PDX Abdomen for exam 3
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what is total absence of bowel sounds a sign of | show 🗑
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how long must you listen to bowel sounds for | show 🗑
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peritonitis | show 🗑
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show | "as silent as the grave" - failure of passage of enteric contents thru small bowel and colon; paralysis of intestinal motility
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ascites | show 🗑
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show | palpation technique used to evaluate a structure that is floating by bouncing it gently and feeling it rebound
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show | prolonged, audible abdominal sounds produced by gas moving thru the intestines. hyper peristalsis or stomach growling
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calculi | show 🗑
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colic | show 🗑
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constipation | show 🗑
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possible causes of constipation | show 🗑
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dyspepsia | show 🗑
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dysphagia | show 🗑
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show | accidental passage of bowels
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hematemesis | show 🗑
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coffee ground emesis (type of hematemesis) | show 🗑
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show | may be a sign of early bowel obstruction
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hypoactive bowel sounds | show 🗑
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show | seen in acute obstruction: hernia, diarrhea, early obstruction - high pitched. also seen in hyperactive intestinal peristalsis
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melena | show 🗑
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peristalsis | show 🗑
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puritis | show 🗑
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show | condition that occurs when gastric juices or small amounts of food from the stomach flow back into the esophagus and mouth. aka: regurgitation
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steatorrhea | show 🗑
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show | straining to have a bowel mvmnt. may be painful and continue for a long time without a bowel mvmnt occurring.
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show | stretched veins such esophageal varices from cirrhosis
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show | dry mouth. caused by or associated with RA, diabetes, kidney failure, HIV, meds, radiation tx for mouth or throat CA
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show | if divided into 9: epigastric is upper region, umbilical is middle region, and hypogastric or suprapubic is lower region. otherwise just the 4 quadrants
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show | liver, gallbladder, duodenum, R kidney and adrenal, hepatic flexure of colon, head of pancreas, ascending and transverse colon
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what organs are in the LUQ | show 🗑
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what organs are in the RLQ | show 🗑
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what organs are in the LLQ | show 🗑
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what are two important differences that must take place for an abdominal exam | show 🗑
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show | fluid, fat, feces, flatus, fatal growth, fetus
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show | severe weight loss, seen with debilitating disease
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venous distention in abdominal area | show 🗑
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show | the 4 quadrants. listen for borborygmi, incr or decr bowel sounds
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for auscultation of the abdominal area, what do you use the bell for | show 🗑
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name the order of abdominal palpation | show 🗑
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show | between the umbilicus and ASIS and corresponds with where the appendix is.
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Murphy's sign | show 🗑
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what are some common misdiagnosed tumors of the abdomen | show 🗑
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what is the flick the flank test, or puddle sign, used for | show 🗑
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normal liver findings | show 🗑
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findings of enlarged liver | show 🗑
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liver cancer findings | show 🗑
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show | pneumonia - pus filled lung - empyema. painful problem below the diaphragm (gallbladder). phrenic nerve related problems
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show | liver movement of less than 2cm on inspiration. liver is moved by the diaphragm
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normal appendix findings | show 🗑
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show | insp: sick pt, antalgia, possible air accumulation (distention). ausc: bowel sound may be nl or reduced (adynamic ileus). percuss: may be too tympanic if air accumulation. palp: tenderness in RLQ at McBurney's - often the pain of maximal tenderness
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show | Rovsings - pain in RLQ w pressure in LLQ. rebound tenderness - pain at McBurney's w sudden pressure withdrawal locally (elsewhere in the abdomen). passively stretch psoas: would cause pain in area (& not just a stretch pain)
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show | passive knee and hip flexion with external rotation - a localizing peritoneal sign - pain at McBurney's point
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irritable bowel syndrome | show 🗑
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risk factors of irritable bowel syndrome | show 🗑
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show | foods, stress, hormones, gastroenteritis - general term for stomach ache
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show | an inflammatory bowel disease in which the rectum and or colon develop ulcers. unknown cause - maybe hereditary or immune compromise.
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show | abdominal pain, diarrhea w blood or puss, rectal bleeding, anemia, fatigue, weight loss, loss of appetite.
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show | obs: finger clubbing unrelated to cardiovascular. ausc: nl bowel sounds but hyperactive bowel sounds when active. percuss: may be more resonant. palp: rigidity noted over the abdomen & may be painless or painful.
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show | pos rebound tenderness and pos Rovsings - push on L abdomen and pain on R where appendix is and vice versa
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show | type of irritable bowel disease that causes inflammation of intestinal lining. MC effects ileum and colon.
