Notes in Abdomenal PE

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Status	Last Update	Fields
Published	09/08/2024	{{c1::DysphaGIa}}: difficulty swallowing
Published	09/08/2024	{{c1::dysphaSia}}: difficulty speaking/communicating
Published	09/08/2024	localization of {{c1::visceral pain}} is often times difficult to localize
Published	09/08/2024	localization of {{c1::Parietal}} pain is more {{c2::Precisely}} localized over {{c3::involved}} structure
Published	09/08/2024	the localization of {{c1::referred}} pain is not localized
Published	09/08/2024	Pain felt at distant site where nerve innervation is approximately at the same spinal level as the disordered structure is {{c1::referred}} pain
Published	09/08/2024	Inflammation of {{c1::parietal}} peritoneum is typically {{c2::steady/achy}} pain {{c3::more}} severe than visceral
Published	09/08/2024	{{c1::visceral}} pain is typically described as gnawing, burning, cramping, or aching pain
Published	09/08/2024	when abdominal organs contract, become distended, or stretched causes {{c1::visceral}} pain
Published	09/08/2024	{{c1::parietal}} pain is tpyically worse with movement/coughing
Published	09/08/2024	with referred pain, distant pain may develop {{c1::first}}
Published	09/08/2024	{{c1::Pancreatitis}}: knife like/stabbing pain, penetrating, typically epigastric
Published	09/08/2024	{{c1::AAA}} → Flank / back
Published	09/08/2024	{{c1::Kehr’s Sign}}:  pain in {{c3::left shoulder}} due to presence of blood/irritants in {{c4::peritoneal cavity}} when patient lying down …
Published	09/08/2024	{{c2::Gallbladder}} → pain is referred to the {{c1::shoulder blade }}
Published	09/08/2024	{{c1::Kidney Stone}} pain is typically referred to Flank / Genitals / scrotum
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Published	09/08/2024	{{c2::Peptic ulcer disease}} is typically described as {{c1::burning}} or {{c1::gnawing }}
Published	09/08/2024	{{c2::Pancreatitis}} pain is typically described as {{c1::penetrating }}
Published	09/08/2024	{{c1::Colicky}}: means it comes and goes in fierce {{c3::waves}}, may also hear this term used with {{c2::kidney stones/nephrolithiasis}}
Published	09/08/2024	•{{c1::Biliary colic}}: the term used to describe a type of pain related to the {{c2::gallbladder}} that occurs when a {{c3::gallstone}} transiently {…
Published	09/08/2024	acute pain is considered as {{c1::<1 hour }}
Published	09/08/2024	rapid pain is considered {{c1::>1 hr}}
Published	09/08/2024	gradual pain is over {{c1::days }}
Published	09/08/2024	gradual pain can be described as {{c1::smoldering }}, a constant pain that sticks around, maybe getting worse
Published	09/08/2024	A {{c1::Meckel's diverticulum}}, a true {{c2::congenital}} diverticulum, is a slight {{c3::bulge}} in the {{c4::small}} intestine present at bir…
Published	09/08/2024	aggravating/relieving effects can be {{c1::postural, meal-related, or bowel-related}}
Published	09/08/2024	uAlarm Features for bowel movements  (4) u{{c1::Over 50 uNew blood somewhere uNew constipation ufamily hx of colon cancer }}
Published	09/08/2024	oldcaarts does not work well for {{c1::bowel change cc}}
Published	09/08/2024	bristol sloot chart type {{c1::1}} is separate hard lumps like buts (hard to pass)
Published	09/08/2024	bristol sloot chart type {{c1::2}} is sausage shaped but lumpy
Published	09/08/2024	bristol sloot chart type {{c1::3}} is like a sausage but with cracks on the surface
Published	09/08/2024	bristol sloot chart type {{c1::4}} like a sausage or snake, smooth and soft
Published	09/08/2024	bristol sloot chart type {{c1::5}} soft blobs with clear cut edges
Published	09/08/2024	bristol stool chart type {{c1::6}} is fluffy pieces with ragged edges, a mushy stool
Published	09/08/2024	bristol sloot chart type {{c1::7}} is water, no solid pieces. entirely liquid
Published	09/08/2024	{{c1::Tenesmus}}: A distressing and persistent but ineffectual urge to empty the rectum or bladder.
