Term
| what organs in the abdomen are not palpable |
|
Definition
| stomach, most of the liver and spleen. |
|
|
Term
| the majority of the stomach is in what quadrant |
|
Definition
| left upper quadrant (epigastric quadrant) |
|
|
Term
| what organs are in the epigastric quadrant |
|
Definition
1. stomach
2. liver
3. pancreas
4. gallbladder |
|
|
Term
| what quadrant is the gallbladder located |
|
Definition
| right upper quadrant or the epigastric quadrant |
|
|
Term
| the head of the pancreas is located in what quad |
|
Definition
|
|
Term
| where can you see some visible pulsations on the abdomen |
|
Definition
| the aorta can be visible in the middle upper quadrant |
|
|
Term
| when and where can you palpate the bladder |
|
Definition
| middle lower quadrant above the symphysis pubis when the bladder is distended. |
|
|
Term
| what muscle surrounds the bladder and contracts around it to make you pee at the same time telling your brain its time to pee |
|
Definition
|
|
Term
| what age group has dimishing sensitivity to abdominal pain and possible acute abdominal pathologies |
|
Definition
|
|
Term
|
Definition
| chronic or recurrent discomfort or pain centered in the upper abdomen |
|
|
Term
| heartburn is aggravated by what foods |
|
Definition
1. alcohol
2. chocolate
3. citrus fruits
4. coffee
5. onions
6. peppermint
7. positions |
|
|
Term
| acute diarrhea lasts up to how long? Chronic diarrhea is defined as lasting ___ weeks or longer |
|
Definition
Acute diarrhea up to 2 weeks.
Chronic diarrhea 4 weeks or more |
|
|
Term
| what is the criteria for constipation |
|
Definition
presence of constipation for 12 weeks of the prior 6 months with at least two of the following conditions
1. 3 or less BMS weekly
2. 25% of BMS invovle straining or sensation of incomplete emptying
3. lumpy or hard stools
4. manual facilitation |
|
|
Term
| where is bile made, then where stored and where removed |
|
Definition
| hepatocytes congjugate bilirubin with other substances to make bile water soluble. Then bile is excreted into the cystic duct to the common bile duct. From common bile duct empties into the duodenum at the ampulla of vater. |
|
|
Term
| is uncongjugated or congjugated bilirubin toxic |
|
Definition
| unconjugated bilirubin is toxic. Conjugated bilirubin is water soluble so its not likely to cross the BBB |
|
|
Term
| can conjugated bilirubin or uncongjugated billirubin be excreted in urine |
|
Definition
| only conjugated bilirubin because it is water soluble. |
|
|
Term
| prosthetic pain is felt where |
|
Definition
| in the perineum and sometimes in the rectum |
|
|
Term
| the feeling of _____ suggests bladder infection or irrritation |
|
Definition
|
|
Term
| for women internal burning urinary sx are associated with____ while external burning urinary sx associated w/ ____ |
|
Definition
Internal burning women = urethritis
External burning women = vulvovaginitis |
|
|
Term
| polyuria is large amount of urine in 24 hours and is typically how much |
|
Definition
|
|
Term
| what percentage of america has alcohol abuse problems |
|
Definition
|
|
Term
| CDC recommends hepatitis A vaccination for children age __ |
|
Definition
|
|
Term
| people at risk for hep C are those with blood transfusions or organ transplant before year ___ |
|
Definition
|
|
Term
| third most common cancer in both men and women |
|
Definition
|
|
Term
| stomach gurgling reflects hyperperistalsis also known as? |
|
Definition
|
|
Term
| acute abdomen results from 2x |
|
Definition
1. inflammaiton of the parietal peritoneum
2. peritonitis |
|
|
Term
|
Definition
1. positive cough test (ask pt to cough and see where pain is, palpate there first)
2. guarding
3. rigidity
4. rebound tenderness
5. percussion tenderness |
|
|
Term
| what is the difference between regidity and guarding |
|
Definition
| rigidity is involuntary reflex contraction of the abdominal wall that persists over several examinations while guarding is the voluntary muscle contraction in response to pain or threat. |
|
|
Term
| causes of peritonitis are |
|
Definition
