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L's abd abnorm
| Question | Answer |
|---|---|
| Alimentary Tract | frequent loos or liquid stools lasting <4wks, mostly viral; food-borne c internt'l travelers; contaminated water; undercooked poultry/beef; raw shelfish Norwalk virus; food poisoing |
| Alimentary Tract | abrupt onset last <2wks; abd pain, n/v, fever, tenesmus, vomiting several hrs ingestion of source; bloody diarrhe with some organisms |
| Alimentary Tract | diffus abd tenderness; may mimic peritoneal inflamm c RLQ & guarding; if sever may have mod-severe dehydration esp infants, children, and older adults |
| GERD | relaxation incompetence of lower esoph sphincter; delayed gastric emptying is predisposing factor; more common elderly & preg |
| GERD | heartburn, bitter/sour taste, hoarseness, back arching/fussiness c feeding or regurg.; precip acute asthma exacerbation |
| GERD | unremarkable exam; may have eryth of pharynx and edematous vocal cords |
| IBS | 1-5 Americans more in women; begin late adol. Or early adult rarely for 1st time p age 50 |
| IBS | cluster sympt (abd pain, bloating, const & diarr); alt diarr/const; mucus in stool; bouts at times of stress |
| IBS | unremarkable exam; dx p excluding other etiol; Rome III dx criteria |
| Hiatal Hernia c Esophagitis | women & older adults; assoc c obesity, preg, ascites, tight clothing, mus weakness |
| Hiatal Hernia c Esophagitis | epig pain/ heartburn; water brash; dysphagia; asymp; incarcerated |
| Hiatal Hernia c Esophagitis | unremark exam; erythema of pharynx & edematous vocal cords |
| Duodenal Ulcer | H pylori or >gastric acid sec; approx twice as often in men as women |
| Duodenal Ulcer | localized epig pain when empty stomach; upper GI bleed |
| Duodenal Ulcer | ant ulcers tender on palp; ant more likely perforate/ post like to bleed; perf = acute abd |
| Crohn's disease | chronic inflam any of GI tract c ulcerations, fibrosis, & malab.; imbalance proinflamm & antiinflamm mediators |
| Crohn's disease | chronic diarrhea comp nutritional status; arthritis, iritis, eryth nodosum; unpred flares and remissions |
| Crohn's disease | RLQ tend, abd mass 2 inflamm bowel, perianal skin tags/fistulas/abscess; cobblestone appear of mucosa; fistula formation |
| Ulcerative Colitis | chronic inflam colon/rectum; ulceration; immuno & genetic factors?; predisposed to cx |
| Ulcerative Colitis | bloody, freq diarrhea; wt loss & fatigue; mild-severe; remission for yrs; scleroising cholangits= fatigue & jaundice |
| Ulcerative Colitis | no fistula or perianal disease; loss of mucosal pattern on rad; s.c. = cholestatic pattern of elev transaminases |
| Stomach Cancer | epith cells of mucous mem; lower half most common; as prog moves to muscle layer |
| Stomach Cancer | vague & nonspec c/o; loss of appet, feeling of fullness, wt loss, dysphagia, epig pain |
| Stomach Cancer | midepig tenderness, hepatomeg, elrged supraclav nodes, ascitis; epig mass late stages |
| Diverticular Disease | mucosal outpouchings thru colonic muscle; sigmoid most common; etiol uknown, colonic dysmotility? |
| Diverticular Disease | asymp; diverticulitis LLQ pain, anorexia, n/v, const; Diverticular Disease |
| Colon Cancer (Colorectal Cancer) | rectum, sigmoid, prox & desc colon; 2nd most common cx in US |
| Colon Cancer (Colorectal Cancer) | symp dep location; abd pain c bloody stools or change in stools; occult blood earliest sign |
| Colon Cancer (Colorectal Cancer) | few early exam finidngs; palp abd mass R or LLQ, may be palp by digital exam; symptoms of anemai |
| Hepatitis | hepatocellular necrosis; viral/drug/alcohol; hep d only with hep b; hep e fecal contam waters (nat disaster) |
| Hepatitis | asymp; jaundice, anorexia, abd pain, clay-colored stools, tea-colored urine, fatigue |
| Hepatitis | LFT's abnorm; jaundice & hepatomeg; may have cirrhosis with assoc findings |
| Cirrhosis | fibrous, nodular liver; wks-yrs progression; symp from |
| Cirrhosis | jaundice, abd pain, anorexia, clay-colored stool, tea-colored urine, fatigue; cutaneous spinder angiomas, abd fullness |
| Cirrhosis | LFT's and coag abnorm; liver enlrg'd & nonfirm; scarring prog liver reduced; neuro abnorm seen; port htn lead to esoph varices |
| Hepatocellular Carcinoma | setting of cirrhosis 20-30 yrs p injury;6 mos; met to lungs, nodes, bone, brain; vacc may reduce incidence |
| Hepatocellular Carcinoma | jaundice, anorexia, fatigue, abd fullness, clay-colored stools, tea-colored urine |