Published	09/08/2024	{{c1::Acute upper GI}} bleed: Commonly present with hematemesis OR melena
Published	09/08/2024	{{c1::•Hematemesis}}: vomiting of blood or coffee-ground-like material
Published	09/08/2024	{{c1::•Melena}}: black, tarry stools
Published	09/08/2024	•{{c1::Acute lower GI}} bleed: commonly presents with hematochezia
Published	09/08/2024	{{c1::•Hematochezia}}: passage of maroon or {{c2::bright red}} blood or blood {{c2::clots}} per rectum
Published	09/08/2024	mucosal abnormalities for {{c2::upper GI}} bleed differential: {{c1::ulcers, inflammation, tumors}}
Published	09/08/2024	{{c2::gastroesophageal varcies}} with upper gi bleeds are associated with {{c1::portal HTN}}
Published	09/08/2024	{{c1::mallory-weiss tear}}: Laceration of mucosa at {{c2::gastro-esophageal junction}} commonly following {{c3::vomiting}}
Published	09/08/2024	{{c1::•Varices}}: enlarged veins that are susceptible to bleeding, often seen with {{c2::cirrhosis/chronic liver}} disease (Portal vasculature: stomac…
Published	09/08/2024	{{c1::Boerhave’s}}: full {{c2::transmural}} perforation or rupture of {{c3::esophagus}}
Published	09/08/2024	over 95% of lower gi bleeds are {{c1::colonic sources }}
Published	09/08/2024	If having indigestion, or GERD sx, always ask about {{c1::trouble or pain with swallowing}}
Published	09/08/2024	{{c1::Odynophagia}}= pain with {{c2::swallowing}}
Published	09/08/2024	{{c1::•Zenkers diverticulum}}: {{c2::structural}} condition (outpouching of esophagus) may lead to {{c3::regurgitation}} of undigested food (including…
Published	09/08/2024	{{c1::•Schatzki’s ring}}: submucosal ring around the lower esophagus, leading to {{c2::stricture}}, typically trouble with {{c3::solids}} only: {{c4::…
Published	09/08/2024	•{{c1::Achalasia}}: failure of relaxation of {{c2::lower esophageal}} sphincter accompanied by loss of {{c3::peristalsis}} in distal esophagus
Published	09/08/2024	Indigestion, Heart burn, Vomiting, Reflux: differential dx is (4)  {{c1::GERD -Esophagitis (NSAID or Fungal) -Malignancy -Zenkers Diverticu…
Published	09/08/2024	if a pt complains of loss of appetite is it because they are getting {{c1::full faster}} or just not {{c1::hungry}}?