1. appendicitis
2. cholecystitis
3. perforation of the bowel |
|
|
Term
| what is a normal liver size in CM at the right midclavicular line and midsternal line |
|
Definition
midclavicular line: 6-12 cm
midsternal line: 4-8 cm |
|
|
Term
| on inspiration the liver edge is palpabe approximately ___ cm below the right costal margin in the midclavicular line |
|
Definition
| 3 cm below the right costal margin in the midclavicular line |
|
|
Term
| causes of peritonitis are |
|
Definition
1. appendicitis
2. cholecystitis
3. perforation of the bowel |
|
|
Term
| what is a normal liver size in CM at the right midclavicular line and midsternal line |
|
Definition
midclavicular line: 6-12 cm
midsternal line: 4-8 cm |
|
|
Term
| on inspiration the liver edge is palpabe approximately ___ cm below the right costal margin in the midclavicular line |
|
Definition
| 3 cm below the right costal margin in the midclavicular line |
|
|
Term
| what is the name of the area where you can percuss an enlarged spleen? where would the anterior border of a normal spleen be compared to an enlarged spleen |
|
Definition
| traube's space. Normal spleen stays behind mid axillary line. Enlarged spleen is above mid axillary line |
|
|
Term
| bladder is normally not palpable unless it is distended over the ___ |
|
Definition
|
|
Term
| Bladder must be ___ to ___ mL beore dullness appears on percussion |
|
Definition
|
|
Term
| a distended bladder will feel? be __ to percussion |
|
Definition
| Dull to percussion, and smooth to palpation |
|
|
Term
| Where does intraurethral tone come from? Why is this important |
|
Definition
Intraurethral tone is important for overcoming rising bladder pressure and preventing incontinence. IT is derived from
1. internal urethral sphincter
2. urethral mucosa
3. in women -> pelvic muscles.
4. striated muscle around urethra can voluntarily contract to change flow. |
|
|
Term
| liver separated into the right and left lobes by |
|
Definition
|
|
Term
| how many total segments does the liver have |
|
Definition
|
|
Term
| most hepatocytes all the same except for the kupffer cells which are ___ cells |
|
Definition
|
|
Term
| a normal liver weights __ Kg |
|
Definition
|
|
Term
| immune function of the liver is found in the ___ cells |
|
Definition
|
|
Term
| liver's blood supply consists of |
|
Definition
1. right and left hepatic arteries
2. portal vein |
|
|
Term
| portal circulation is unique in that it... |
|
Definition
| connects two organs from capillary to capillary bed without a heart in between. (direct conneciton) |
|
|
Term
| Name the body's two portal systems and what is connected by it |
|
Definition
1. hypothalamus <-> Pituitary gland
2. Liver <-> GI intestines |
|
|
Term
| gut supplied by o2 rich blood via? Its vein goes to ? |
|
Definition
| Mesenteric artery supplies O2 rich blood, used venous blood goes to portal system. |
|
|
Term
| bile is important for what role in the body |
|
Definition
1. absorption of fat
2. excretion of bilirubin, cholesterol and many drugs |
|
|
Term
| Is bile mostly water? how much? |
|
Definition
| 90% water, the rest is bile salts. |
|
|
Term
| what vitamins require bile for absoprtion |
|
Definition
fat soluble vitamins
ADEK
1. Vitamin A
2. Vitamin D
3. Vitamin E
4. Vitamin K |
|
|
Term
| if sphincter of Oddi spasms, you can treat it with |
|
Definition
|
|
Term
| liver function tests reflect hepatocellular integrity or hepatic function? |
|
Definition
|
|
Term
| liver disorders can be divided into what two categories |
|
Definition
1. obstructive disorders (biliary excretion effected)
2. parenchymal disorders (gen hepatocellular dysfunction) |
|
|
Term
| what test of the liver reflects the balance of bilirubin production and excretion |
|
Definition
|
|
Term
| with biliary obstruction is more or less hepatic alkaline phosphatase syntehsized and released into circulation |
|
Definition
| increase hepatic alkaline phosphatase |
|
|
Term
| incrase blood ammonia is associated with what issues at the liver |
|
Definition
| due to disruption of hepatic urea synthesis and severe hepatocellular damage |
