• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

Card Range To Study

through

image

Play button

image

Play button

image

Progress

1/321

Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

321 Cards in this Set

  • Front
  • Back
  • 3rd side (hint)
Where do the lungs end?
A. Anteriorly
B. Laterally
C. Posteriorly
A. 6th ICS
B. 8th ICS
C. T10
On which side is the diaphragm higher up?
Right side d/t the liver
What are the muscles of respiration?
Diaphragm, Intercostal muscles, Trapezius, and Sternocleidomastoid muscles
What is pectus carinatum?
prominent sternal protrusion
Does not cause many lung issues
What is pectus excavatum?
indentation of the lower sternum
Can cause lung issues
What is kyphosis?
curvature of the spine
In what people is kyphosis common?
Women over the age of 52 (menopausal)
What health promotion tips do we give for kyphosis?
Take a Calcium supplement and do weight bearing exercises
What is a normal AP:Transverse diameter in adults? in newborns?
Adults- 1:2
Newborns- 1:1
In what disorder will you have an increased AP ratio?
Emphysema
Where do the lung apices lie?
2-4 cm above the clavicle
Where does the Visceral pleura lie?
over the lungs
Where does the Parietal pleura lie?
lining the chest wall
Where does the Trachea bifurcate?
High anteriorly and T4 posteriorly
What is orthopnea?
dyspnea when lying flat
What is trepopnea?
dyspnea when lying on one side
common in CHF
What is platypnea?
dyspnea when sitting up
common with liver failure or ascites
If someone has a CC of lung origin, what other systems will you review?
Cardiac, HEENT, GI
What are some questions you may ask about a respiratory review of systems?
Dyspnea, sputum production, cough, wheezing, history of...cancer, asthma, TB, chest pain, COPD/Emphysema
What are some important social history questions to ask with a CC of respiratory origin
Exposure to asbestos/chemicals in your work environment, history of smoking
What are some important family history questions to ask with a CC of resp. origin?
TB, cystic fibrosis, asthma, lung cancer
What are some specific things related to infants and children that may be significant in a lung related history?
low birth weight, assisted ventilation, difficult feeding, apneic periods, sibling SIDS death, recurrent spitting up
What may it mean if a baby consistently spits up?
they may have GERD
When do babies develop surfactant?
32 weeks
Who has a higher risk of asthma?
pacific islanders, filipinos, cubans, puerto ricans, those in inner cities
Who have higher incidence of lung cancer?
smokers, african americans, native americans
What are some lung risks for immigrants?
increased TB, poor housing (mold/lead)
What will you inspect when examining respiratory?
pattern of breathing, mode of breathing, is it audible?, pursed lips?, skin/mucous membrane color, posture with breathing? accessory muscle use, nasal flaring, cough, depth and rate and symmetry
What will you inspect in the thorax?
for the symmetry/bones (kyphosis, scoliosis), intercostal spaces, symmetry, skin (color, scars, venous patterns), shape (1:2)
What may it mean if you see a venous pattern on the cest?
it may be a tumor
What will you palpate on a respiratory inspection/assessment?
position of trachea, costal angle (should be less than 90 degrees), pulsations, asses, tenderness, thoracic expansion (anterior and posterior), tactile fremitus, spinal position, diaphragmatic excursion
When might the costal angle widen?
in pregnancy
How do you assess tactile fremitus?
have the patient say 99 repeatedly, feel vibrations, should be symmetrical
When will tactile fremitus be increased?
in pneumonia, due to mucous transmitting sound
When will tactile fremitus be decreased unilaterally?
pneumothorax, pleural effusion, bronchial obstruction, atelectasis
When will tactile fremitus be decreased bilaterally?
COPD, chest wall thickening d/t fat or muscle
What is the sound of percussion over a solid organ?
dull
What is the sound of percussion over a structure with air inside the tissue?
resonance
What is the sound of percussion over hollow spaces?
tympanic
What is the sound of percussion over bone?
flat
What is the sound of percussion normally heard over the lungs?
resonance
What is the order of percussion in the lungs?
Right to left, apices to base (like a ladder)
Where do you hear bronchial breath sounds?
over the trachea
Where do you hear bronchovesicular breath sounds?
over the mainstem bronchi
Where do you hear vesicular breath sounds?
over the lung periphery
What triggers respirations?
the respiratory center in the brainstem, cellular demands, and mostly, carbon dioxide
