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dx tests & meaning in abdominal eval
GI
43
Medical
Graduate
08/30/2010

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Term
what do pt's biggest complaints relate to?
Definition
work-related, personal/family, or financial
Term
if a pt tells you a complaint started 2 months ago, what should your next question be?
Definition
"what happened 2 months ago?"
Term
what can a indigestion complaint be due to?
Definition
n/v, anorexia, anicteric heptitis (viral, toxin, alcohol, drug), pregnancy, diabetic ketoacidosis, uremia (w/renal failure), and emotional stress
Term
what can lead to belching/aerophagia?
Definition
agitated/nervous pts may gulp down food, cauliflower/asparagus/beans can cause gas, IBS, and lactose intolerance
Term
what can lead to abdominal fullness or early satiety?
Definition
diabetic gastroparesis, acute duodenal ulcer near pylorus - the edema of which may cause early satiety, occult neoplasm (pain-free and losing weight), cicatrix formation (scars from past ulcers), and hepatitis
Term
what may cause hematemesis (blood beginning proximal to the ligamentum treitz - bright red/coffee grounds)?
Definition
could be secondary to retching, mallory-weiss, or boerhaave syndrome
Term
what are important questions to ask about vomiting?
Definition
when, what does it look like. also need to look at hx (possible esophageal web, look for plummer vinson syndrome)
Term
if a pt says they vomit 30-40 min after eating and that it is mixed with bile, what should you be thinking of?
Definition
a problem with the pylorus, such as an ulcer, neoplasm, or cictrix
Term
if a pt says they vomit 2 hrs after eating and it looks/smells terrible, what should you be thinking of?
Definition
obstruction at the ilocecal valve (could be due to a gallstone - gall stone ileus). odor because of succus entericus, the enzymes that are put out by the pancreas, biliary system, liver to digest foods
Term
what are the three types of pain pts will complain of?
Definition
visceral pain (first pain; generalized burning/cramping), parietal pain (pain gravitates toward a specific organ), and referred pain (ex. acute cholecystitis irritates glisson's capsule which is innervated by the phrenic nerve, so it can refer to the shoulder)
Term
what is cholecystocoronary syndrome?
Definition
gallbladder pathology leading to an MI
Term
what is the important differentiation for pts with jaundice? what are other important questions?
Definition
determine if the jaundice is pre, intra, or extra-hepatic. ask if the pt has started any new medication and ask if they have shakes/chills (potential pre-hepatic lysis of cells, can be caused by quinidine)
Term
what can cause intra-hepatic jaundice?
Definition
toxins from work, alcohol, medications (HMG CoA-reductase inhibitors, nitrofurantoins)
Term
what are important questions to ask about diarrhea?
Definition
how many bowel movements per day/per night (bacteria stay up at night/IBS calms down w/sleep), any blood, what does it look like (watery/diarrhea/no odor - IBS, large/greasy/foulsmelling - malabsorption or infection)
Term
what might flank pain be indicative of?
Definition
renal stone
Term
when examining the abdomen, what things need to be looked at?
Definition
scars (think of adhesions). the only indication for removing adhesions is if they cause pain.
Term
if a pt complains of epigastric pain, what should you think of?
Definition
stomach and liver
Term
when examining the liver, what things need to be looked at? about how big should the liver be?
Definition
if liver seems large, need to percuss liver to make sure it isn't just being pushed farther below the costal margin b/c of COPD. a normal sized liver for women is about 6-10 cm and for men is about 8-12 cm. a sharp edge with some pain is normal for liver palpation, if it feels nodular/fatty - could indicate alcoholic cirrhosis. if the nodules feel larger - possible post-necrotic viral cirrhosis. if any abnormality - need to scan.
Term
what is courvoisier's law?
Definition
1) if patient has a large gall bladder, no jaundice and right upper quadrant pain, most likely have a stone in cystic duct
2) if patient has small gall bladder, jaundice and pain, most likely a stone in common bile duct
3) if patient has a large gall bladder, no pain and jaundice, most likely a carcinoma at the head of the pancreas
Term
what is a positive JB murphy sign?
Definition
have a the pt take a deep breath and hold your fingers at the upper R quandrant as they exhale. if they catch their breath for a second upon contact of your finger w/the gall bladder = postive JB murphy sign
Term
what do light yellow stools mean? what other sign might accompany this?
Definition
improper micelle formation due to lack of bile (due to some impedance) - pts may also belch often w/this condition
Term
what is the boas sign?