|
|
Term
| what percentage of normal factor activity is needed for homestasis during bleeding |
|
Definition
| only 20-30% so PT should NOT change unless severe liver disease or vitamin K deficiency |
|
|
Term
|
Definition
| activity of fibrinogen, prothrombin, factors V, VII, and X |
|
|
Term
| classical appendicitis has what type of pain? located where? |
|
Definition
| periumbilical pain that is visceral in nature |
|
|
Term
| describe the atypical respiratory symptoms assoiaated with GERD |
|
Definition
1. cough
2. wheezes
3. Aspiration PNA |
|
|
Term
| what GERD sx may be present that warrants an upper endoscopy |
|
Definition
alarm sx:
1. difficulty swallowing
2. pain with swallowing
recurrnet vomiting or weight loss. |
|
|
Term
| normal length of the esophagus is |
|
Definition
|
|
Term
| pain while swallowing is called |
|
Definition
|
|
Term
| for chronic conspitaiton to be diagnoses what criteria must patient meet |
|
Definition
presents of constipation for 12 weeks out of the past 6 months with at least two of the following:
1. fewer than 3 BM week
2. 25% or more defecationswith either straining or sensation of incomplete evacuation
3. lumpy or hard stools
4. mnaual facilitation |
|
|
Term
| for men painful urination without frequency or urgency is likely from |
|
Definition
|
|
Term
| stress incontinence most common in man who have had what done and in women with what? |
|
Definition
women: weakness of pelvic floor post childbirth or from post menopausal atrophy of mucosa
Men: post porstatic surgery |
|
|
Term
| what is the physiology for urge incontinence |
|
Definition
| You get a sudeen urge to pee from increased bladder pressure and then your detrusor uncontrollable contracts and this overcomes the resistance of your urethral sphincter causing incontinence. |
|
|
Term
| most common etiology leading to urge incontinence is |
|
Definition
| diseases that inhibit or decrease our conscious cortical control to override detrusor muscle. (brain tumor, emential and lesions of the spinal cord above the sacral levels) |
|
|
Term
| Which type of incontinence occurs when the detrusor muscle is not strong enough to create a high enough pressure to overcome the urethral pressure. |
|
Definition
|
|
Term
| diabetic neuropathy usually contributes to this type of incontinence..Why |
|
Definition
| overflow incontinence. peripheral nerve disease from diabetes. If impiared bladder sensation that interrupts the reflex arc. |
|
|
Term
| correct order for examination of the abdomen |
|
Definition
1. inspection
2. auscultation
3. percussion
4. palpation |
|
|
Term
| name for belly which sinks in on supine patient |
|
Definition
|
|
Term
| normal bowel sounds are how many / minute |
|
Definition
|
|
Term
| rebound tenderness is a classical sign of |
|
Definition
| peritonitis, which can be associated with many things including appendicitis |
|
|
Term
| normal liver edge is soft or hard? |
|
Definition
|
|
Term
| normal liver edge is dull or sharp |
|
Definition
|
|
Term
| what type of patinets would you use a "hooking" technique to feel the liver |
|
Definition
|
|
Term
| cirrhotic liver feels like.. |
|
Definition
1. nontender edge
2. firm or hard |
|
|
Term
| what differentiates urethritis from bladder infection |
|
Definition
| So both have pain with urination but bladder infection will have urgency while urethraitis will not have urgency or frequency |
|
|
Term
| ureter pain radiates where |
|
Definition
| from below the CVA to the groin. it is severe and colicky |
|
|
Term
| if the patient has protuberant abdomen and bulging flanks this is highly likely indicative of |
|
Definition
|
|
Term
| the goal when assessing a patient with ascites is to |
|
Definition
| determine the border of the tympany and dullness with the patient supine |
|
|
Term
| what direction does the spleen move if it is enlarged |
|
Definition
| it moves anterior then medially and downward |
|
|
Term
| dullness with percussion when assessing spleen indicates enlargement ___% of the time |
|
Definition
