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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adynamic ileus | show 🗑
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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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borborygmi | show 🗑
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calculi | show 🗑
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colic | show 🗑
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show | diagnosed if pt has 2 or more of following symptoms over course of 3 mos: straining during a bowel mvmnt more than 25% of the time; hard stools more than 25% of the time; incomplete evacuation more than 25% of the time; two or fewer bowel mvmnts in a week
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show | poor diet, dehydration, hypothyroidism, IBS, depression, colon cancer, overuse of laxatives
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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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show | blood that has mixed with acid is dark and clumped
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high pitched bowel sounds | show 🗑
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hypoactive bowel sounds | show 🗑
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hyperactive bowel sounds | show 🗑
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show | passage of dark-colored, tarry stools. due to the presence of blood altered by the intestinal juices
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peristalsis | show 🗑
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puritis | show 🗑
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reflux | show 🗑
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show | yellow, fatty stools. caused by malabsorption syndrome. fat malabsorption is the most obvious. stools are frequent, fatty (yellow), foul smelling, flushing resistant
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tenesmus | show 🗑
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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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what organs are in the RUQ | show 🗑
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show | stomach, spleen, liver, body of pancreas, L kidney and adrenal, hepatic flexure of the colon, transverse and descending colon
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what organs are in the RLQ | show 🗑
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show | descending colon, sigmoid colon, L ovary, L spermatic cord, L ureter
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show | auscultation must be performed prior to palpation. pt must also have an empty bladder prior to the start of the exam.
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show | fluid, fat, feces, flatus, fatal growth, fetus
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scaphoid abdomen | show 🗑
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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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show | abdominal aorta, renal aa, common iliac aa, femoral aa. listen for any bruits. also listen to the liver and spleen for any friction rubs
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name the order of abdominal palpation | show 🗑
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McBurney's point | show 🗑
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show | performed by asking patient to breathe out and gently place hand below costal margin on right side at mid-clavicular line (approx location of gallbladder). pt is then instructed to inspire. pos if pain and stops inspiring - cholecystitis
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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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what is considered a hypomobile liver | show 🗑
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show | insp: no abnormal findings. ausc: nl bowel sounds, no friction, no ribs, no bruit. percuss: no percussive change (resonant). palp: no placatory discomfort (neg McBurney's, rebound tenderness, Rosvings. special: neg posts and obturator
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acute appendicitis | show 🗑
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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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special tests for ulcerative colitis | show 🗑
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active Crohns disease | show 🗑
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risk factors of crohns disease | show 🗑
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show | diarrhea, fever, fatigue, abdominal pain and cramps, bloody stools, anorexia, weight loss, mouth sores
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show | obs: abdominal bloating, oral apthous ulcers. ausc: normal bowel sounds. percuss: resonance unless disease is caused by an underlying tumor. palp: diffuse abdominal tenderness, local pain over affected region; mass palpated bc of thickened/inflamed bowel
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show | insp: cannot see. ausc: cannot hear. percuss: cannot percuss. palp: cannot palpate, non tender
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show | insp: pt may have antalgia and have guarded mvmnts, if they move at all. ausc: friction rubs may occur. percuss: may cause dullness if peritoneal fluid accumulates. palp: severe mm guarding (boardlike rigidity) may accomany
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phys exam of small intestines (1 of 2) | show 🗑
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show | percuss: there's nl air in gut - so tympany predominates throughout the abdomen. palp: the soft squishy tubes are not nl palpable
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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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show | partial or early obstruction: hyperactive and loud. late partial or total obstruction: hypoactive. paralytic ileus: silent as the grave
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phys exam of sigmoid colon | show 🗑
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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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phys exam of gallbladder | show 🗑
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show | an inspiratory rest sign. a sign of an abnormally tender gallbladder. pt stops inspiration due to incr pain as they breath in. thumb/fingertip pressure is directed toward the gallbladder under the rib margin. very focal pain, no radiation
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acute cholecystitis | show 🗑
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risk factors of cholecystitis | show 🗑
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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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phys exam of cholecystitis | show 🗑
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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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stomach GERD | show 🗑
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ssx of stomach GERD must happen 2x/week | show 🗑
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peptic ulcers | show 🗑
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show | excessive alcohol. reg use of aspirin, ibuprofen, naproxen or other NSAIDs. smoking cigarettes or chewing tobacco.
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ssx of peptic ulcers | show 🗑
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what happens if a peptic ulcer becomes too deep | show 🗑
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show | insp: nl. ausc: nl. percuss: nl. palp: may have burning tenderness in epigastrum, many false positives
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phys exam of spleen | show 🗑
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show | insp: may see w deep inspiration. ausc: the spleen remains silent. percuss: area of dullness may expand ant inf as the spleen grows. palp: only becomes palpable if 3x nl size - NEVER squeeze bc it may rupture.
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how do you palpate the spleen | show 🗑
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show | lowest rib interspace, anterior axillary line, should stay tympanic when pt breaths in. tap all the way down and it'll go from being very resonant to a very hollow sound as they're taking a breath in if positive
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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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kidney phys exam | show 🗑
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show | a special kidney maneuver - pt standing on toes and suddenly drops weight to their heels
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fist percussion | show 🗑
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kidney enlargement phys exam | show 🗑
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kidney stones - nephrolithiasis | show 🗑
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risk factors of kidney stones | show 🗑
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show | extreme back or flank pain - renal colic. groin or testicular pain. fever or chills. vomiting. blood in urine. cloudy urine. foul smelling urine. burning urination sensation
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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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show | obs: no abdominal findings. ausc: no alterations. percuss: no alterations (painful). palp: suprapubic tenderness or pain
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show | abdominal aorta, renal aa, common iliac aa. normally no sounds are produced. abnormal arterial flow causes sounds to be produced - low pitched listened with the bell.
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show | age 65+. smoking. male. genetics.
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show | severe abdominal or back pain. sweating. nausea, vomiting. dizziness, syncope - temp loss of consciousness caused by a fall in blood pressure. tachycardia - rapid, shallow heart rate.
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veins of the abdomen | show 🗑
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Created by:
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