What occurs on inspiration?
the diaphragm contracts and flattens, pulling the lungs down
500-800 mL of air enters the lung
What occurs on expiration?
it is passive and the lungs and diaphragm recoil
What do vesicular lung sounds sound like?
soft, low-pitched, heard over fine airways/peripheral lung
What do bronchial lung sounds sound like?
loud, high-pitched, heard over trachea
What is the mechanism and causes of crackles in the lungs?
M: excess airway secretions and deflated small airways/alveoli
C: bronchitis, respiratory infections, pulmonary edema, atelectasis, fibrosis, CHF
What is the main mechanism and cause of wheezing in the lungs?
M: rapid airflow through an obstructed airway (larger airways)
C: asthma, P. edema, CHF, bronchitis
What is the main mechanism and cause of rhonchi in the lungs?
M: transient airway plugging
C: pneumonia, bronchitis
What is the main mechanism and cause of pleural rub in the lungs?
M: inflammation of the pleura
C: pleuritis
What is the main mechanism and cause of stridor in the lungs?
M: partial blockage of aiway from an object or inflammation; can be life threatening
C: croup, aspiration, epiglottitis
When should you ausculatate voice sounds?
when tactile fremitus abnormal, when adventitious sounds present, or when dullness is percussed
What are the 3 methods of voice sounds?
A. Bronchophony (99)
B. Egophony (ee)
c. Whispered pectoriloquy (123)
What are some Dx tests you might order for CC of resp. origin?
CBC (WBC), ABG, CXR, V/Q scan, CT, Pulm. fxn tests, O2 sat
How long is the newborn's chest?
the same circumference as the head until age 2
What occurs in the newborn's lungs with age?
increase in the size of airway and number of alveoli
What are some health promotion tips for a newborn lungs?
use a bulb syringe for clearing nose/mouth, learn CPR
What occurs in the geriatric lungs?
loss of elasticity, atrophy of alveoli, decreased muscle tone, increased susceptibility to infection, and decrease in vital capacity/skeletal changes
What are some health promotion tips for respiratory in the elderly?
Pneumonia vaccine after age 65, maintain physical activity, health screenings for TB and CXR
What is the infant chest look like?
1:1 ratio with resps of 30/min at rest and 60/min with crying
What babies are at high respiratory risk?
premature, SGA, respiratory support
What are signs of resp. distress in infants?
nasal flaring, retractions, grunting (audible expiration)
What is some health promotion for the babies at risk for lung issues?
parents should stop smoking, learn signs of resp. distress, learn to clean infant's nose with bulb syringe, get immunizations, breast feed, back to sleep, and prevent suffocation
What is the leading cause of death in the US
cardiovascular disease
What is the flow of blood through the body
Through the sup. vena cava into the right atrium, tricuspid valve, right ventricle, pulmonic valve, pulmonary artery, lungs, pulmonary vein, left atrium, mitral valve, left ventricle, aortic valve, aorta, body
What is the electric pathway through the heart?
SA node, AV node, Bundle of His, Bundle Branches, Purkinje fibers
Where is the aortic area?
2nd ICS right sternal border
Where is the pulmonic area?
2nd ICS left sternal border
Erbs point
3rd ICS left sternal border
Where is the tricuspid area?
4th ICS left sternal border
Where is the mitral area?
5th ICS Left midclavicular line
Where is the apex?
down at the tricuspid and mitral valves; where you hear S1 loudest
Where is the base?
up towards aortic and pulmonic valves, where you hear S2 loudest
What occurs at S1
closure of tricupsid and mitral valves, loudest at apex
What occurs at S2
closure of the aortic and pulmonic valves; heard loudest at base
When can the opening of heart valves be heard?
if they are damaged
What is an opening snap?
a sound heard when a narrowed/stenotic AV valve opens during diastole
What is an ejection click?
the opening of a narrowed/stenotic semilunar valve during systole
Where is an ejection click heard?
at the base/ aortic and pulmonic valves
Where is an opening snap heard?
at the apex; mitral and tricuspid valves
What is arterial blood pressure
the lateral pressure exerted by a column of blood against the arterial wall
What is BP dependent on?
volume of blood ejected, velocity of blood, distensibility of arterial wall, viscosity of blood, and pressure within the vessel after ejection
What is normal BP
Less then 120/80
What is pre-hypertension
120-130/80-89
What is stage 1 hypertension?
140-150/90-99
What is stage 2 hypertension?
>160/>100
