Left upper quadrant pain is usually associated with
- Heart of chest cavity, spleen, pancreas, stomach, left kidney or ureter
2. Right lower quadrant pain is associate with
- Appendix, bowel, right ureter, or pelvis.
3. Pain that migrates across several quadrants is typically associated with
-...
1. Left upper quadrant pain is usually associated with
- Heart of chest cavity, spleen, pancreas, stomach, left kidney or ureter
2. Right lower quadrant pain is associate with
- Appendix, bowel, right ureter, or pelvis.
3. Pain that migrates across several quadrants is typically associated with
- Bowel
4. 3 signs and symptoms most predictive of acute appendicitis are
- Pain that starts in the epigastrum or periumbilical area
- Migration of pain to right lower quadrant
- Abdominal rigidity
5. What follows the onset of pain in acute appendicitis
- Anorexia, n/v, constipation and rarely diarrhea, low grade fever
6. What is the are associated with appendicitis pain causing localized tenderness in the right lower
quadrant between the umbilicus and the anterosuperior iliac spine
- McBurney point
7. What is the rovsing sign
- Right lower quadrant pain elicited by palpating the left lower quadrant
8. The obturator sign can be best described as abdominal pain elicited by
- Passive flexion and internal rotation of the hip
9. What is the psoas sign described as
- Patient reports pain during exercise where practitioner has patient who is supine raise
leg against resistance
10. is the treatment of acute appendicitis
- Appy usually within 24 hours
11. What are the complications of appendicitis
- Perforation, gangrene, abscess formation
12. What is an ileus
- Paralysis of the intestinal musculature
13. What is intusssception
- When a bowel segment telescopes into the adjacent bowel resulting in symptoms of
intermittent bowel obstruction
14. What is volvus
- Abnormal Twisting of a bowel segment along its mesenteric axis
15. How does bowel obstruction manifest
- Intermittent and crampy abd pain, vomiting, obstipation, abd distention, hyperactive
bowel sounds, and fever.
16. in a bowel obstruction what usually relieves pain
- vomiting
17. what indicates strangulated obstruction
- pain that progresses in severity, localizes, or becomes constant
18. how do bowel sounds in a ileus differ?
, - They are more frequently decreased or absent
19. How can a bowel obstruction be diagnosed
- With a plan radiography or ultrasound
20. If xray shows free air what could this indicate
- Perforation
21. If the patient has an ileus what results will the xray show
- Distended loops in both the large and small bowel
22. If the patient has an obstruction what will the xray show
- Segment proximal to the obstruction is distended and the distal bowel loops are
decreased in caliber
23. What is the initial mgmt. of bowel obstruction
- NPO, ivf, electrolyte replacement as needed, acid base correction, symptom relief
24. If a patients bowel obstruction does not resolve on its own with supportive care what is the plan
of care
- Laparotomy
25. What are the s/s of ischemic bowel
- Fever, severe and continuous pain, hematemesis, peritoneal signs, hypotension, gas in
the bowel wall or portal vein, abd free air and acidosis
26. Peptic ulcer formation is more common with
- Duodenal ulcers
27. What are the factors that predispose an individual to peptic ulcers
- NSAIDS, H. Pylori, asa, potassium chloride, and bisphosphonates
28. What are the s/s of a perforated peptic ulcer
- Pain begins in epigastrium and spreads rapidly throughout the abd with frequent early
radiation of pain to the scapular areas
- Addition: vomiting coffee ground emesis, hematemesis, melena, hematochezia
- Boardlike rigidity of the abd
29. A patient who has been reporting s/s perforated ulcer, stops having pain about 6-12 hours after
onset, why is this alarming
- Although there is no pain, the patient will becoming severely ill within hours
30. On an xray, if a patient has a peptic ulcer perforation, what will the result indicate from the
report
- Pneumoperitoneum on upright abd
31. What is the mgmt. of a peptic ulcer perforation
- Ivf, electrolytes, ng suction, iv ppi, Broad spectrum antibiotics
32. What are the clinical manifestations of peritonitis
- High fever, acute abd pain that is diffuse, localized or referred. n/v/d or constipation
33. If a patient with cirrhosis has peritonitis how will his pain differ
- He may not have any and may only have a fever of 37.7 or higher
34. What are physical exam findings found in someone with peritonitis
- Abd dist, rigidity, decreased bowel sounds, diffuse abd tenderness, rebound tenderness,
and guarding. Fever, tachycardia, and tachypnea may also be present
35. The diagnosis of peritonitis should be suspected on what basis
- Fever, abd pain, tenderness, and leukocytosis
, 36. In peritonitis what procedure is warranted for confirmation of peritonitis
- Laparotomy
37. What type of antibiotic is used to treat peritonitis
- Broad spectrum 3rd or 4th generation cephalosporin or a quinolone until further results
are ready (because usually the gram stain is often negative)
38. s/s upon physical exam of a ruptured AAA includes
- pulsatile abd mass, bruit over site, pulsations are felt directly over the mass and
displace the examining fingers laterally
39. what is the standard test for confirmation of AAA rupture if time allows
- CT scan
Chapter 128 anorectal complaints
1. Most common s/s hemorrhoids
- Bleeding, pruritis, protrusion, and pain
- Internal hemorrhoids are usually painless
2. Treatment for hemorrhoids is based on
- Degree of pts symptoms
- A high fiber diet
- Increased fluid intake
3. What is a complication of hemorrhoids
- Strangulation because they can become gangrenous
4. Complications of rubber band ligation
- Increased pain, infection, sepsis
5. Hemorrhoidectomy has been associated with
- UTI’s
6. What are the clinical manifestations of an anal fissure
- Severe rectal pain, during and after bm and small amounts of bright red rectal bleeding
seen on the toilet paper
7. What is the difference in appearance of an acute vs chronic anal fissure
- Acute appears to be a laceration, and chronic is associated with an indurated, fibrotic
appearance and an anal skin tag or polyp
8. Treatment for anal fissures include
- Sitz baths, increased fiber, stool softner
- Chronic fissures- topical or oral calcium channel blockers or topical nitrates
9. What is the most common cause of anorectal abscess
- Bacterial infections of the anal crypt glands
10. S/s of an abscess
- Acute pain and swelling. Increases with mvmt, sitting, or bowel movements
11. s/s of anorectal fistula includes
- persistent purulent drainage with a hx of abscess that has either be drained
spontaneously or surgically
12. what is the mgmt. of anal fistulas
- tx with metronidazole along with high fiber diet, stool softners/bulk forming agents, sitz
baths
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