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show | family hx, immune compromise, less than 30 yo, NSAID use, smoking, poor diet, stress
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ssx of crohns disease | show 🗑
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phys exam of crohns disease | show 🗑
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show | insp: cannot see. ausc: cannot hear. percuss: cannot percuss. palp: cannot palpate, non tender
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phys exam of peritonitis | show 🗑
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phys exam of small intestines (1 of 2) | show 🗑
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phys exam of small intestines (2 of 2) | show 🗑
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show | insp: distention. ausc: incr bowel sounds heard in early obstruction & hypoactive or silent later in obstruction. percuss: hyper-tympanic. palp: mm guarding and pain
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small intestine bowel sounds | show 🗑
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show | insp: nl cannot see. ausc: nl bowel sounds. percuss: tympanic to dull depending on sigmoid contents. palp: nl tender to palpate, feces may be palpable.
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hernias | show 🗑
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show | insp: bulge worse w incr intra-abdominal pressure (cough). ausc: bowel sounds may be incr early, or decr late. percuss: NONE! palp: bulge worse w incr intra abdominal pressure
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show | insp: none. ausc: nl bowel sounds, no friction rubs, no bruit. percuss: no percussive changes. palp: no palpatory discomfort. so shouldn't be able to feel, palpate, see nor hear it.
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murphy's sign (of the gallbladder) | show 🗑
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acute cholecystitis | show 🗑
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show | female (4:1), fertile, pregnancy, >40yo, obesity, flatulent
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show | formation of calculi within the gallbladder. "lith" means "stone"
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show | sharp, cramping pain in RUQ lasting min of 30 min. midback pain or below R shoulder blade. clay-colored stools. fever, nausea & vomiting. yellowing of skin and whites of eyes (jaundice)
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show | insp: nl to slight bloating. ausc: nl bowel sounds, no bruit or friction rubs. percuss: pain when percussing over R midclavicular line. palp: pain when palpating the liver. pos Murphy's sign
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show | normally cannot see. ausc: contributes to bowel sounds. percuss: very tympanic bc of gastric air bubble (magenblase) - typical size and location - NL <2" behind the lower ribs on the L
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show | when the cardiac sphincter allows stomach contents to reflux into esophagus causing irritation.
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show | heartburn - throat and chest burning. acidic taste in mouth. dry cough - clearing of throat - not a true cough. trouble swallowing. however, no outward observations, no ausculatory changes, no percussive changes, no palpatory changes.
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show | breakdown in the lining of the stomach or duodenum.
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risk factors of peptic ulcers | show 🗑
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show | upper abdominal pain. abdominal pain that wakes the pt at night. feeling of fullness. hunger w/in 1-3 hrs after eating. nausea decr after vomiting. bloody vomit. bloody stools (look black or tarry). fatigue. weight loss.
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what happens if a peptic ulcer becomes too deep | show 🗑
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phys exam of peptic ulcers | show 🗑
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phys exam of spleen | show 🗑
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phys exam of splenomegaly | show 🗑
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how do you palpate the spleen | show 🗑
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special spleen maneuver: splenic percussion sign | show 🗑
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show | MC if splenomegaly. causes acute blood loss. may irritate the left diaphragm. may cause elevation of the left testicle - Kerr's sign
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what is Kerr's sign | show 🗑
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show | insp: nl can't see. ausc: nl the kidney and its vessels are silent. percuss: nl not tender to fist percussion (Murphy's punch). palp: occasionally the R kidney may be palpable on very thin ppl using bimanual deep palpation
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heel-jar test | show 🗑
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fist percussion | show 🗑
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show | insp: may fill in the flank. ausc: no change. percuss: there may be incr sensitivity to fist percussion. palp: may become palpable
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show | MC stones consist of crystals made up of Ca oxalate or Ca phosphate
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show | dam history, 40+ yo, male, dehydration, diet - high protein, sugar and sodium; obesity, irritable bowel syndrome, chronic diarrhea
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six of kidney stones | show 🗑
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show | obs: no abnormal findings. ausc: hypoactive. percuss: painful kidney punch. palp: during early obstruction may be able to palpate an enlarged kidney (hydronephrotic). placatory tenderness, tenderness at the costovertebral angle
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show | UTIs occur when bacteria ascend the urethra to the bladder. if the bacteria ascends the ureter to the kidneys, it is called pyelonephritis
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show | incr urge and frequency of urination. burning sensation. cloudy urine. bloody urine. could smelling urine. pelvic pain.
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phys exam of UTIs | show 🗑
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arteries of the abdomen | show 🗑
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risk factors of abdominal aortic aneurysms | show 🗑
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ssx of abdominal aortic aneurysms | show 🗑
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show | normally no sounds are produced. when too much blood flows thru the vv, a "hum" occurs. continuous low pitched sound. suggest incr venous blood flow. liver is commonly involved area.
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