What are important s/s in a review of systems for Cardiac
chest pain, palpitations, dyspnea, syncope, fatigue, dependent edema, hemoptysis, cyanosis
What is the most important symptom of CV disease?
chest pain
What are some differential diagnoses for chest pain
cardiac, pulmonary, intestinal, gallbladder, MSK
Describe anginal chest pain?
retrosternal, diffuse, left arm/jaw/back, aching, dull, pressing, squeezing, milkd to severe, lasts minutes, precipitated by effort, emotion, eating, or cold, relieved by rest and nitro
If it is angina, it should never last longer than...
20 minutes
What are some common causes of cardiac related chest pain
CAD, aortic valvular disease, pulm. htn, mitral valve prolapse, pericarditis
What are some common causes of vascular chest pain
dissection of the aorta
What are some common causes of pulmonary chest pain
PE, pneumonia, pleuritis, pneumothrorax
What are some common causes of MSK related ches pain
costochondroitis, arthritis, muscle spasm, bone tumor
What are some common causes of neural related chest pain
herpes zoster (pain may come before the rash)
What are some common casess of GI related chest pain
ulcer disease, bowel disease, GERD, pancreatitis, hiatal hernia, cholecystitis
What are some common causes of emotional related chest pain
anxiety or depression
What are some common causes of palpitations
thyrotoxicosis, hypoglycemia, fever, anemia, pheochromocytoma, anxiety, caffeine, tobacco, drugs, panic disorders
What occurs with paroxysmal nocturnal dyspnea
waking up from sleep in the supine position from SOB
What is orthopnea
the need to sleep with pillows; dyspnea when lying flat
What do you ask if a patient has dyspnea?
how many level of blocks or stairs can they walk
What is trepopnea?
SOB less while lying on side
What are some cardiac causes of dyspnea
LV failure, mitral stenosis
What are some pulmonary causes of dyspnea?
obstructive disease, asthma, restrictive diseases, PE, pulmonary hypertension
What are some emotional causes of dyspnea
anxiety
What do you ask if a patient reports syncope
Were you doing anything before this? What position were you in? Did you have any other symptoms? Do you see an aura?
What is syncope
fainting d/t inadequate cerebral perfusion
What are some common causes of cardiac related syncope
cardiac rhythm disturbance
What are some common causes of metabolic related syncope
hypoglycemia, hyperventilation, hypoxia
What are some common causes of psych related syncope
hysteria
What are some common causes of neuro related syncope
epilepsy, CVA
What are some common causes of syncope d/t orthostatic hypotension
low fluid volume, antidepressant meds, antihypertensive meds, BPH meds
What are some common causes of cough related syncope
chronic lung disease
What is a common, vague complaint of cardiac issues
fatigue
What may be some causes of fatigue
depression, anxiety, anemia, heart disease, chronic disease
What occurs with edema in CHF patients?
it is symmetrical and dependent and worsens as the day goes on
What is hemoptysis
coughing up blood
What is a cardiac cause of hemoptysis
mitral stenosis, d/t rupture of the bronchial veins d/t high pressure
What may a dry, hacking cough be a side effect of?
ACE inhibitors
When is cyanosis a common sign of heart disease
in pediatrics
What might you assess in inspection for cardiac
general appearance, skin color, nails, face/eyes/mouth for cyanosis, neck, chest, extremities
What is ortho hypotension
drop in systolic BP of 20 mmHg or more in response to dizziness or syncope when standing
How to rule out supraclavicular aortic stenosis
increased BP in right arm but not same reading in left arm
How to check for coarctation of the aorta
if BP is elevated in arms, check in the legs. If the leg is lower than the arm, this is positive for possible coarc
How to check for cardiac tamponade
If pt has a low BP and a rapid pulse, look for pulsus paradoxus (a fall in systolic BP during inspiration that is greater than 10 mmHg)
What is cardiac tamponade a s/e of
pulling pacer wires
What is pulsus paradoxus
fall in systolic BP greater than 10 mmHg during inspiration
What should you do before palpating carotid arteries?
auscultate for bruits
How should you assess JVD?
check on the right internal jugular at a 30-45 degree angle with penlight or tangential lighting
How do you check hepatojugular reflex?
abdominal compression; place pressure over the liver and the neck will distend
What may be the cause if the PMI is misplaced laterally, instead of the 5th ICS LMCL
it may mean cardiomegaly
How do you assess cardiac for thrills?
with ulnar surface of hands