Published	09/08/2024	make sure to always ask about {{c1::weight changes/loss}} when a pt complains of a a loss of appetite
Published	09/08/2024	always consider {{c1::malignancy}} when a pt is having unexplained weight loss
Published	09/08/2024	order of abdominal exam should be:{{c1::inspectionauscultationpercussionpalpation}}
Published	09/08/2024	Palpation may stimulate {{c1::bowel activity}} and give {{c1::false bowel sounds}} if done prior to auscultation
Published	09/08/2024	for an abodominal exam, pt should be {{c1::supine}} with head on {{c1::pillow}}, knees {{c1::slightly flexed}}, and their arms by {{c1::their side&nbs…
Published	09/08/2024	pt's abdomen should be exposed from {{c1::xiphoid}} to {{c1::pubic symphysis }}
Published	09/08/2024	inspection of abdomen is for skin characeteristics, {{c1::contour/symmetry (distention, masses/hernias), and surface motion (peristalsis or pulsations…
Published	09/08/2024	{{c1::Caput Medusae}}: (picture) the appearance of distended and engorged superficial epigastric veins, which are seen radiating from the umbilicus ac…
Published	09/08/2024	{{c1::dilated veins}} on the abdomen are commonly seen in hepatic cirrhosis
Published	09/08/2024	if there is jaundice and it is associated with fever/chills → {{c1::cholangitis}} until proven otherwise
Published	09/08/2024	Slowly developing icterus with clay-colored stools, itching, and cola-colored urine reflects {{c1::obstructive jaundice}}
Published	09/08/2024	Charcot’s Triad: •{{c1::Jaundice •Fever •RUQ pain}} → {{c2::Acute Cholangitis}}
Published	09/08/2024	{{c1::Icterus}}=jaundice/yellowing
Published	09/08/2024	{{c1::Grey Turner's Sign}}: {{c3::Bruising}} of the flanks. Takes 24–48 hours to develop. May indicate a severe attack of {{c2::acute pancre…
Published	09/08/2024	{{c1::Cullen’s Sign}}: Umbilical {{c3::ecchymosis}} may indicate a {{c2::hemoperitoneum}}
Published	09/08/2024	Inspection for Contour/symmetry The 7 F’s of Abdominal DISTENTION:{{c1::Fat Fluid Feces Fetus Flatus Fibroid (Females) Fatal tumor}}
Published	09/08/2024	{{c1::acute}} pain is VERY PAINFUL. Very SUDDEN, need intervention
Published	09/08/2024	when a pt has acute pain think of: (5){{c1::Perforated Ulcer Ruptured Abscess/Hematoma Esophageal Rupture Dissecting Aneurysm Mesenteric Infarction}}
Published	09/08/2024	{{c1::rapid}} pain builds gradually over an hour
Published	09/08/2024	rapid pain has all causes of sudden/acute plus:{{c1::Intestinal Obstruction Acute Cholecystitis Acute Pancreatitis Acute Diverticulitis Ureteral Colic…
Published	09/08/2024	{{c1::gradual}} paiin builds over days
Published	09/08/2024	gradual pain has all causes of sudden and rapid PLUS:{{c1::Appendicitis (early, not ruptured)Meckels or Uncomplicated Diverticulitis Abdominal Abscess…
Published	09/08/2024	when asking about bowel changes always screen for {{c2::opioids}} which can cause {{c1::constipation }}
Published	09/08/2024	ask about {{c1::trigger foods}} that could cause IBS which has abdominal pain that is relieved with {{c2::defecation }}
Published	09/08/2024	ask about diet when asking about bowel changes because they could have a flare caused by {{c1::fatty}} foods
Published	09/08/2024	if position helps make the pain better or worse, think about {{c1::GERD}} or {{c1::pancreatitis}}
Published	09/08/2024	an acute issue with bowel habits is {{c1::less than 2 weeks }}
Published	09/08/2024	a chronic issue with bowel habits is {{c1::more than 4 weeks}}
Published	09/08/2024	constipation is considered fewer than {{c1::3}} BM per week, 25% of the time {{c2::straining}}, {{c3::lumpy}} or {{c3::hard}} stool, manual facilitati…
Published	09/08/2024	Diarrhea refers to having {{c1::soft/liquid}} stool, or increased {{c2::volume}} in stool.
