exam 4 ryan

what is the superior border of the abdomen?

diaphragm

what is the posterior border of the abdomen?

lumbar vertebrae

what is the anterior border of the abdomen?

rectus abdominis, tranversus abdominis, internal obliques, external obliques

what is the inferior border of the abdomen?

pelvic brim

what is the abdomen lined with?

parietal and visceral peritoneum

list contents of RUQ

liver, stomach, gallbladder, duodenum, R kidney, pancreas, transverse colon, R adrenal gland, small intestines

list contents of RLQ

small intestine, large intestine, cecum, appendix, R ureter, R reproductive organs (ovary, fallopian tube, spermatic cord)

list contents of LUQ

liver, L adrenal gland, stomach, L kidney, pancreas, spleen, transverse colon, small intestine

list contents of LLQ

small intestine, large intestine, L ureter, sigmoid colon, L reproductive organs (fallopian tube, ovary, spermatic cord)

what planes separate the abdomen into four quadrants?

transumbilical, median

in what location are the kidneys located?

costoverebral angle

what are the three broad types of abdominal pain?

visceral, somatic or parietal, and referred pain

what is visceral abdominal pain?

when a hollow organ (although can occur in liver) is distended or ischemic

what type of abdominal pain is usually non-specific and difficult to localize?

visceral

how can visceral abdominal pain be described?

dull, gnawing, cramping, aching, poorly localized

what is the source of somatic/parietal abdominal pain?

skin, muscles, and peritoneum

what is the source of visceral abdominal pain?

mucosal distension

what are examples of visceral pain?

gas pains, hepatitis, early appendicitis, or mesenteric ischemia

where is visceral abdominal pain normally located?

epigastric, periumbilical, or hypogastric

what is somatic or parietal abdominal pain?

pain from inflammation of the parietal peritoneum (peritonitis)

how can somatic or parietal abdominal pain be described?

steady, aching, sharp, intense

is visceral abdominal pain or somatic/parietal abdominal pain more severe?

somatic/parietal

what type of pain is usually more localized and the pt prefers to lie still?

somatic or parietal abdominal pain

what is an example of somatic or parietal abdominal pain?

late appendicitis, fistulas, abscesses, perforation

what happens if you apply pressure to an area where there is referred pain?

non tender, painless

what is referred abdominal pain?

pain felt in more distant sites that are innervated around the same spinal level as the abdominal disorder

where is pancreas pain often referred to?

back

where is biliary pain often noted?

R scapular region

where does a heart attack have referred pain?

L arm, neck, jaw

you should pay attention to how what affects abdominal pain?

food, NSAID use, bowel movements, staying still vs moving around, body positioning, stress, antacids

what should you note for timing of abd pain?

what the pt was doing when it started and patterns to episodes

what is dysphagia?

difficulty swallowing

if pt is having dysphagia with solid food only, what is it more likely to be?

esophageal stricture or narrowing

if pt is having dysphagia with solids and liquids, what is it more likely to be?

motility disorder like achalasia

what is odynophagia?

pain on swallowing

what are causes of odynophagia?

esophageal ulceration, caustic ingestion, radiation, infections such as candida, CMV, herpes, or HIV

what is the general term of distress associated with eating?

indigestion

what is heartburn?

rising, retrosternal burning pain

what is heartburn sometimes used interchangeably with?

dyspepsia

what is dyspepsia?

chronic discomfort or pain in upper abd, often with postprandial fullness or early satiety

what should you always rule out with heartburn?

cardiac causes

what is regurgitation?

reflux of food or stomach contents

heartburn and regurgitation have 90% accuracy of what diagnosis?

