PDX Abdomen Word Scramble

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Question	Answer
what is total absence of bowel sounds a sign of	intra abdominal emergency
how long must you listen to bowel sounds for	2-5 minutes
peritonitis	inflammation of the peritoneum lining the abdominal wall and covering the abdominal organs
adynamic ileus	"as silent as the grave" - failure of passage of enteric contents thru small bowel and colon; paralysis of intestinal motility
ascites	excessive fluid within the abdomen. could be a sign of liver disease or cirrhosis
ballottement	palpation technique used to evaluate a structure that is floating by bouncing it gently and feeling it rebound
borborygmi	prolonged, audible abdominal sounds produced by gas moving thru the intestines. hyper peristalsis or stomach growling
calculi	stones or solid lumps such as gallstones or kidney stones
colic	attacks of abdominal pain, caused by muscle spasms in the intestines.
constipation	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
possible causes of constipation	poor diet, dehydration, hypothyroidism, IBS, depression, colon cancer, overuse of laxatives
dyspepsia	indigestion - symptoms include heartburn, nausea, bloating and gas
dysphagia	problems swallowing food or liquids. usually caused by blockage or injury to esophagus
encopresis	accidental passage of bowels
hematemesis	vomiting of blood. comes from GI tract, not lung. redder it is, the fresher. usual causes are bleeding problems of the esophagus and stomach.
coffee ground emesis (type of hematemesis)	blood that has mixed with acid is dark and clumped
high pitched bowel sounds	may be a sign of early bowel obstruction
hypoactive bowel sounds	reduction in loudness, tone, or regularity of the sounds indicates intestinal activity has slowed. NL during sleep. often caused by meds. following abdominal surgery. often indicates constipation
hyperactive bowel sounds	seen in acute obstruction: hernia, diarrhea, early obstruction - high pitched. also seen in hyperactive intestinal peristalsis
melena	passage of dark-colored, tarry stools. due to the presence of blood altered by the intestinal juices
peristalsis	a wavelike mvmnt of mm in the GI tract. moves food and liquid thru the GI tract
puritis	itching. occurs with incr bilirubin. may occur before jaundice.
reflux	condition that occurs when gastric juices or small amounts of food from the stomach flow back into the esophagus and mouth. aka: regurgitation
steatorrhea	yellow, fatty stools. caused by malabsorption syndrome. fat malabsorption is the most obvious. stools are frequent, fatty (yellow), foul smelling, flushing resistant
tenesmus	straining to have a bowel mvmnt. may be painful and continue for a long time without a bowel mvmnt occurring.
varices	stretched veins such esophageal varices from cirrhosis
xerostomia	dry mouth. caused by or associated with RA, diabetes, kidney failure, HIV, meds, radiation tx for mouth or throat CA
regions of the abdomen	if divided into 9: epigastric is upper region, umbilical is middle region, and hypogastric or suprapubic is lower region. otherwise just the 4 quadrants
what organs are in the RUQ	liver, gallbladder, duodenum, R kidney and adrenal, hepatic flexure of colon, head of pancreas, ascending and transverse colon
what organs are in the LUQ	stomach, spleen, liver, body of pancreas, L kidney and adrenal, hepatic flexure of the colon, transverse and descending colon
what organs are in the RLQ	cecum, appendix, R ovary, R spermatic cord, R ureter
what organs are in the LLQ	descending colon, sigmoid colon, L ovary, L spermatic cord, L ureter
what are two important differences that must take place for an abdominal exam	auscultation must be performed prior to palpation. pt must also have an empty bladder prior to the start of the exam.
causes of distention of the abdomen	fluid, fat, feces, flatus, fatal growth, fetus
scaphoid abdomen	severe weight loss, seen with debilitating disease
venous distention in abdominal area	occurs with blockage of blood flow from SVC, IVC or hepatic portal vein
for auscultation of the abdominal area, what do you use the diaphragm for	the 4 quadrants. listen for borborygmi, incr or decr bowel sounds
for auscultation of the abdominal area, what do you use the bell for	abdominal aorta, renal aa, common iliac aa, femoral aa. listen for any bruits. also listen to the liver and spleen for any friction rubs
name the order of abdominal palpation	light palpation of all 4 quadrants starting w the quad farthest from the pain. deep palpation of all 4 quads. aortic pulse. McBurney's point. kidney. spleen. Murphy's sign. rebound tenderness. ascites.