Published	09/08/2024	frequent stooling is considered having more than {{c1::3}} stools per day
Published	09/08/2024	diarrhea at {{c1::night}} is BAD
Published	09/08/2024	fatty/greasy stools indicate a {{c1::pancreas}} issue
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Published	09/08/2024	lower GI bleeding commonly presents with {{c1::hematochezia}}
Published	09/08/2024	upper GI bleeding commonly presents with {{c1::hematemesis and melena}}
Published	09/08/2024	differential for upper GI bleed:{{c1::mucosal abnormality}} → caused by {{c2::ulcers, inflammation, tumor}}{{c1::gastroesophageal varices}} →  ca…
Published	09/08/2024	with mucosal abnormalities causing upper GI bleeds think {{c1::bulimia}} or {{c1::NSAID}} use (erosive to stomach and esophageal lining).. Maybe even …
Published	09/08/2024	{{c1::esophagitis}} caused by medications (NSAIDs) or fungal can cause upper gi bleeds
Published	09/08/2024	differential for lower GI bleeds includes colonic sources: {{c2::diverticular sources, colorectal malignancy, colititis (ischemic, infectious, UC), he…
Published	09/08/2024	{{c1::Vascular Ectasias}} = vascular changes/malformations that can lead to {{c2::bleeding}}
Published	09/08/2024	with {{c1::dysphagia}} food seems to get stuck or will not go down while {{c1::odynophagia}} has pain with swallowing (could be herpes or yeast)
Published	09/08/2024	differential diagnosis for loss of appetite/early satiety should ALWAYS consider {{c1::malignancy}}, delayed {{c1::gastric emptying}}, {{c1::pregnancy…
Published	09/08/2024	have the patient {{c1::pee}} before the abdominal exam
Published	09/08/2024	having the patient bend their knees for the abdominal exam helps take the pressure off their {{c2::back}} when lying down and {{c1::relaxes}} the abdo…
Published	09/08/2024	{{c1::straie}} on othe abdomen could be due to cushing's or pregnancy, or they could be from weight losss
Published	09/08/2024	skin characteristics to look out for on the abdomen are {{c1::rashes}}, {{c2::dilated veins}}, {{c3::striae}}, {{c4::scars}}, {{c5::jau…
Published	09/08/2024	causes of pre-hepatic jaundice can be {{c1::hemolysis, hematoma, resorption}}
Published	09/08/2024	causes of intra-hepatic jaundice can be {{c1::Alcohol, infectious hepatitis, drug reactions, autoimmune disorders}}
Published	09/08/2024	causes of Post-Hepatic can be {{c1::Gallstone formation (most common), biliary tract infection, pancreatitis, malignancies}}
Published	09/08/2024	Gaseous distention related to eating is {{c1::intermittent}} and relieved by passage of {{c2::flatus or belching}}
Published	09/08/2024	{{c1::Ascites}} is usually insidious development of increased girth noted as increase in {{c2::belt}} size.Usually can see a {{c3::fluid wave}}. Fluid…
Published	09/08/2024	distention could be from {{c2::obstruction}} such as a build up of feces → ask about {{c1::constipation}}/last {{c1::BM}}
Published	09/08/2024	if you find a mass on inspection, it could possibly be a {{c1::hernia}} or {{c1::neoplasm}}.When suspiscious of {{c1::hernias}}, ask about {{c2::surge…
Published	09/08/2024	{{c1::hernia}}: a protrusion, bulge, or projection of an organ or part of an organ through the body wall that normally contains it.
