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74 Cards in this Set
- Front
- Back
viseral pain |
hollow organs contract difficult to localize cramping, aching, burning gnawing n/v, sweating, pallor, restlessnes |
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Visceral periumblical pain early may signify |
acute appendicitis gradually will change to parietal pain in RLQ |
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Parietal pain |
Inflammed parietal parietal peritoneum Steady aching pain More severe than visceral pain Located precisely over involved structure Aggravated by coughing moving |
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If pt prefers to lie still think |
Parietal pain |
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Melena |
black sticky, shiny, tarry stool Upper GI-esophagus, stomach, duodenum may occur with as little as 100cc |
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Hematochezia |
Red or maroon colored Lower GI bleed-colon, rectum, or anus |
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Blood on toilet paper |
hemorrhoids |
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Black nonsticky stools |
Injestion of iron, bismuth salts, licorice, or chocolate cookies. |
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Reddish but nonbloody stools |
ingestion of beers |
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2 causes of obstructed bile ducts |
gallstones pancreatic carcinoma |
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Dark urine indicates |
obstructed or impaired excretion of bilirubin into GI tract. |
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Itching over liver may indicate |
Obstructive jaundice cholestatic jaundice |
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Stress incontinence |
weak urethral sphincter causes: childbirth, surgery, prostatic surgery leakage w/ coughing, laughing, sneezing bladder not detected on exam |
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Urge incontinence-bladder small |
Detrusor contractions stronger and overcome urethral resistance. -stroke, brain tumor, lesions of spinal cord -hyperexcitability of sensory pathways-bladder infections, tumors and fecal impaction -deconditioning of voiding reflexes as in freq vol voiding at low bladder volumes |
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Urge incontinence |
Invol volume loss preceded by urge to void. Volume-moderate. Urgency, freq and nocturne with small to moderate volume. Possibly "pseudo-stress incontinece"-voiding 10-20 secs after stress-coughing/sneezing or change in position. Bladder not detectable on exam. |
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Functional incontinence |
Inablility to get to the toilet because of weakness, poor vision or other conditions. On way to toilet or early in am. Bladder not detectable. |
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Overflow incontinence-bladder large |
Detrusor contractions are insufficient to overcome urethral resistance.Obstruction of bladder outlet, impaired bladder sensation that interrupts the reflex arc. Continuous dribbling, decreased force of urinary flow. ***Enlarged bladder found on exam may be tender. |
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Psoas Sign |
Access for possible appendicitis Place your hand able the pt.'s R knee, ask pt to turn raise that thigh against your hand.Then ask pt to turn on L side and extend the pt.'s R leg at the hip. Flexion of the leg-psoas m contracts, extension stretches it. **Increased pain=+Psoas sign=irritation of the psoas m by an inflamed appendix. |
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Rovsing's sign |
Appendicitis test Press deeply and evenly into the LLQ. Then w/draw fingers. Pain in RLQ during left sided pressure is + Rosvings sign. |
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Murphy's Sign |
Assess acute cholecysitits Hook you L thumb/fingers under the costal margin where the lateral border of the rectus m intersects with the costal margin. If liver is enlarged, hook thumb/fingers under the liver edge. Ask the pt to take a deep breath. Watch the pt breathing and note the degree of tenderness |
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+ Murphys Sign |
A sharp increase in tenderness with a sudden stop in inspiratory effect = a + Murphy's sign of acute cholecystitis. Hepatic tenderness may also increase with this maneuver but is usually less well localized. |
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Oburator's Sign |
Flex the pt R thigh at the hip, with the knee bent, and rotate the leg internally at the hip. This stretches the internal oburator muscle. Right hypogastric pain = a + obturator's sign from irritation of the oburator m by an inflamed appendix. |
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Gray Turner's Sign |
Bruising of the flanks- last rib and the top of the hip. Sign of retroperitoneal hemorrhage, or bleeding behind the peritoneum. May takes 24–48 hours to develop, and can predict a severe attack of acute pancreatitis. May be accompanied by Cullen's sign. Indicative of pancreatic necrosis with retroperitoneal or intraabdominal bleeding. |
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Ascites |