GERD

what is the medical term for belching?

eructations

what is the most concerning cause of eructations?

bowel obstruction

what is eructations normally caused by?

indigestion or food choice

what is passage of no stool or gas?

obstipation

what is no gas or obstipation a concern for?

bowel obstruction (o)

increased gas or flatulence can be a sign of what?

food intolerance, excess fiber or biome imbalance

what is anorexia?

loss or lack of appetite

food fear, early satiety, and reactions to food products are all examples of what?

food intolerance

what is the correct terminology for "feeling sick to my stomach"?

nausea

what is vomiting?

forceful expiration of stomach contents

what should you ask about vomiting?

number of times, quantity, color, odor, blood

what might vomit look like in a pt with bowel obstruction?

fecal like vomit

what is the correct terminology for bloody emesis?

hematemesis

what does hematemasis with coffee ground appearance indicate?

partially digested blood

what might cause hematemesis with bright red blood?

mallory weiss tears (small amount), esophageal varices (large amount), or pectic ulcer disease (PUD)

Bristol Stool Chart: what type is separate hard lumps?

type 1

Bristol Stool Chart: what type is lumpy and sausage like?

type 2

Bristol Stool Chart: what type is sausage shape with cracks in surface?

type 3

Bristol Stool Chart: what type is like a smooth, soft sausage or snake?

type 4

Bristol Stool Chart: what type is soft blobs with clear-cut edges?

type 5

Bristol Stool Chart: what type is mushy consistency with ragged edges?

type 6

Bristol Stool Chart: what type is liquid consistency with no solid pieces?

type 7

what is loose or watery stool?

diarrhea

what is acute diarrhea?

less than 14 days

what is acute diarrhea usually caused by?

food borne and infectious

what is persistent diarrhea?

14-30 days

what is chronic diarrhea?

more than 30 days

what is chronic diarrhea usually caused by?

IBS, ulcerative colitis, Crohn, or food intolerance

when is diarrhea usually pathologic?

when it occurs at night

what is the urge to defecate?

tenesmus

what is it called when diarrhea is greasy, frothy, or floating?

steatorrhea

what is steatorrhea usually a sign of?

malabsorption in pancreatic insufficiency, celiac or small bowel bacterial overgrowth

what is this criteria called?

constipation that is present for the last 3 months and onset 6 months ago include 2 or more criteria

-less than 3 BMs/week

-25% or more defecations with straining or sensation of incomplete evacuation

-lumpy or hard stools

-require manual facilitation

Rome IV criteria

what medications can cause constipation?

iron, calcium supplements, anticholinergics

what chronic medical conditions can cause constipation?

hypothyroidism, diabetes, MS, Parkinson's disease

what is the correct terminology for fresh blood passed in stool?

hematochezia

what are causes of hematochezia?

lower GI cancer, ulcerative colitis, diverticulitis, hemorrhoids, larger volume of bleed from upper GI source

what is the correct terminology for black or tarry stools?

melena

what is melena more likely to be from?

upper GI tract

how does rectal bleeding normally present?

bright red blood streaking outside of stool

what might rectal bleeding be associated with?

ulcerative colitis, hemorrhoids, cancer, or anal fissure

what are hemorrhoids?

swollen and possibly inflamed veins in rectum

when do hemorrhoids cause discomfort?

when thrombosed

describe external hemorrhoids

below dentate line, easily palpable and visible

describe large internal hemorrhoids

may be palpable and cause rectal fullness or tenesmus sensations

which type of hemorrhoids are more painful?

external hemorrhoids

what is yellow discoloration of the skin and sclera?

jaundice/icterus

what is jaundice/icterus due to?

increased levels of bilirubin from breakdown of hemoglobin

if hemoglobin isn't processed and cleared fast enough, what kind of issue is it?

liver or gallbladder issue

if hemoglobin breaks down too fast, what kind of issue is it?

blood hemolysis issue

how would a gallbladder or liver issue causing hemoglobin to not be processed or cleared fast enough present?

white/light stool and dark urine

what is painless jaundice a red flag for?

cancer: pancreatic or biliary

what are the kinds of chronic hepatitis with lifelong issues in blood?

hepatitis B and C

with hx of cholelithiasis, there is an increased risk of what?

cholecystitis and common duct obstruction

list acute upper abdominal pain differentials

gastric or duodenal ulcer/peptic ulcer disease with worsening or perforation, acute heartburn, MI, acute pancreatitis, gastroenteritis, acute cholelithiasis

list conditions causing chronic upper abdominal discomfort

dyspepsia, GERD, PUD, malignancies, chronic pancreatitis, chronic cholecystitis, IBS

list conditions causing acute lower abdominal pain

appendicitis, diverticulitis, bowel obstruction, gyn sources like PID, ectopic pregnancy, and ruptured ovarian follicle, and nephrolithiasis