Published	09/08/2024	most common complaint regarding hernia is {{c1::bulge}}/{{c1::swelling}} with or without {{c2::pain}}
Published	09/08/2024	major complications of hernias are {{c1::intestinal obstruction}} or {{c1::strangulation}}
Published	09/08/2024	you want the patient to raise their {{c1::head}} to detect a hernia
Published	09/08/2024	type of hernia depends upon {{c1::location }}
Published	09/08/2024	{{c1::Inguinal}} and {{c1::femoral }} hernias are palpated while standing
Published	09/08/2024	if the patient has a pulsatile abdominal mass → must rule out {{c1::AAA}}
Published	09/08/2024	{{c1::Diastasis recti}} is a > 2 cm separation of the right and left rectus abdominis muscles resulting in protrusion of a…
Published	09/08/2024	when ausculating the abdomen, we are listening for {{c1::bowel sounds}}, {{c1::friction rubs}}, and {{c1::bruits }}
Published	09/08/2024	{{c1::Bowel}} sounds reflect motility of air & fluid
Published	09/08/2024	not hearing any bowel sounds in 2 minutes in a quadrant is {{c1::BAD}} and could indicate {{c2::ileus }}
Published	09/08/2024	having {{c1::5-34}} sounds/min is normal in all 4 quadrants
Published	09/08/2024	a {{c1::hypo}}active abdomen could be due to medication, surgery, constipation
Published	09/08/2024	a {{c1::hyper}}active sound abdomen could be from diarrhea or eating
Published	09/08/2024	{{c1::high}} pitch, {{c1::tinkling}} sounds in the abdomen could indicate early intestinal obstruction
Published	09/08/2024	{{c2::Borborygmi}} ({{c3::low}} pitch), {{c3::growling}} sound in the abdomen could indicate {{c1::hyperperistalsis}}
Published	09/08/2024	friction rubs occur over the {{c1::liver}} and {{c1::spleen}}
Published	09/08/2024	{{c1::friction rubs}} indicate inflammation of {{c2::peritoneal}} surface of organ. And can change with {{c3::respiration}}
Published	09/08/2024	when listening for friction rubs have the patient take several {{c1::breaths }}
Published	09/08/2024	{{c1::bruits}} are vascular obstructions and can be in any artery
Published	09/08/2024	a patient with {{c2::high BP}} and has {{c3::bruits}} heard in systole and diastole in the abdomen or CVA region means that they have {{c1::ather…
Published	09/08/2024	bruits heard in {{c1::systole}} only are common and not pathologic
Published	09/08/2024	bruits are heard as a {{c1::swishing}} sound
Published	09/08/2024	the {{c1::bell (light pressure)}} of the stethoscope is used for listening for bruits
Published	09/08/2024	percussion of the abdomen tells us the distribution and amount of {{c1::gas}} in abdomen, {{c1::masses}}, {{c1::fluid}}, and {{c1::size/inflammation}}…
Published	09/08/2024	a {{c2::tympany}} sound = {{c1::gas/air}}
Published	09/08/2024	a {{c2::dullness}} sound = {{c1::fluid, feces, or organs}}
Published	09/08/2024	Normal abdomen is going to be more {{c1::tympanic}} (gas and air), areas of {{c1::dullness}} over organs, or maybe constipated
Published	09/08/2024	a protuberant abdomen that is {{c1::TYMPANIC}} means there is likely an intestinal obstruction
Published	09/08/2024	a protuberant abdomen that is {{c1::DULL}} is likely due to pregnancy, tumor, ascites
Published	09/08/2024	a normal liver should measure {{c1::6-12}} cm at the MCL
Published	09/08/2024	a normal liver measured at the MSL should be {{c1::4-8}} cm
Published	09/08/2024	when measuring the liver, the sound will change from {{c1::tympanic}} to {{c1::dull}} once you reach the liver
Published	09/08/2024	{{c1::Resonant}} sound: {{c2::low}} pitched, {{c2::hollow}} sound (lung)
Published	09/08/2024	{{c1::Tympanic}} sound: {{c2::hollow}}, {{c2::high}}, {{c2::drum}}-like sounds (abdomen)
Published	09/08/2024	causes of hepatomegaly are {{c1::hepatitis, carcinoma, cirrhosis}}.
Published	09/08/2024	{{c1::lung consolidation}} and {{c1::gas}} in the colon can falsely increase liver size
Published	09/08/2024	Spleen lies in curve of diaphragm {{c1::posterior}} to mid-{{c2::axillary}} line. When enlarged, it moves {{c3::downward}} toward midline.
