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44 Cards in this Set
- Front
- Back
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Common Concerning GI S/S (6) |
1. Abdominal pain, acute & chronic 2. Indigestion, nausea, vomiting (including blood) 3. Loss of appetite, early satiety 4. Dysphagia and/or odynophagia (painful swallowing) 5. Change in bowel function, diarrhea or constipation 6. Jaundice |
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Common Concerning Urinary/Renal S/S (8) |
1. Suprapubic pain 2. Dysuria, urgency, or frequency 3. Hesitancy, decreased stream in males 4. Hematuria 5. Urinary incontinence 6. Ureteral colic (obstruction) 7. Kidney or flank pain 8. Polyuria, nocturia |
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Ways to Name Abdominal Area |
1. Quadrants (UR, UL, LR, LL) 2. 3 Regions (Epigastric, Periumbilical, Pelvic/Hypogastric) 3. 9 Regions (3 above, R/L Hypochondriac, R/L Lumbar, R/L Iliac) |
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Visceral Pain in Abdomen |
1. Abdominal organs (i.e. intestine or biliary tree) contract in unusually forceful manner 2. Organs are stretched or distended (inflamed, something pushing on them) ***May be difficult to localize |
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Parietal Pain in Abdomen |
*Originates from inflammation in parietal peritoneum 1. Steady aching pain that is more severe than visceral pain and more precisely localized 2. Aggravated by moving or coughing 3. Patients prefer to lie down still, or quadruped |
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Pleura |
Two membranes around lungs 1. Visceral: envelopes lung 2. Parietal: lines inner chest wall -Normally small quantity (3-4 tsp) of pleural fluid spread thinly b/t 2 pleurae --> acts as lubricant b/t 2 membranes |
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Pleurisy |
Pain from pleural surfaces rubbing against one another due to irritation & inflammation; rubbing irritates nerve endings in outer membrane -MC irritant = infection -can also be from abnormal presence of air, blood, or cells --> cause displacement of normal pleural fluid |
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Referral Patterns from Organs |
-May be felt locally -May be felt remote from site of origin |
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Referred Pain in Abdomen |
*May be referred from chest, spine, pelvis -Usually felt in more distant sites which are innervated at approx the same level as the dysfunctional structures -Often not the same as the initial site of pain, but becomes more intense & travels as original site gets worse |
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Acute Upper Abdominal Pain Screening ?'s (6) |
1. Timing of pain?
2. How did it begin? 3. How gradually did it come on? (i.e. gallstones, tumor = gradual, bleed or rapid infection = rapid) 4. 24 hour pattern? (i.e. only when eat? mornings?) 5. Are you acutely ill? (nausea? vomiting?) 6. Is this a chronic problem or something that you have had before? |
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Prevalence of Upper Abdominal Pain |
-40-45% have non-specific pain complaints -15-30% need surgery for appendicitis, intestinal obstruction, or cholecystitis |
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Causes of Acute Upper Abdom. Pain (5) |
1. Appendicitis 2. Obstruction/Foreign object 3. Adhesions w/ air 4. Paralytic Ileus 5. Acute cholecystitis |
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Describing Acute Upper Abdom Pain |
1. Where is it? 2. Where did to start? 3. Where did it travel to? 4. Type of pain (give adjectives if they are unable to answer) -Kidney stones = doubling over w/ cramping, colicky pain -Gallstone Pancreatitis = sudden knifelike epigastric pain |
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Chronic Abdominal Pain |
Changes in bowel habits can indicate colon cancer or IBS
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GI Symptoms that Accompany Abdom Pain (5) |
1. Anorexia, nausea, vomiting 2. Hematemesis 3. Regurgitation 4. Abdominal fullness or early sateity 5. Dysphagia, Odynophagia (painful swallowing) |
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Bowel Function Screening ?'s (10) |
1. How often do they go? 2. Volume, consistency? 3. Do you have difficulty? 4. Do you have excessive gas? 5. Are you constipated? 6. Do you have diarrhea? 7. Is there mucus, pus, or blood? (mucus = inflam. in intestines, blood = ulcers, CA) 8. Are stools greasy, frothy or foul smelling? 9. Does it float? (Sink = not enough fiber) 10. Color (Dark = sitting for a while or infection) |
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Ideal Bowel Movement |
-Medium brown, color of plain cardboard -Leaves body easily w/ no straining or discomfort -Consistency of toothpaste, approx. 4-8 inches long -Enters water smoothly & slowly fall once it reaches water -Little gas or odor |
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Greasy, Frothy, Foul Smelling Stool |
Steatorrhea = high fat content -Lipase needed to break down fat can cause: 1. Pancreatic insufficiency 2. Chronic pancreatitis 3. Obstruction of bile duct 4. Bacterial growth 5. Celiac disease Frothy = malabsorption |
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Celia Sprue |
Inherited autoimmune disease where lining of small intestines is damaged form eating gluten & other proteins found in wheat |
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Diarrhea |
-High volume, frequent & watery stool -Volume >200 gm in 24 hours -If mucus, pus, blood or tenesmus --> Inflammatory condition Acute = </ 2 weeks; usually due to infection or parasites Chronic = >/ 4 weeks; Crohn's/Ulcerative Colitis (precursor to CA) |