Definition
run fingers gently down the back, about a cm lateral to the spine on each side - if there is excitability/hypersensitivity at T11-L1 = positive boas sign, possible indication of cholecystitis
Term
what kind of pain to pts with pancreas problems often complain of?
Definition
peri-umbilical pain esp in the *supine position (feel better w/leaning forward)
Term
what is cullen's sign?
Definition
bluish discoloration around the umbilicus - predicts a severe attack of acute pancreatitis
Term
what is grey-turner's sign?
Definition
retroperitoneal bleeding coming around the flanks, which may be accompanied by cullen's sign, and if so it may be indicative of pancreatic necrosis with retroperitoneal or intraabdominal bleeding
Term
if you percuss the liver and find it to be within the normal range (8-12 cm for male and 6-10 cm for a female ), can you then say the liver is normal?
Definition
no - if there is cirrhosis, the pt will have portal HTN, which will enlarge the spleen as well
Term
what can stria on the abdomen mean?
Definition
stria can be secondary to portal HTN/cirrhotic liver (inability of the liver to break down estrogens), also cushing's or obesity
Term
what is an anatomic change to the rectus abdominus muscles as pts age?
Definition
they become more moon-shaped
Term
which is better, a large or small epigastric hernia?
Definition
large - b/c it can move freely, whereas smaller hernias can lead to edema
Term
what do distended superficial veins proximal to the umbilicus (caput medusa) tell you?
Definition
there is cirrhosis, and the portal blood is taking an alternate route to drain b/c it can't get through the liver back to the heart
Term
how does appendicitis present?
Definition
pain starts in visceral area and then refers to RLQ. the pt will point to pain emanating from an area 1/3 the distance from the ASIS to the umbilicus - known as mcburney's point
Term
what is the blumberg sign?
Definition
press in the area softly, then let up quickly. if the peritoneal wall contracts or spasms, that is a positive sign for appendicitis
Term
what is the rovsings sign?
Definition
go to the LLQ and press gently, then pull up. when you push in gently, you are pushing the intestinal coils to the R, and when you let up they will experience RLQ pain = positive sign for appendicitis
Term
what is the psoas sign?
Definition
since the appendix lays in contact with the psoas muscles, if you take a leg off to the side and drop it off the table to put compression onf the appendix, pain is a positive sign for appendicitis
Term
what is the obturator sign?
Definition
flex the leg and medially rotate it to stretch the obturator internus over an inflamed appendix, if there is pain, it is a positive sign for appendicitis
Term
how is the rectal exam for appendicitis performed? why is this important to do?
Definition
go up and to the R side and you can touch the inflamed area of the retro-cecal appendix - discomfort/pain = positive sign for appendicitis. 60% of appendices were retro-cecal
Term
how do you test for ascites?
Definition
have the pt lay on one side, and percuss up until the solid sound becomes resonant, then make a mark and do it on the other side. if the level is the same on both sides, that which is producing the solid sound is liquid and the pt likely has ascites
Term
what can you do if you think a pt has ascites, but there is not much fluid?
Definition
have the pt get on their hands and knees and percuss their abdomen - if it is dull, they have some ascitic fluid
Term
what is the SNG gradient? what can it tell you?
Definition
the serum/ascites albumin gradient. if (S/A) it is greater than 1.10 g/dl - most of the albumin is in the serum (less in ascitic fluid), meaning it is transudate - you are probably dealing with a cirrhotic liver, nephrosis or CHF. if it is 1.10 g/dl or less - most of the exudate is in the abdominal cavity, the fluid is exudate and the pt may have a pancreatic neoplasm or TB
Term
what is the SNG gradient? what can it tell you?
Definition
the serum/ascites/albumin gradient. if it is greater than 1.10 g/dl - most of the albumin is in the serum (less in ascitic fluid), meaning it is transudate - you are probably dealing with a cirrhotic liver, nephrosis or CHF. if it is 1.10 g/dl or less - most of the exudate is in the abdominal cavity, the fluid is exudate and the pt may have a pancreatic neoplasm or TB
Term
where is an important place to look if a pt has ascites?
Definition
check the supraclavicular lymph nodes, GI neoplasms will have L supraclavicular adenopathy
Term
where is an important place to look if a pt has ascites?
Definition
check the supraclavicular lymph nodes, GI neoplasms will have L supraclavicular adenopathy
Term
where should be checked for aortic aneurysms? what is the normal diameter for the aorta?
Definition
midway between the xiphoid process and the umbilicus, where the renal arteries are and check them for stenosis or metaplasia. the aorta is in the center and should be around 2.5 cm in diameter. stress the importance of pts getting this checked out if it is larger.
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