How do you assess cardiac for heaves or lifts?
with palm or fingers
What are the four positions for cardiac auscultation?
sitting, leaning forward, lying, and left lateral recumbent
What do you listen to with the heart when patient is lying?
All areas with bell and diaphragm
What do you listen to with the heart when patient is in left lateral recumbent?
listen to Tricuspid and mitral with the bell
What do you listen to with the heart when patient is sitting up?
all areas with bell and diaphragm
What do you listen to with the heart when patient is leaning forward?
Tricuspid and mitral with the diaphragm
How do you describe murmurs?
with timing, location, radiation, duration, intensity, pitch, quality, relationship to respiration, and relationship to body position
What are some abnormalities of the first heart sound/ S1 (apex)?
rate of rise of ventricular pressure, condition of valve, position of valve, distance of heart from chest wall
What are some abnormalities of the second heart sound/ S2 (base)?
changes in systolic pressure, condition of valve, splitting of S2 (associated with inspiration)
What are some reasons for an S3 heart sound?
pathologic, marker of ventricular overload or systemolic function; common with CHF; heard in early diastole, hooked onto end of S2
When do you hear S3 sound?
early diastole, hooked onto end of S2
When do you hear S4
late in diastole, hooked onto the beginning of S1
What is S4
pathologic; marker of poor diastolic function; most often in poorly controlled HTN or recurrent ischemia
S3 is commonly due to...
CHF
S4 is commonly due to...
HTN
When do ejection clicks occur?
early or middle of systole, at the aortic or pulmonic semilunar valves
When do midsystolic clicks occur?
with mitral valve prolapse at the Apex
Where do ejection clicks occur?
at the base (semilunar, A and P)
Where do you hear opening snaps?
AV valves; mitral stenosis; at the apex
When do you hear a murmur?
when there is turbulent energy in the walls of the heart and blood vessels; systole or diastole
What is a stenotic murmur?
due to valves not opening; hardened; likely from plaque
What is a regurgitation murmur?
valves not closing
What is a grade 1 murmur?
lowest intensity, often not heart by inexperienced; very faint
What is grade 2 murmur?
low intensity, usually audible by inexperienced
What is grade 3 murmur
medium intensity without thrill, as loud as S1 or S2
What is grade 4 murmur?
medium intensity WITH a thrill
What is grade 5 murmur?
loudest murmur that is audible with steth; associated WITH a thrill
What is grade 6 murmur?
loudest intensity, audible with steth is removed from chest; associated WITH a thrill
When will you feel a thrill with a murmur?
Grades IV-VI
What are arteries?
high pressure and receive blood
What are veins?
low pressure, have valves, return blood to heart
What are common s/s with per. vascular issues?
pain, change in skin temperature and color, edema, ulceration, emboli, stroke, dizziness
What is a common issue in men with peripheral vascular?
erectile dysfunction; may be d/t blockage of femoral artery
What is intermittent claudication
pain in lower extremity during exercise (calf, arch of foot, thighs, hips, buttocks); site of pain distal to occlusion
What is Leriche syndrome
chronic aortoiliac obstruction that causes intermittent claudication and erectile dysfunction
What will skin be like with arterial insufficiency?
cool and pale; nonhealing ulcers
What will skin be like with venous insufficiency
warmer than usual; blood pooling
What is DVT
red, swelling, warm; 2cm difference in extremities at ankle or midcalf
When is lymphedema common
after breast surgery or lymphedema
What is ulceration
persisent ichemia of a limb that can lead to gangrene
What is the most important cause of a thrombus formation?
venous stasis
What are secondary s/s to emboli
SOB (with PE), abd pain (splenic, intestinal or renal artery), neuro symptoms (if carotid or vertebrobasilar artery), pain and parethesias (if per. artery)
Where is the epitrochlear node and how do you feel lit?
in the groove of the elbow; have pt flex elbow 90 degrees and feel in groove; should NOT be palpable
What does it likely mean if epitrochlear node is palpable?
acute infections or non-hodgkins lymphoma
What are the 5 "P" signs of arterial occlusion?
pain, pallor, paresthesia, paralysis, pulselessness
What is DVT s/s
unilateral, marked swelling of lower extremity with redness, pain, warmth and tenderness (change in calf size to baseline)
What are the 3 color changes of Raynauds?
1. Pallor/White- artiospasm and decreased blood supply