Seeks the lowest pt in the abdomen. Dull percussion Umb may protrude Turn pt onto one side to detect shift in position of the fluid level |
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Ascites assessment-Turn pt to one side |
In ascites, dullness shifts to the more dependent side, whereas tympany shifts to the top. |
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Test for fluid wave |
Ask pt to press edges hands down midline Tap one flank sharply with fingertips Feel the opposite flanks for an impulse transmitted through the fluid. **Sign is negative until ascots is obvious and can be positive in people w/out ascites ***An easily payable impulse suggests ascots |
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appendicitis |
Peaks 10-12 Begins as dull, steady pain in periumblical area Progresses over 4-6 hrs and localizes to RLQ Nausea, low grade fever, anorexia, cough hurts Sudden pain relief may be appendix rupture. Rebound tenderness at McBurney's point. Early voluntary guarding replaces involuntary muscular rigidity. |
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Cholecystitis |
Fever and leukocystosis jaundice, N/V, Anorexia, jarring deep breathing aggravate, fat intolerance. Abdominal distention/fullness Abdomina pain-RUQ or epigastric-steady, aching May radiate to back Increase pain with deep breath |
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Pancreatitis |
Eprgastic pain that may radiate to back. Lying supine or alcohol or heavy meals my aggravate. Leaning forward may relieve. Fatty stools, Anorexia n/v, wt loss, jaundice, depression. Rebound tenderness Pancreatic enzyme insufficiency, diarrhea with fatty stools (steatorrhea) and DM |
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Mcburney point |
Just below the middle of a line joining the umb and the anterior superior iliac spine |
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AAA s/s |
A pulsating feeling near the navel. Deep, constant pain in your abdomen or on the side of your abdomen Back pain |
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AAA risk factors |
>65 hx of smoking male 1st degree relative with hx of AAA repair |
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AAA |
Normal aorta 3cm wide >3cm suggest AAA Pain may signal rupture |
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Assess AA |
Press deep in the upper abdomen, slightly left of midline and identify aortic pulsations. |
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Cancer stomach |
Pain variable-persistent, slowly progressive Not relieved by food, antacids may Anorexia, nausea,early satiety, wt loss and sometimes bleeding. Most common 50-70 |
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Cancer pancreas |
Steady deep epigastric pain may radiate to back. Relentlessly progressive illness. Leaning forward with trunk flexed. A/N/V, wt loss and jaundice, depression. |
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Liver enlargement- Downward displacement of the liver by a diaphragm. |
Seen in COPD Percussion reveals low upper edge and liver span is normal. Liver palpable below costal margin. |
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Liver enlargement- Normal variation in the liver shape |
Some people have an elongated liver and the lobe is easily palpable as it projects downward toward the iliac crest. Such elongation is called Riedel's lobe. Just a variation in shape not size. |
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Liver enlargement- Smooth large liver |
Cirrhosis may produce a enlarged liver with a firm, nontender edge. The cirrhotic liver may be scarred and contracted. An enlarged liver with a smooth tender edge suggests inflammation as in hepatitis, venous congestion-right sided heart failure. |
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Liver enlargement- Irregular large liver |
An enlarged liver that is firm orchard and has an irregular edge or surface suggest hepatocelluar carcinoma. There may be one or more nodules. The liver may be tender or nontender. |
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Urinary frequency-mechanims |
Decreased capacity of the bladder -increased bladder sensitivity to stretch because of inflammation. -dec elasticity of the bladder wall -dec cortical inhibition of bladder contraction. Impaired emptying of the bladder with residual urine in the bladder -from obstruction or loss of nerve supply |
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Urinary frequency-Causes |
Infections, stones, tumors, foreign bodies, Scar tissue, motor disorders of the CNS-stroke, beign prostatic hyperplasia, diabetic neuropathy |
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Urinary frequency-symptoms |
Burning on urination, urinary urgency, gross hematuria, Hesitancy in starting stream, straining to void, reduced size and force of stream and dribbling |
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Nocturia with high volume-mechanism |
Most types of polyuria Decreased concentrating ability of the kidney Excess fluid intake before bedtime Fluid retaining-dep edema accumulates during the day and is excreted at night. |
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Nocturia with high volume-cause |
