Patient Assessment II: Abdominal/GI history + PE

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79 Terms

1
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what is included in the upper GI tract

mouth, pharynx, esophagus, stomach

2
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what is included in the lower GI tract

SI, LI, rectum, anus

3
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main fxs of GI system

assimiliate nutrients and eliminate wastes

4
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located in mouth - produce digestive juices

salivary glands

5
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located in RUQ - produces bile which helps digestion

liver

6
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located in RUQ - connects bile ducts, stores bile

gallbladder

7
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located in LUQ - produces digestive enzymes

pancreas

8
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lines abdominal cavity acting as protective cover

peritoneum

9
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fat anchoring the SI

mesentery

10
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what connects the pharynx to the stomach and is located posterior to the trachea

esophagus

11
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what are the 3 sections of the stomach

fundus

body

pylorus

12
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where are most nutrients absorbed in the GI tract

SI (primarily jejunum)

13
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how long does it take for food to travel through the SI

~5hrs

14
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what are the primary functions of the LI

- absorb water and electrolytes from undigested food

- form solid waste

- produces and absorbs certain vitamins

- maintain fluid balance

- bacterial fermentation

- immune function

15
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what are the sections of the LI

cecum

colon (ascending, transverse, descending, sigmoid)

rectum

anus

16
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what is the small organ under the liver that stores and releases bile to aid in fat digestion?

gallbladder

17
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what is the exocrine function of the pancreas?

- produces digestive enzymes (amylase, lipase, protease) to breakdown carbs, fats and proteins in SI

- secrete bicarb ions to neutralize stomach acid

18
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what is the endocrine of the pancreas?

produces insulin to regulate blood glucose levels

produces glucagon to raise blood sugar

produces somatostatin - inhibits release of insulin and glucagon

19
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what organ in LUQ has white pulp which filters blood and produces lymphocytes

spleen

20
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kidneys are located in the ______

retroperitoneum

21
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what are the functions of the kidney

- get rid of water soluble waste

- produce renin, erythropoietin, and vit D (calcitrol)

- synthesize prostaglandins

- control pH

22
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what contains the umbilicus

linea alba

23
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what are the branches of the descending aorta

iliac arteries

splenic artery

renal arteries

24
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what are considered structural diseases

IBD (ulcerative colitis, chrons)

colorectal cancer

25
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what are the most common GI symtpoms

- constipation

- diarrhea

- nausea

- vomiting

- abd pain

- heartburn/reflux

- bloating

26
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what are some red flag symptoms with GI complaints?

- unexplained weight loss

- dysphagia

- odynophagia

- profuse and prolonged vomiting

- GI bleeding

- nocturnal diarrhea

- jaundice

- severe pain

27
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what type of pain:

- when hollow organs contract forcefully or distend

- difficult to localize

- gnawing, burning, aching

visceral

28
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what type of pain:

- inflammation of the parietal peritoneum

- steady aching pain, more severe

- localized

- aggravated by coughing or movement

parietal

29
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common clinical presentation of heartburn

burning substernal pain

usually occurs after meals

worse at night with laying down

30
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what are some silent symptoms of heartburn

chronic cough

wheezing

hoarseness

sore throat

halitosis

choking

31
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clinical presentation of upper GI bleed

melena or hematemesis

black or tarry stools

iron deficiency anemia (+/-)

32
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clinical presentation of lower GI bleed

bright red/maroon stool

iron deficiency anemia (+/-)

33
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what can cause dysphagia/odynophagia

structural anomalies

motility disorder

infections/ulcerations

34
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disorders of the urinary tract can cause _______ or ______ pain

abd; back

35
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what are s/s of urinary tract infection/disorder

suprapubic pain

dysuria, urgency, frequency

polyuria/nocturia

urinary incontinence

hematuria

kidney/flank pain

36
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what are some common GI s/s seen with pregnant women?

heartburn

gallstones

urinary stasis/urgency

constipation or flatus

hemorrhoids

37
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what functional abilities of GI tract are often seen in older adults

slow motility

secretion and absorption slows

*may result in food intolerances

38
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for abd exam, you should expose pt from _____ to _____

xyphoid; symphysis of pubis

39
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what organs/areas are included in abdominal exam

mouth/teeth/tongue

stomach

liver/gallbladder

pancreas

SI/LI

rectum/anus

spleen

kidneys

vasculature

bladder and female reproductive organs

40
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what is the order of the abdominal exam

inspection

auscultation

percussion

palpation

special tests

41
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always ____ before palpation/percussion in the abdomen!!!