McBurney's point	between the umbilicus and ASIS and corresponds with where the appendix is.
Murphy's sign	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
what are some common misdiagnosed tumors of the abdomen	pregnant tumors, sacral promontory, feces in sigmoid colon, floating rib cartilage
what is the flick the flank test, or puddle sign, used for	to determine dull percussion of ascites
normal liver findings	inspection: can't see. auscultation: silent. percussion: 6-12cm of dullness at midclavicular line, down 2cm w inspiration. palpation: occasionally palpable in a healthy person
findings of enlarged liver	inspection: can possibly see. auscultation: venous hum may occur if there's incr superficial collateral blood flow. percussion: incr span. palpation: enlarged w right heart failure, enlarged & tender w hepatitis, nodular & maybe non tender in liver CA
liver cancer findings	insp: nl or may be enlarged and seen. ausc: hepatic bruit and friction rubs. percuss: incr span. palp: enlarged w R heart failure. enlarged & tender w hepatitis. nodular & maybe non tender in liver carcinoma
what could be the causes of a hypomobile liver	pneumonia - pus filled lung - empyema. painful problem below the diaphragm (gallbladder). phrenic nerve related problems
what is considered a hypomobile liver	liver movement of less than 2cm on inspiration. liver is moved by the diaphragm
normal appendix findings	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
acute appendicitis	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
additional maneuvers for acute appendicitis	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)
additional maneuvers for acute appendicitis: obturator sign	passive knee and hip flexion with external rotation - a localizing peritoneal sign - pain at McBurney's point
irritable bowel syndrome	lg intestine is not damaged but has a functional problem. symptoms: chronic, cramping, abdominal pain, abdominal bloating, gas, diarrhea, constipation, mucus in stool. exam findings vary depending upon type
risk factors of irritable bowel syndrome	female, family history and less than 45 yo
triggers of irritable bowel syndrome	foods, stress, hormones, gastroenteritis - general term for stomach ache
ulcerative colitis	an inflammatory bowel disease in which the rectum and or colon develop ulcers. unknown cause - maybe hereditary or immune compromise.
symptoms of ulcerative colitis	abdominal pain, diarrhea w blood or puss, rectal bleeding, anemia, fatigue, weight loss, loss of appetite.
physical exam of ulcerative colitis	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.
special tests for ulcerative colitis	pos rebound tenderness and pos Rovsings - push on L abdomen and pain on R where appendix is and vice versa
active Crohns disease	type of irritable bowel disease that causes inflammation of intestinal lining. MC effects ileum and colon.
risk factors of crohns disease	family hx, immune compromise, less than 30 yo, NSAID use, smoking, poor diet, stress
ssx of crohns disease	diarrhea, fever, fatigue, abdominal pain and cramps, bloody stools, anorexia, weight loss, mouth sores
phys exam of crohns disease	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
phys exam of peritoneum (appendicitis can be under this term also, but can also be separate)	insp: cannot see. ausc: cannot hear. percuss: cannot percuss. palp: cannot palpate, non tender
phys exam of peritonitis	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
phys exam of small intestines (1 of 2)	insp: NL - no distention, peristaltic activity is occasionally seen on very thin ppl. ausc: there is NL frequency and intensity of bowel sounds (5-30/min). they are high pitched sounds that incr after meals
phys exam of small intestines (2 of 2)	percuss: there's nl air in gut - so tympany predominates throughout the abdomen. palp: the soft squishy tubes are not nl palpable
phys exam of sm intestine obstruction	insp: distention. ausc: incr bowel sounds heard in early obstruction & hypoactive or silent later in obstruction. percuss: hyper-tympanic. palp: mm guarding and pain
small intestine bowel sounds	partial or early obstruction: hyperactive and loud. late partial or total obstruction: hypoactive. paralytic ileus: silent as the grave
phys exam of sigmoid colon	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.
