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39 Cards in this Set
- Front
- Back
Organs in the RUQ
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1) Small bowel
2) Liver/gallbladder 3) Pylorus/Duedenum 4) Upper portion of R kidney 5) portion of pancreas |
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Organs in the LUQ
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1) Small bowel
2) Spleen 3) Part of liver 4) body of pancreas 5) stomach 6) Upper portion of kidney |
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Organs in the RLQ
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1) Cecum and appendix
2) Lower portion of kidney |
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Organs in the LLQ
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1) Sigmoid in color
2) Lower portion of kidney |
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Visceral ABD Px characteristics?
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1) Often poorly localized
2) Gnawing/Burning/Vague deep ache 3) Cramping or colicky (comes and goes) in nature 4) Typically palpable near midline at levels that vary with structure involved |
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Visceral Px is stimulated by?
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specific receptors (nociceptors) for stretch, inflammation, and oxygen starvation (ischemia).
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Parietal ABD Px characteristics?
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1) Precisely localized
2) Steady aching pain or Sharp 3) Aggravated by movement, couching 4) Patients typically prefer to lie still |
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Parietal Px?
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Source – parietal peritoneum
Receptors activated - Somatic innervation (spinal nerves). |
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Pain form a duodenal or pancreatic origin may be referred to?
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the back.
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Pain from the biliary tree Px may be referred to?
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right shoulder or right posterior chest
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Pleuritic pain or MI pain referred to
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the epigastric
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melena
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black, tarry stool
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hematochezia
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blood in the stool
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white or gray stools can indicate
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liver or gallbladder disease
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lower back in men
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may be prostrate Px
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Caput medusa
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vein destintion of cirrhosis or inferior vena cava obstruction
* usually from ascities |
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Peristalsis increased in
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obstruction
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Friction rub upon auscultation of the ABD
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* Grating, scrapping, or rubbing sound produced be visceral pleura rubbing against parietal pleural
* Spleen (listen over spleen) * Liver (listen over liver) |
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Light Palpation is used for?
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Identifying any superficial organs, masses, areas of tenderness, or increased resistance to your hand
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Involuntary guarding indicates?
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peritoneal inflammation
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Deep Palpation is used for?
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1. Physiologic- pregnant uterus
2. Inflammatory- diverticulitis of the colon 3. Vascular- abdominal aortic aneurysm 4. Neoplastic- carcinoma of the colon 5. Obstructive- a distended bladder or dilated loop of bowel |
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Dunphy’s Sign - def
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cough worsens ABD pain
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Rebound tenderness is due to?
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caused by rapid movement of an inflamed peritoneum
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Traube’s Space
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* It's a crescent-shaped space overlying the stomach.
* The surface marking: the left sixth rib,the left mid-axillary line andthe left costal margin. * Percussion should be carried out at one or more levels of Traube’s space from medial to lateral. |
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Splenic Percussion sign
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1) Percuss the lowest interspace in the left anterior axillary line. (should be tympanic)
2) Ask the patient to take a deep breath in and re-percuss. (normally remains tympanic) * Positive sign is tympany to dullness on inspiration |
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Ascites causes?
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1. Increased hydrostatic pressure in cirrhosis, CHF, constrictive pericarditis
2. Hepatic or inferior vena cava obstruction 3. Decreased osmotic pressure in nephrotic syndrome and malnutrition 4. Inflammatory from infection or masses |
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Types of ascites?
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* Transudative – cirrhosis, CHF, hepatic or IVC occlusion, nephrotic syndrome, malnutrition
* Exudative – cancer, infection, pancreatitis, Tb |
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Ascites - S/S?
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* Abdominal distension/bulging flanks
* SOB * leg swelling * bruising * hematemesis * encephalopathy * Shifting dullness, fluid wave, dullness in dependent areas (due to gravity) |
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Serum ascites-albumin gradient (SAAG) -
High gradient (>1.1 g/dL) indicates? |
ascites due to portal hypertension, usually related to cirrhosis, CHF
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Low gradient (<1.1 g/dL) SAAG indicates?
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ascites not due to portal hypertension as in nephrotic synd., Tb, cancers
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Shifting Dullness in ascites?
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* In the supine position:
Percuss from midline moving out towards the perimeter. Mark position where sound changes from tympany to dullness * Pt in the lateral decubitus position: Repeat percussion. Gravity dependent fluid will have shifted in a pt with ascites |
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Fluid Wave in ascites?
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1) Have patient occlude midline of abdomen with the edge of his/her hand
2) Tap one flank 3) Feel for transmission of the sensation on the opposite flank |
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Appendicitis S/S?
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* Initial periumbilical pain then localizes to RLQ, followed by, N/V, lastly fever
* Diarrhea very unlikely * Peritoneal inflammation Note: Perform a rectal examination in both sexes and a pelvic examination in women may help identify or suggest other causes of abdominal pain |
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Rovsing’s sign - def?
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* Deep palpation in LLQ, then withdraw quickly.
* postive = pain w/ rebound in RLQ - appendicitis |
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Psoas sign - def?
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* Ask the patient to raise the right leg with resistance applied above right knee (or on L side extend R hip).
* Increased pain with either = positive psoas sign (suggests irritation of the psoas muscle by an inflamed appendix) |
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Obturator sign - def?
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* Flex the patient's right thigh at the hip with the knee bent, and rotate the leg internally at the hip. This stretches the internal obturator muscle.
* Positive = right hypogatric pain (suggests irritation of obturator muscle by inflamed appendix) |
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Dunphy’s sign - def?
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Abdominal pain worsened with cough. (may be a sign of appendix irritation)
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McBurney’s point - def?
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point between umbilicus and ASIS, Px upon palpation is indicative of appendicitis
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Jar test - def?
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* Tap heel while supine
* Increased pain = positive |