|
|
Term
| normal percussion for spleen assessment |
|
Definition
| thre should by tympanny regardless if inspiration or expiration on all the costal margins. But if the spleen is enlarged it will move ANTERIOR/MEDIALLY and downward. So then tympany on the anterior midaxillary line will be replaced with dulllness. + splenic percussion sign |
|
|
Term
| what percent of people may have a palpable splenic TIP |
|
Definition
|
|
Term
| how do you illicit CVA tenderness of kidney |
|
Definition
| by placing ulnar side of one hand over the costvertebral angle CVA and hitting it with a closed fist from the other hand. + pain is usually indicative of pyelonnephritis |
|
|
Term
| what is the difference in percussion between assessing for splenomegaly and enlarged kidneys |
|
Definition
| in enlarged kidneys percussion will remain tympanny but in splenomegaly since it moves anterior and medially then percussion will turn dull. |
|
|
Term
| does dyspesia cause an ulcer in the stomach? |
|
Definition
| NO JUST CAUSES similar sx as peptic ulcers |
|
|
Term
| what type of GI sx tend to cause pain that wakes patients in the middle of the night |
|
Definition
1. duodenal ulcers
2. dyspepsia |
|
|
Term
| chronic pancreatitis will present with pain that is located where? Radiates where? |
|
Definition
| epigastric pain that radiates to back |
|
|
Term
| Chronic pancreatitis is a result of? is aggravated by? |
|
Definition
| Chronic inflammation causes firbrosis. Aggravated by ETOH and heavy/fatty meals. |
|
|
Term
| Chronic Pancreatitis is associated with what three things |
|
Definition
1. pancreatic enzyme insufficiency
2. steatorrhea
3. DM |
|
|
Term
| most common cancer of the pancreas is |
|
Definition
|
|
Term
| A very pecululiar sx of pancreatic cancer is development of what sx |
|
Definition
|
|
Term
| what are the three patterns of IBS |
|
Definition
| diarrhea or constipation or combination |
|
|
Term
| a change in bowel habits often associated with diarrhea, abd pain, bleeding or weight loss is likely what |
|
Definition
| cancer of the rectum or sigmoid colon. |
|
|
Term
| cancer of the rectum or signmoid colon often causes this change in the bowel which then causes most of the sx |
|
Definition
| progressive narrowing of the bowel lumen from adenocarcinoma which leads to bowel obstructions and related sx |
|
|
Term
| Two signs of rectal cancer are |
|
Definition
1. tenesmus: feeling of needing to go, but no stool (cancer pushing on those nerve fibers)
2. Pencil-shaped stools (from the progressive narrowing of this type of cancer) |
|
|
Term
| fecal impactation most often concerns what part of the GI tract |
|
Definition
|
|
Term
| other than cancer, what other lesions/diseases contribute to bowel obstruction (4x) |
|
Definition
1. diverticulitis
2. volvulus
3. intussuception
4. hernia |
|
|
Term
| currant jelly stools is from what bowel issue |
|
Definition
|
|
Term
| what metabolic conditions contribute to constpiation 3x |
|
Definition
1. pregnancy
2. hypothyroidism
3. hypercalcemia |
|
|
Term
| acute diarrhea is less than ___ days |
|
Definition
|
|
Term
| transit time for melena is? Where does blood come from |
|
Definition
| 7-14 hours, originates in esophagus, stomach, duodenum. |
|
|
Term
| diseases that cause melena |
|
Definition
1. GERD
2. Gastritis
3. Peptic ulcer
4. Esophageal varices
5. Mallory-Weiss Tear |
|
|
Term
| black non blood stool caused by |
|
Definition
1. licorice
2. iron
3. Bismuth salts |
|
|
Term
|
Definition
1. colon
2. rectum
3. anus
less freq jejunum or ileum. |
|
|
Term
| for an upper GI bleed to result in hematochezia you need to loose roughly how much blood |
|
Definition
|
|
Term
| disease causes of hematochezia |
|
Definition
1. colon cancer
2. polyps
3. diverticula
4. inflammatory conditions
5. ishemic colitis
6. hemorrhoids
7. anal fissure |
|
|
Term
| hepatocyte necrosis is followed by what changes |
|
Definition
1. fibrosis
2. nodular regeneration |
|
|
Term
| name three common findings with cirrhosis patients |
|
Definition
1. jaundice
2. ascites
3. spider angiomas |
|
|