2. Cyanosis/ Blue- increased peripheral extraction of oxygen

3. Rubor/Red- return of blood supply
What is gangrene
necrosis of deep tissues resulting from decreased blood supply
What occurs in cardio and peripheral vascular with age?
Decreased elasticity of aorta; regurgitant or stenotic valves; degeneration of conduction system; arrthymias (afib), hypertension, risk in systolic pressure w/o diastolic rise
What may cause angina, MI, or fatigue in elderly
coronary atherosclerosis
What are some CV labs you might draw?
Troponin, CPK-MB, CBC w/ diff, CMP, O2, PT/INR, Mg, lipid
What are some diagnostic CV tests?
echo, EKG, CXR, carotid doppler, periperal doppler, tilt study, CT abdomen, sleep study, 24 hour BP monitor. 24 hour Holter, 30 day event recorder, angio
What are some CV drugs
antihypertensives, beta blockers, nitrates, ARBs, ACE inhibitors, antiarrythmics, coumadin, pradaxa, plavix, aspirin, statins, fenofibrates, niacin
Who can NOT have pradaxa?
those with a valve issue
What are some educational topics about CV disease
low sodium cardiac diet, aerobic exercise, BP management, side effects of meds, cardiac rehab
What should you do if taking Beta blocker?
sit up slowly
What are some health maintenance tips for cardiac
weigh loss/BMI (decrease in 5 pounds lowers BP by 10 points), stop smoking
What organs are located in the LUQ
spleen, stomach, body of pancreas, kidney, transverse and descending colon
What organs are located in the LLQ
kidney, sigmoid colon, ovary/fallopian tube
What organs are located in the RUQ
liver, gallbladder, duodenum, head of the pancreas, kidney, ascending and transverse colon
What organs are located in the RLQ
kidney, cecum, appendix, ascending colon, ovary/fallopian tube
What is the #1 abdominal complaint?
gastritis (LUQ)
Where will you feel pain with cholecystitis?
RUQ and referred scapula pain
Where will you feel pain with pancreatitis?
Upper quadrants and shoulders
If they have lower quadrant pain, what should you ask?
LMP? Any pregnancies? It may be pregnancy related, ovary torsion/twisting, dysmenorrhea
What should you ask if a male patient has abdominal pain and is older?
his voiding history
Which quadrants of the abdomen are flexible and may change with eating?
lower quadrants
What are the 3 savlivary glands?
Parotid- empties into Stenson duct
Sublingual- empties into Wharton's duct
Submandibular-
What occurs in the mouth?
mechanical digestion, carbohydrates are broken down
What does saliva do?
lubricates for speech and swallowing and cleans teeth and breaks down food
What is the pH of the esophagus?
alkaline; pH 6-8
What is a large issue with the esophagus?
GERD
What occurs in the stomach?
chemical digestion
What are some problems with the stomach?
peptic ulcer, gastritis, reflux, stomach CA
Who is at higher risk for stomach cancer?
Asians
What is the pH of the stomach?
acid, 2-4
How much gastric juice does your stomach make each day?
2-3 liters
When does food move into the duodenum?
about 2-4 hours after eating
How long does it take for the stomach to empty?
6 hours
What occurs mainly in the small intestine?
absorption of nutrients
What is the order of the small intestine?
Duodenum, Jejunum, Ileum, Ileoceccal valve
What happens when food enters the duodenum from the stomach?
pancreatic enzymres are stimulated and the gallbladder contracts to release bile
What occurs in the large intestine?
water and electrolytes are absorbed and stool is formed
Where is the liver located?
RUQ
What is the largest solid organ in the body?
liver
Where is the liver normally?
from the 5th rib to 1-2 cm below the right costal margin
What are the functions of the liver?
glucose storage, metabolism of proteins, lipids and carbs, production/secretion of bile, production of clotting factors, and detoxification
What are the 3 ways to assess the size of the liver?
1. to feel for percussion of the liver span