| Hepatocellular Carcinoma | hepatomeg hard irreg liver border; nodules may be palp and tender or nontndr finding r/t cirrhosis |
| Cholelithiasis | crystals mix with mucus and form sludge & stones; cholesterol & ca+ bilirubinate; fibrosis & dysf predisp to gall blad cx |
| Cholelithiasis | asymp; indigestion, colic, mild transient jaundice |
| Cholelithiasis | episodes of acute cholecystitis |
| Cholecystitis | inflamm most d/t obst by stone; distended c comp blood flow; acute s stones d/t condition effect emptying; |
| Cholecystitis | ruq pain rad to midtorso and R scap; fever, jaundice, anorexia; fat intol c chronic, flatulence, nausea, anorexia & abd pain |
| Cholecystitis | ruq & epig, invol guarding or rebound; may have palp gallbladder; may be subtle like diffuse abd pain |
| Nonalcoholic Fatty Liver Disease (NAFLD) | spectrum of disorders; hepatic cell inflam/injury d/t accum triglyc; genetic a & enviro; insulin resist |
| Nonalcoholic Fatty Liver Disease (NAFLD) | asymp; ruq, fatigue, malaise, jaundice |
| Nonalcoholic Fatty Liver Disease (NAFLD) | lft's abnorm; elev transaminases; elev bmi; hepatomeg in half; jaundice & ascites; MRS & biopsy |
| Acute Pancreatitis | acute inflamm process release of pancreatic enz result in glandular autodig., chronic alch use 80% |
| Acute Pancreatitis | sudden onset persistent epig pain may rad to back; constant dull pain; n/v, abd distension, fever, anorexia |
| Acute Pancreatitis | diffuse abd tenderness, invol guarding, abd distens, |
| Chronic Pancreatitis | irrevers morph changes result in atrophy, fibrosis, |
| calcification; congenital, alcohol, hereditary, cystic fibrosis, autoimmune | |
| Chronic Pancreatitis | constant, unremitting abd pain; wt loss; steatorrhea |
| Chronic Pancreatitis | chronic > likelihood of pseudocyst form; malnutrition and < subq fat & temporal wasting; enz elev, glucose intol |
| Spleen Laceration/Rupture | most common inj organ p abd trauma d/t location; blunt or penetrating; most often blunt |
| Spleen Laceration/Rupture | pain to LUQ with radiation to shoulder (Kehr sign); hypovolemia signs with blood loss |
| Spleen Laceration/Rupture | LUQ on palp, signs of peritoneal irrit, dx made by paracentesis or CT, hypotension and |
| Acute Glomerluonephritis | inflamm capillary loops of renal glomeruli; immune complex deposition or form, causes common inf/ IgA nephropathy |
| Acute Glomerluonephritis | nonspec |
| Hydronephrosis | dilation renal pelvic anc calyces d/t obst; > ureteral pressure = changes glom filtration, tubular function, renal blood flow |
| Hydronephrosis | acute obst int & sever pain with n/v; asymp c hydroneph on rad; 2 inf report abd pain/hematuria /flank pain/fever |
| Hydronephrosis | most unremark exam; sever kidneys are palp, CVA tenderness; lower tract obst distended bladder palpable |
| Pyelonephritis | inf kidney & renal pelvis; gram-neg bacilli, less common c hosp & indwell cath; risk factors |
| Pyelonephritis | fever, dysuria, flank pain; rigors, polyuria, urinary freq, urgency, hematuria |
| Pyelonephritis | ill-appearing sig pain; fever, CVA tend dist from UTI; pyuria & bacturia on lab confirm dx |
| Renal Abscess | localized inf medulla or cortex of kidney, often gram-pos, medullary ab commonly gram-neg (E-coli, Klebsiella) |
| Renal Abscess | pyelo sympt persist beyone 72hrs of abx therapy; chills, fever, dysuria, flank pain |
| Renal Abscess | ill-appearing, fever, sig pain; CVA tend; pyuria & bacturia on UA if in medulla pyuria only if in cortex |
| Renal Calculi | stones in pelvis assoc c obst & inf; calcium salts, uric acid, cystine, or struvite; alkaline urine conducive; more in men |
| Renal Calculi | fever, dysuria, hematuria, flank pain; renal colic = severe cramping flank pain with n/v from flank to groin then scrotal/labial area |
| Renal Calculi | present in ER with severe cramping pain; CVA tend and abd tend on palp; UA micro hematuria & elev Ca+ to Creatinine ratio |
| Acute Renal Failure | sudden impairment renal function hrs to days; serum creat .5-1;< GFR = rtent of nitrog waste and extracell fluid; prerenal, renal, postrenal; intrinsic ARF d/t renal parenchymal inj, acute tubular nechrosis from nephrotoxic med, sepsis, ischemia; |
| Acute Renal Failure | urine output may be norm < or absent; prerenal may have had symp dehyd (vom, diarr, < intake, diuretic use); postrenal symp of urinary obst; intrinsic ARF symp r/t underlying cause (glomer neph, systemic lupus) |