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Tenesmus |
Constant urge to defecate, accompanied by pain, cramping & involuntary straining |
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Constipation |
< 3 bowel movements per week >/ 25% of defecations w/ either straining or sensation of incomplete evacuation -Lumpy or hard stool -Requires manual facilitation -Causes of obstruction: CA, apple-core lesion, polyp |
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Apple-core Lesion of Sigmoid Colon |
Thin, pencil-like stool due to obstruction |
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Prevalence of Colorectal CA |
-3rd mc cancer in men & women -Accounts for 10% of all CA deaths ->90% occur after 50 y/o |
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Risk Factors for Colorectal CA |
RF's 1. DM 2. Alcohol 3. Obesity 4. Smoking 5. High fat diet |
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Protective Factors for Colorectal CA |
1. Diet high in fruit & veggies 2. Diet high in fiber 3. Regular Physical activity 4. Use of aspirin or NSAIDS (can inhibit growth or polyps) |
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Blood in Stool |
1. Melena = GI hemorrhage -100 mL of blood = Upper GI bleed -1000 mL of blood = Lower GI bleed 2. Blood on surface or TP = Hemorrhoids 3. Pale or Grey stool = Cholecystitis, Gallstones, Giardia Parasitic Infeciton, Hepatitis, Chroinc Pancreatitis, Cirrhosis -insufficient bile output-->bile salts from liver give stool its brownish color |
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Jaundice |
Yellow discoloration of skin & sclera from increased levels of bilirubin (bile pigment from breakdown of hemoglobin) |
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Mechanics of Jaundice |
1. Increased production of bilirubin 2. Decreased uptake of bilirubin 3. Decreased ability of liver to conjugate bilirubin 4. Decreased excretion of bilirubin into the bile resulting in reabsorption back into blood |
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Causes of Jaundice from Increased Production, Decreased Uptake or Decreased Conjugation of Bilirubin |
1. Hemolytic Anemia - premature destruction of RBC's 2. Gilberts Syndrome - hereditary disorder of bilirubin breakdown |
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Causes of Decreased Excretion of Bilirubin into Bile |
1. Viral Hepatitis 2. Cirrhosis 3. Primary Biliary Cirrhosis 4. Pancreatic Carcinoma causing obstruction of bile duct |
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Screening Questions for Cause of Jaundice |
1. Hep A - Travel or meal in area w/ poor sanitation, ingesting contaminated water 2. Hep B - Mucus membrane exposure to infected body fluids (blood, serum, semen, saliva) esp. through sex or IV drugs (vaccine) 3. Hep C - IV drugs or blood transfusion (CA) 4. Alcoholic Hepatitis - from alcohol use 5. Toxic Liver Damage - Meds, industrial solvents, environmental toxins |
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Screening Questions for Alcohol Abuse |
1. CAGE (cut--annoyed--guilty--eye) 2. AUDIT (Alcohol Use Disorders Identification Test) 3. Heavy Drinking Days - How many times in 1 year have you had >/ 4 drinks a day (women) >/5 drinks a day (men) |
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Concerning Alcohol Use |
Women: >/ 3 drinks per occasion, >/ 7 drinks per week Men: >/ 4 drinks per occasion, >/7 drinks per week |
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General Inspection of Skin of Abdomen |
1. Scars 2. Striae/Stretch marks (Cushing's syndrome) 3. Dilate veins (Hepatic Cirrhosis, IVC Obstruction) 4. Rashes or lesions |
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General Inspection of Contour of Abdomen |
1. Flat vs. Round? 2. Bulging of flanks? 3. Symmetry? 4. Masses? |
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Abdominal Exam Findings |
1. Obese 2. Umbilical Hernia 3. Gall Bladder enlargement 4. Ascites 5. Hepatomegaly 6. Aortic Aneurysm (don't push!) - 911! 7. Inguinal Hernia 8. Peristalsis (may be visible if thin) |
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Aortic Aneurysm |
1. Observe: Visible pulsations in epigastrium 2. Auscultation for Bruits 3. Palpate ONLY if not concerned about aneurysm: Palpate along sides of abdominal aorta to determine width; check of widened pulse |
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Auscultation of Bowel Sounds |
*Listen before palpation or percussion (may alter bowel sounds) -5 auscultation sites (L/R Renal, L/R Iliac, Aortic) -Bruits = vascular occlusive disease -Bowel sounds can be altered by: Diarrhea, Intestinal obstruction, Paralytic Ileus, Peritonitis |
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Percussion of Abdomen |
*Percuss all 4 quadrants -Assists w/ amount & distribution of gas in abdomen -ID's solid masses or fluid-filled areas -Dullness from fluid or feces = Normal |
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Palpation of Abdomen |
Useful for finding: -Tenderness -mm. resistance -Superficial organ masses Keep hand & forearm on horizontal plane w/ fingers together & flat on surface -Start light, then palpate deeper |
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Areas to Palpate |
1. Liver (if extends past ribs, may be enlarged) 2. Spleen 3. Kidneys (left from front, right on side) 4. Appendix 5. Gallbladder (Murphey's Sign) 6. Aorta |
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Appendicitis Test |
1. McBurney's Point 2. Rovsing's Sign (rebound tenderness) 3. Psoas Sign (irritation of appendix by psoas - patient sidelying, extend hip) |
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Ascites |
*Feel for pulse transmission with Percussion -will present as dullness on more dependent side & tympany on top |