2. Scratch test

3. Hook the liver
What do you do to assess liver span?
Start at MCL, percuss for resonance and move down til turns dull. Then begin at umbilicus and percuss upward until dull
Where is the pancreas located?
RUQ & LUQ
What is the exocrine function of the pancreas?
secrete bicabonate and pancreatic enzymes
What is the endocrine function of the pancreas?
to secrete hormones of insulin and glucagon
Where is the spleen located?
LUQ
What is the largest lymph organ in the body?
spleen
What does the spleen do?
act as a reservoir for red blood cells and filters old RBCs and platelets
What happens with mono?
the spleen gets enlarged
Where is the appendix?
RLQ
What does the appendix do?
fill with digestive material from the cecum
What happens if the appendix does not empty completely?
it becomes obstructed of infected
Who most commonly gets appendicitis?
those under age 20 or the elderly
What does the gallbladder do?
stores and concentrates bile produced by the liver and releases it into the duodenum when stimulated
Where are the kidneys?
T4-L3
What will help tell if kidneys are inflamed?
testing for CVA tenderness
Some questions to ask in abdominal health history:
medications, bowel habits, enema use, stool color and consistency, hemorrhoids, bleeding, N/V/D
What is description of GERD
gastric secretions emptying into the esophagus
What is the etiology of GERD
increased intra-abdominal pressure
What are clinical findings with GERD?
heartburn
regurgitation
dyphagia
What is the description of a hiatal hernia?
Protrusion of the stomach through the esophagus
What is the etiology of a hiatal hernia?
weekend abdominal muscles
What are clinical findings with hiatal hernia?
heartburn, regurgitation, dysphagia
What is the description of peptic ulcer disease
ulcer in the esophagus, stomach, or duodenum
What is the etiology of peptic ulcer disease
H. pylori, stress, or medications
What are clinical findings with peptic ulcer disease
Pain 1-4 hours after eating; relieved by antacids
What is a description of crohn's disease
chronic bowel inflammation; narrowing of the lumen; mucosa ulcerated and forming fistulas
What is the etiology of Crohn's Disease
Unknown
What are clinical findings with Crohn's Disease
Severe CRAMPING abdominal pain, diarrhea, weight loss, can affect ANY area of GI
What is the description of ulcerative colitis
chronic inflammatory bowel disease that starts in the rectum to the large intestines
What is the etiology of ulcerative colitis
unknown
What are clinical findings with ulcerative colitis
severe abdominal pain, fever, chills, anemia, weight loss, bloody stools
What is the description of diverticulitis?
herniations in the muscular wall of the colon with inflammation and abscesses
What is the etiology of diverticulitis
unknown
What are clinical findings with diverticulitis?
LLQ crampy pain, N/V, constipation, distended abdomen, decreased bowel sounds, fever
How can you diagnose divertilicutis
CT scan or colonoscopy
What are signs of hepatitis?
N/V, anorexia, jaundice, clay colored stools, fatigue
How do you get Hep. A?
bathrooms, dirty food/water, travel
How do you get Hep. B
drugs, sex
How do you get Hep C
usually healthcare related or drug users
What is the description of hepatitis
inflammation of the liver
What is the etiology of hepatitis
viral
What are s/s of hepatitis?
Anorexia, vague abdominal pain, N/V, enlarged liver, jaundice, clay-colored stool, dark amber urine
What is the description of cirrhosis?
chronic degenerative disease of the liver; lobes become infiltrated with fat
What is etiology of cirrhosis?
usually alcoholism, biliary obstruction, or hepatitis
What are clinical findings with cirrhosis?
liver hardening, ascites, jaundice, clay colored stools, dark amber urine
What is the description of cholecystitis?
inflammation of the gallbladder, chloelithiasis (gallstones)
What is the etiology of cholecystitis?
