Blood is present in cul-de-sac.
Shock & hemorrhage occurs if ruptures.Life threatening.
Immediate laporoscopy or laparotomy is indicated.
Ectopic Pregnancy