Published	09/08/2024	must percuss the spleen in the {{c1::6th}} ICS from the anterior {{c1::axillary}} line ({{c2::traube's space}})
Published	09/08/2024	a normal spleen will sound {{c1::tympanic}}. An enlarged spleen will sound {{c1::dull}}
Published	09/08/2024	a positive splenic percussion sign is when percussing the spleen the patient takes a deep breath and it changes from {{c1::tympanic}} to {{c1::dull}} …
Published	09/08/2024	causes of splenomegaly could be {{c1::malaria, mono, leukemia }}
Published	09/08/2024	causes of CVA tenderness could be {{c1::pyelonephritis, kidney stone, MSK causes}}
Published	09/08/2024	{{c1::Guarding}} is voluntary contraction of abdominal wall
Published	09/08/2024	Palpating to find areas of {{c1::tenderness}}, to find {{c1::masses}}, palpate for {{c1::ascites}}
Published	09/08/2024	typically light palpation is done with {{c2::one}} hand and deep is done with {{c2::2}} hands. Can use a {{c1::dip and slide}} technique. Make sure to…
Published	09/08/2024	remember to ask the patient to take a {{c1::deep breath in}} when palpating the liver and spleen
Published	09/08/2024	the liver should feel {{c1::soft}}, but {{c1::firm}}, {{c2::well}} defined edge, regular with a {{c3::smooth}} surface and non-{{c3::tender }}
Published	09/08/2024	an abnormal liver will have {{c1::irregular}} borders, enlarged {{c2::firm}}/{{c2::hard}} edge, and be {{c3::tender}}
Published	09/08/2024	will be able to feel the liver in {{c1::1/2}} of patients
Published	09/08/2024	the {{c1::spleen}} is NOT palpable in normal conditions
Published	09/08/2024	If spleen is enlarged, the tip is usually palpable 2cm below the left costal margin upon {{c1::deep inspiration}}
Published	09/08/2024	{{c1::left}} kidney is rarely palpable as it sits higher than the {{c1::right}} kidney
Published	09/08/2024	the {{c1::kidneys}} should feel like smooth, round mass descending with inspiration
Published	09/08/2024	{{c1::capturing the kidney}} involves the patient taking a deep breath in and having hands approximately at 12th rib, cup them around the kidney once …
Published	09/08/2024	a {{c1::lumpy}} kidney could be from PCKD or carcinoma
Published	09/08/2024	an {{c1::enlarged}} kidney could give concern for for hydronephrosis, pyelonephritis, Carcinoma, PCKD
Published	09/08/2024	an aorta greater than {{c1::4}} cm is highly worrisome for an AAA
Published	09/08/2024	if you have a concerning aorta measurement, must follow up with an {{c1::US}}
Published	09/08/2024	shifting dullness and the fluid wave test for {{c1::ascites}}
Published	09/08/2024	a positive mcburney's point indicates {{c1::appendicitis}}
Published	09/08/2024	the psoa's sign tests for {{c1::acute appendicitis and peritonitis}}
Published	09/08/2024	Positive obturator sign is suspicious for {{c1::acute appendicitis/peritonitis}}
Published	09/08/2024	Positive Rovsing’s sign is suspicious for {{c1::acute appendicitis/peritoneal irritation }}
Published	09/08/2024	Positive rebound tenderness suspicious for {{c1::peritonitis/acute appendicitis}}
Published	09/08/2024	when performing rebound tenderness, want to ask {{c1::which hurts more, when I press down or let go?    }}
Published	09/08/2024	heel jar exam tests for {{c1::generalized peritoneal irritation}}
Published	09/08/2024	Positive murphy’s sign is indicative of {{c1::cholecystitis}}
Published	09/08/2024	A positive {{c1::Carnett’s sign}} indicates that the {{c2::abdominal wall}} is the primary source of the pain and not the {{c3::internal org…
Published	09/08/2024	{{c2::Viscera}}: An {{c1::internal}} organ, specifically an organ located within the abdomen or chest.
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