gallstone obstruction
What are clinical findings with cholecystitis?
RUQ colicky/spasming pain that radiates to the right scapula, indigestion
What is the description of pancreatitis?
inflammation of the pancreas from autodigestion
What is the etiology of pancreatitis?
untreated gallstone obstruction or alcoholism
What are clinical findings associated with pancreatitis?
steady boring, sharp pain that radiates to the back, N/V, weight loss, glucose intolerance, epigastric pain that radiates; feels better when sitting up and forward
What makes pancreatitis pain better?
sitting up and forward
What hurts the most with pancreatitis pain?
lying down
What is the description of a UTI
inflammation of the bladder
What is etiology of UTI
gram negative organisms
What are clinical findings with an UTI
frequency, urgency, dysuria
When should you begin screening for colorectal cancer?
at age 50 (or 45 if African American)
What is the preferred screening for colorectal cancer detection?
colonoscopy
What are alternate screenings for colorectal cancer?
fecal immunohistochemical testing yearly, CT colonography every 5 years, or flex sig every 5 years
Who is at highest risk for GI cancers?
Males, over the ages of 50-60, those who smoke and drink alochol
What are risk factors for esophageal cancer?
males, ages 70-80, African American, smoking, alcohol, deficiencies of fruits and veggies, Barrett's esophagus
What are risk factors for stomach cancer?
Males, over age 65, Asians, Hispanics, African-Americans, smoking, alcohol, diets high in smoked foods, and those with H. pylori
What are risk factors for colon cancer
males, age over 50, Jewish, smoking, alcohol, diets high in animal fat, those with diabetes
Who are at high risk for liver cancer?
males, over age 65, smoking, alcohol, and hepatits or cirrhosis
Who are at risk for pancreatic cancer?
males, ages 60-80, smoking, diet high in meat and fats, those with diabetes
Who are at risk for bladder cancer?
males, age over 68, caucasians, smoking, diet with contaminates in fluids, chronic bladder inflammation
What is a description of parietal pain?
steady aching, worsened by position change or cough and rebound tenderness
Describe pain in the visceral peritoneum?
covers organs, described as diffuse, gnawing, crampy, aching, sharp, throbbing, can be pointed to
What is obturator muscle test?
test for appendicitis; patient lying supine, flex R knee and internally rotate the hip, causes pain
What is the ileopsoas sign?
Have patient lay supine, raise the Right leg against resistance or roll on the Left side and extend the Right leg back/hyperextend and it will cause increased RLQ pain
What is rebound tenderness?
test for appendicitis or parietal pain- press the abdomen and let go, pain on release
What is Rovsings sign?
test for appendicits; press into the LLQ and pain will increase in the RLQ
What is Kehr's sign?
test for spleen problems; lift arm above the head, you will feel LUQ pain
What is the order for the abdominal assessment?
inspect, auscultate, percuss, palpate
What is murphy's sign?
test for gallbladder problems, push on the gallbladder while the patient is taking deep breath and pain will cause breathing to stop
What are some reasons, starting with "F", that the abdomen will be rounded?
fat, flatulence, fetus, fluid, fibroid tumor, feces
What may a venous pattern on the abdomen mean?
portal hypertension
What should you do if you suspect a hernia?
ask the patient to raise his/her head and shoulders off the table and cough; the bulge of a hernia will usually appear with this action
What is a sign of internal bleeding on the abdomen?
Cullen's sign; blue umbilicus
How long must you listen before you make bowel sounds as absent?
5 minutes
Where will you listen to the abdomen with the bell and what are you listening for?
bruit- abdominal aorta, renal arteries, iliac arteries, femoral arteries