hernias	protrusion of the intestinal contents. more apparent with higher intra abdominal pressure (cough). occurs in areas of abdominal wall weakness. groin is MC. scars and umbilicus are also common.
phys exam of hernias	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
phys exam of gallbladder	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.
murphy's sign (of the gallbladder)	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
acute cholecystitis	occurs when bile becomes trapped in gallbladder. often happens bc gallstones block cystic duct leading to swelling and infection.
risk factors of cholecystitis	female (4:1), fertile, pregnancy, >40yo, obesity, flatulent
cholelithiasis	formation of calculi within the gallbladder. "lith" means "stone"
ssx of cholecystitis	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)
phys exam of cholecystitis	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
phys exam of stomach	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
stomach GERD	when the cardiac sphincter allows stomach contents to reflux into esophagus causing irritation.
ssx of stomach GERD must happen 2x/week	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.
peptic ulcers	breakdown in the lining of the stomach or duodenum.
risk factors of peptic ulcers	excessive alcohol. reg use of aspirin, ibuprofen, naproxen or other NSAIDs. smoking cigarettes or chewing tobacco.
ssx of peptic ulcers	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.
what happens if a peptic ulcer becomes too deep	it can bleed and then become infected and sometimes can be cancerous
phys exam of peptic ulcers	insp: nl. ausc: nl. percuss: nl. palp: may have burning tenderness in epigastrum, many false positives
phys exam of spleen	insp: nl can't see. ausc: nl no sound. percuss: nl dull at T8-T10 ribs post to midaxillary line. palp: nl not palpable - a palpable spleen is a red flag
phys exam of splenomegaly	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.
how do you palpate the spleen	bimanual w pt supine and or slightly on their left lateral side. use cephalad hand to lift up flank and caudal hand to press down on the area.
special spleen maneuver: splenic percussion sign	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
ruptured speen	MC if splenomegaly. causes acute blood loss. may irritate the left diaphragm. may cause elevation of the left testicle - Kerr's sign
what is Kerr's sign	when the spleen ruptures and it causes elevation of the left testicle
kidney phys exam	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
heel-jar test	a special kidney maneuver - pt standing on toes and suddenly drops weight to their heels
fist percussion	a special kidney manuever - firm strike to the CVA of the involved side is abnormally tender compared to the nl side. indicates sensitivity of the caps - typically due to inflammation (kidney infection) or obstruction (hydronephrosis)
kidney enlargement phys exam	insp: may fill in the flank. ausc: no change. percuss: there may be incr sensitivity to fist percussion. palp: may become palpable
kidney stones - nephrolithiasis	MC stones consist of crystals made up of Ca oxalate or Ca phosphate
risk factors of kidney stones	dam history, 40+ yo, male, dehydration, diet - high protein, sugar and sodium; obesity, irritable bowel syndrome, chronic diarrhea
six of kidney stones	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
kidney stone phys exam	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
bacterial urinary tract infection (UTI)	UTIs occur when bacteria ascend the urethra to the bladder. if the bacteria ascends the ureter to the kidneys, it is called pyelonephritis
ssx of UTIs	incr urge and frequency of urination. burning sensation. cloudy urine. bloody urine. could smelling urine. pelvic pain.
phys exam of UTIs	obs: no abdominal findings. ausc: no alterations. percuss: no alterations (painful). palp: suprapubic tenderness or pain
arteries of the abdomen	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.
risk factors of abdominal aortic aneurysms	age 65+. smoking. male. genetics.
ssx of abdominal aortic aneurysms	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.
veins of the abdomen	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.

Created by: bptotheeng