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Abdomen 2

Advanced Physical Assessment

A pilonidal cyst fairly common, congenital, midline superficial to the coccyx or the lower sacrum- tuft of hair, pus if infected
External hemorrhoids are dilated hemorrhoidal veins below the pectinate line covered with skin- seldom produce symptoms- unless thrombosis occurs (acute local pain that increases with defecation) tender, swollen, bluish, ovoid mass is visible at the anal margin
Internal hemorrhoids cannot see unless prolapsed- may cause bright-red bleeding, during defecation- if prolapsed, appears as reddish, moist
Prolapse of the Rectum appearing as a doughnut or rosette of red tissue- is relatively small and shows radiating folds
Anal fissure painful- comes with constipation- midline posterior- less commonly anteriorcentinal skintag below it- apply lidocaine beforehand d/t pain
Anal fistula it is an inflammatory tract or tube that opens at one end into the anus or rectum and at the other end onto the skin surface or into another viscus. An abscess is the cause- look for the opening
Biliary colic female, fertile, 40s, fatty- releasing cholecystokinin- pain radiates to the chest after fatty meal- no tenderness? (acute cholecystitis has INFLAMMATION- difference- abdomen is tender +Murphys)
23 y/o male presents with several hours h/o RUQ/ epigastric pain, n/v, Pain radiates to back. No hematemesis, no melena, hematochezia, night of heavy drinking, Denies f/c, No d/c acute pancreatitis
64 y/o male presents with 3 day h/o pain LLQ, Nonradiating, no change w/meals, better with BM, Some constipation, no melena, hematochezia, No f/c, no n/v. no dysuria, hematuria diverticulitis LLQ
Tenderness, rebound tenderness, rigidity, fever peritonitis
TEST s/s never wake you up at night irritable bowel no weight loss, no fever, no blood in stool inflammatory WILL WAKE YOU
Hiatal Hernia with Esophagitis Part of the stomach passes through the esophageal hiatus in the diaphragm into the chest cavity-Epigastric pain or heartburn- worsens with lying down-relieved by sitting up or antacids-Water brash, Dysphagia, sudden onset of vomiting, pain
Duodenal ulcer from infection with H. pylori, & ↑gastric acid secretion (e.g. Zollinger-Ellison syndrome or gastrinoma), twice as often in men as in women, during fasting, relieved by food
Gastric ulcer pain is worse with food
Stomach cancer hard to detect early, loss of appetite, feeling full, dysphagia, hepatomegaly, wt loss, mid epigastric tenderness, enlarged supraclavicular lymph node (left side) need endoscopy for persistent epigastric pain/ulcer
Crohns disease characterized by fistulas- any point in the gut- the anus- antibiotic is cipro/flagyl-
Ulcerative colitis Chronic inflammatory disorder of the colon and rectum that produces mucosal friability and areas of ulceration-immunologic and genetic factors have been implicated-predisposes to colon cancer, wt loss, fever
Colon cancer Symptoms depend on cancer location (rectum, sigmoid, proximal, and descending colon), size, and presence of metastases-abdominal pain, blood in the stool, or a recent change in the frequency or character of stools- 2nd most common CA
Hepatitis- any Some are asymptomatic; others report jaundice, anorexia, abdominal pain, clay-colored stools, tea-colored urine, and fatigue- hepatomegaly- abnormal lfts
Gallstones/cholelithiasis mild colicky pain 1st with mild transient jaundice with inflammation, indigestion
Cholelithiasis/gallstones Stone formation in the gallbladder occurs when certain substances reach a high concentration in bile and produce crystals- produces episodes of acute cholecystitis
Cholesystitis pain in the RUQ, may be rebound w/ radiation to the right scapular region; abrupt, severe, lasts for 2-4 hours, fever, jaundice, anorexia, fat intolerance, flatulence, anorexi, full palpable gallbladder in the RUQ, +Murphys
2 most common causes of acute pancreatitis etoh and gallstones (fatty foods)
Acute glomerulonephritits many causes; most common infx (poststreptococcal) and immune-mediated (IgA nephropathy)- Inflammation of the capillary loops of the renal glomeruli- s/s- nausea, malaise; flank pain, headache secondary to hypertension, tea-colored urine or gross hematuria
Hydronephrosis big kidney- turns into bags of water- Dilatation of the renal pelvis and calyces due to an obstruction of urine flow anywhere from the urethral meatus to the kidneys-kidneys palpable, cva tenderness, abdominal/flank pain, hematuria, fever, n/v
Pyelonephritis Infection of the kidney and renal pelvis, fever, dysuria, flank pain, rigors, polyuria, urinary frequency, urgency, and hematuria, cva tenderness, pyuria and bacteriuria are present and confirm dx
Renal calculi vs renal calculi renal stones are more painful
Renal Calculi Stones formed in pelvis of the kidney-causes obstruction and infections in the urinary tract- made of calcium salts, uric acid, cystine, and struvite- n/v, fever, dysuria, hematuria, flank pain
Pruritis Ani infectious- treat the family- Commonly caused by fungal infection in adults and by parasites (pin worms) in children
Created by: arsho453