venous hum- umbilicus
Where will you listen for a friction rub?
over the liver and spleen
What is Ballance sign?
You should hear tympany over the LUQ. If you percuss and hear a dull sound, it may be that the spleen is enlarged, and this is a positive Ballance sign
What sounds do you normally hear with percussion over the stomach and intestines?
tympany
Where do you normally percuss dullness in the abdomen?
in the abdominal organs and a distended bladder
How do you do the liver scratch test?
place steth diaphragm over the RUQ liver, start to scratch in RLQ and move upward. Make when sound becomes louder. Mark all areas of the liver to determine size.
How do you test liver span?
start at R MCL 3rd ICS and assess when it changes from resonance to dull and mark it.

Then start at R MCL at umbilicus moving up, check when it changes from tympany to dull and mark it.

Measure the spaces, and this is liver span. Should be 6-12 cm
What is normal liver span?
6-12 cm
What do you percuss the kidneys for?
pain/CVA tenderness
When is a pulsation in the abdomen okay?
2 cm is okay, 4 cm is still sometimes okay, 5 cm we intervene
How do you check rebound tenderness?
press hand firmly into abdomen and then release
How do you check McBurney's point?
rebound tenderness at the RLQ 1/3 distance from the iliac crest to the umbilicus
How do you test cutaneous hypersensitivity?
gasp a fold of skin or touch the abdomen with an open safety pin
What occurs in the abdomen with age?
abdominal muscles diminish in mass and tone, fat increases, GI motility slows and absorption is altered, decreased acid, increased malignancy, changes in bowel habits
What is a healthy waist circumference?
women less than 35 inches; men less than 40 inches
What are some tests/labs you would do for abdominal assessment?
CBC with dif (any -itis)
Chem panel (kidneys)
Amylase/lipase (pancreas)
UA/HCG (if preg/female)
Stool culture (diarrhea, travel)
EKG- UQ/epi pain
Films- Xray to r/o air in the bowel
US
Abdominal CT- highest diagnostic yield
Colonoscopy- lower bowel