Chronic renal insuff d/t disease Alcohol/coffee heart failure, nephrotic syndrome, hepatic cirrhosis with ascites, chronic venous insuff |
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Nocturia with high volume-symptoms |
Edema and other symptoms of the underlying disorder |
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Nocturia with low volumes |
Voiding up at night w/out real urge "pseudofreqency. Cause-insomina |
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Polyuria-mechanism |
Def of antidiuretic hormone (diabetes insipidus) Renal unresponsiveness to antidiuretic hormone Solute diuresis -electrolytes such as sodium/salt -nonelectrolytes such as glucose Excess water intake |
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Polyuria-cause |
disorders of the post pituitary and hypothalmus. kidney dz uncontrolled DM Large saline infusions, potent diuretics |
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Polyuria-symptoms |
Thrist, polydipsia, nocturia |
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Constipation |
-present for at least 12 weeks of the prior 6 months with at least 2 of the following conditions -fewer than 3 BM's week -25% or more defecations with either straining or sensation of incomplete evacuations -lumpy, hard stools -manual facilitation. |
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consider mediations such as anticholinergic agents, calcium channel blockers, iron supplements and opiates |
meds that cause constipation |
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Obstipation |
No passage of feces or gas |
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Constipation-life activities that cause |
-inadquate time for the defecation reflex -diet deficient in fiber -false expectation of bowel habits |
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Constipation causes |
Irritable bowel syndrome-constipation/diarrhea Cancer of rectum fecal impaction lesions drugs depression neurologic disorders metabolic conditions |
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dysphagia |
difficultly swallowing from impaired passage of solid food or liquids. Foods seem to stick |
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Dysphagia causes-oropharyngeal |
Due to motor disorders affecting the pharyngeal muscles. Acute or gradual. Aspiration into lungs From stroke or other neuromuscular conditions |
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Dysphagia causes-esophageal |
Stricture, cancer or ring/web Factors that relieve-regurggitaion of the food Factors that aggravate-solid foods |
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Dysphagia causes-Motor disorders |
esophageal spasm scleroderma achalasia Factors that aggregate solids/liquids Factors that relieve-repeated swallowing movements such as straightening the back, raising the arm or a valsalva maneuver. |
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diarrhea |
stool volume > than 200g in 24 hours loose watery stools acute lasts up to 2 weeks chronic-4 or more weeks |
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Acute diarrhea |
infections |
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Chronic diarrhea |
Chron's ulcerative colitis |
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High volume, frequent watery stools |
usually are from the small intestine |
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Small volume stools with tenesmus or diarrhea with mucous, pus, or blood occur in... |
rectal inflammatory conditions |
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Noctural diarrhea |
usually pathological |
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Steatorrhea or fatty diarrheal stools from malabsorption occur in |
celiac sprue, pancreatic insufficiency |
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Diarrhea |
common with meds |
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Bowel sounds increased |
diarrhea, or early intestinal obstruction |
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Bowel sounds decreased or absent |
adynamic ileus or peritonitis before decided BS are absent listen for 2 minutes or longer. |
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high pitched BS |
suggest intestinal fluid and air under tension in a dilated bowel. |
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Rushes of high pitched sound with abdominal cramping |
indicate intestinal obstruction |
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Bruits hepatic arterial |
Hepatic suggests carcinoma of the liver or alcoholic hepatitis. Arterial with both systolic and diastolic components suggest partial occlusion of the aorta or large arteries. Partial occlusion of the renal artery may explain HTN. |
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Venous Hum |
A venous hum is rare. It is a soft humming noise with both systolic and diastolic components. It indicates increased collateral circulation btwn portal and systemic venous systems, as in hepatic cirrhosis. |
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Friction Rubs |
Friction rubs are rare. They are grating sounds with respiratory variation. They indicate inflammation of the peritoneal surface of an organ as in liver cancer. When a systolic bruit accompanies a hepatic friction rub, suspect carcinoma of the liver. |