auscultate

42
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what are you looking at during inspection of abdomen

general appearance

skin (jaundice, rashes etc)

contour (flat round, scaphoid, protuberant)

movement

superficial veins (should not be present)

facies and hands

abdominal muscles

43
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what sign: superficial edema and bruising in subQ fatty tissues around periumbilicus. d/t hemorrhagic pancreatitis

cullens sign

<p>cullens sign</p>
44
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what sign: blueish discoloration of umbilicus from hemoperitoneum often associated with acute necrotizing pancreatitis

grey turners sign

<p>grey turners sign</p>
45
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when may you hear inc bowel sounds

gastroenteritis, early intestinal obstruction, hunger

46
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when may you hear high pitched bowel sounds

borborygmi - suggests intestinal fluid and air under pressure as in early obstruction

47
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when may you hear dec bowel sounds

peritonitis, paralytic ileus, constipation

48
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when may you hear absent bowel sounds

typically indicate a surgical emergency

49
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what might be heard d/t inc collateral circulation between portal and systemic venous system

venous hum

50
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what might be heard over aoritc, renal and iliac arteries that indicates turbulent flow

bruits

51
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when percussing what sounds do the following produce:

Gas -

Liquid -

Solid -

gas - tympany

liquid - dullness

solid - more profound dullness

52
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what organ is located in traubes space (6th rib posteriorly, L ant axillary line)

spleen

53
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how do you assess shifting dullness

assess for tympanny, dullness while pt is supine, then have them roll to the side

54
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what is the fluid wave test

pt places hand in center of abd, provider taps one side of the abd and notes if they can feel a "wave" on the other side

55
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what are bulging flanks a sign of

ascites

56
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what type of palpation relaxes pt, elicits tenderness/muscle stiffness

light

57
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what type of palpation is required to assess for masses, guarding and rebound tenderness

deep

58
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what organs should not normally be palpable

spleen, kidneys, bladder

59
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what area of hand should you use to palpate the abd

flat part or pads of fingers (not tips)

60
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when should you palpate the painful area

LAST

61
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what are you palpating for with deep palpation

bulges, masses

liver

gallbladder

spleen

kidneys

aortic pulsation

62
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what masses would be considered physiologic

pregnant, uterus

63
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what masses would be considered neoplastic

tumors, firm, nodular

64
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what masses would be considered vascular

pulsatile

65
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what masses would be considered inflammatory

associated with tenderness (diverticulitis or appendicitis)

66
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what is the normal percussable span of the liver in mid clavicular line? sternal line?

6-12cm; 4-8cm

67
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a normal liver may be palpable ______ below the costal margin in midclavicular area

3cm

68
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an enlarging spleen will migrate from _____ to _____

LUQ; RUQ

69
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what can pain with percussion over CVA be associated with?

kidney infection, stone, inflammation or injury

70
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what is a red flag when palpating aorta

>5cm and pain

71
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what is normal aorta size?

3cm

72
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what special test? and when is it used?

straighten and stiffen fingers of one hand and make a jabbing movement toward organ to displace fluid

ballotte; used for ascites

73
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what sign:

+ in appendicitis

press deeply in LLQ and will ilicit pain in RLQ

rovsings

74
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what sign:

+ in appendicitis

pt supine, place hand above R knee and as pt to raise leg against your hand

psoas sign

75
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what sign:

+ in appendicitis

examiner flexes pts right hip and interanlly rotates

obturator

76
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what sign:

+ in appendicitis

palpate this point which is 1.5-2 inches from ASIS

mcburneys point

77
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what test:

assesses for peritoneal inflammation

over area of pain or suspected pain push gently, then firmly, then abruptly let go

rebound tenderness

78
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what sign:

test for inflammation of gallbladder

pt lies supine, ask pt to take a deep breath, if there is pain = positive

murphys sign

79
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what special test should be done on all pts with abd pain

digital rectal exam