| Acute Renal Failure | nonspec exam; signs fluid overload (JVD, edema) or deficit (hypotens, BP changes, dry MMs); postrenal ARF with comp obst may have abd dist and suprapub tend on palp |
| Intussusception | prolapse/telescoping of one seg int into other causing obst; infants 3-12 mos; common site terminal ileum |
| Intussusception | acute int abd pain, abd dist, vom; dramatic onset, int bouts leth; inconsol c legs flexed; ischemia stool mixed blood & mucus |
| Intussusception | sausage-shape mass palp R or LUQ c RLQ empty (Dance sign); signs bowel perf; dx and tx use of an air-contrast enema |
| Pyloric Stenosis | Hypertrophy circ mus of pylorus leads to obst; more commone white males; cause unknown, assoc with erythromycin |
| Pyloric Stenosis | p sev wks of age, regurg prog to proj vom; feeding eagerly; fail to gain wt |
| Pyloric Stenosis | small, rounded, olive-shaped mass RUQ part p infant vom; U/S c surgical consult |
| Meconium Ileus | dist int obst caused by thick inspissated impacted meconium in lower int; first manif CF |
| Meconium Ileus | failure to pass meconium in first 24hrs p birth; symp r/t obst |
| Meconium Ileus | abd distension, signs of shock if complicated; uncomp tx'd with hyperosmolar enemas under fluoro |
| Biliary Atresia | cong obst or absence of bile duct sys result in bile flow obst, most abs entire biliary tree; postnatal or embryonic onset |
| Biliary Atresia | neonatal in 1st wks |
| Biliary Atresia | most full term c jaundice in first 2 mos, hepatomeg, splenomeg indic portal HTN; embry c hear murmur assoc c cong disease |
| Meckel Diverticulum (most common GI congent anomaly) | outpouchin of ileum, varies in size, dev from incomp obliteration of vitelline duct result in blind-ending pouch |
| Meckel Diverticulum (most common GI congent anomaly) | asympt; incidental during rad or surg; bright or darkr red rectal bleeding, abd pain pres c/o, |
| Meckel Diverticulum (most common GI congent anomaly) | painless rectal bleeding, present c int obst & rebound tend; if severe perf occur c peritoneal signs |
| Necrotizing Enterocolitis | inflamm diseas of GI mucosa assoc c prematurity; most common GI emerg in neonates; cause uknown |
| Necrotizing Enterocolitis | subtle symp |
| Necrotizing Enterocolitis | temp instab and subtle signs distress; lethargy, abd dist, apnea, resp distress, pneumatosis intestinalis, fatal d/t comp |
| Neuroblastoma | solid malig of embryonal orig in PSNS; commonly adrenal medulla (anywhere caniopinal axis); cause uknown |
| Neuroblastoma | asympt abd mass; malaise, loss of app, wt loss, protrusion 1 or both eyes; symt arise d/t comp by mass |
| Neuroblastoma | firm, fixed, nontend, irreg, nodular abd mass crosses midline; metastases to periorb; dancing eyes and dancing feet |
| Wilm's Tumor (Nephroblastoma) | most common intrabd tumor children (appear age 2-3); sporadic; wilms tumor gene; assoc sev syndromes |
| Wilm's Tumor (Nephroblastoma) | painless enlrg abd; abd pain, vom, hematuria; id'd during genetic screening |
| Wilm's Tumor (Nephroblastoma) | may feel on abd palp, firm, nontend mass in flank, slightly movable DOES NOT cross midline, HTN may be pres |
| Hirschsprung Diease (Congenital Aganglionic Megacolon) | abs paragang cells in seg of colon; abs of peristalsis lead to obst; most common cause lower obst in newborns |
| Hirschsprung Diease (Congenital Aganglionic Megacolon) | sympt begin at birth c failure to pass meconium 24-48hrs; failure to thrive, const, abd dist, bilious vom |
| Hirschsprung Diease (Congenital Aganglionic Megacolon) | severe constip c abd dist and stool palp in LL abd |
| Hemolytic Uremic Syndrome (HUS) | triac of microangiopathic hemolytic anemia, thrombocytopenia, & uremia; cause ARF child <4; caused by Ecoli |
| Hemolytic Uremic Syndrome (HUS) | preceding URI or gastroent c fever abd pain & vom, bloody diarr; symp of acute abd; sudden onset pallor, weakness, lethargy, |
| Hemolytic Uremic Syndrome (HUS) | dehydration, edema, petechiae, hepatosplenomeg; sever GI disease c peritoneal signs |
| Fecal Incontinence | inability to conrol BM; fecal impaction most common cause; local neurogen disorder; cognitive neuro disorder |
| Fecal Incontinence | most have overlow incont; unable to recognize rectal fullness, stool formed, p meals |
| Fecal Incontinence | dx thru dig rect exam assess rectal tone; rad studies helpful determine cause |
Created by:
lfager
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