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DUNPHY PRIMARY CARE IIB TEST 3
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DUNPHY PRIMARY CARE IIB TEST 3
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DUNPHY PRIMARY CARE IIB TEST 3 .Chief complaint abd pain - Answers- Careful history
HPI (especially)
Pain assessment
Onset, timing
Location
Duration
Characteristics/Associated factors
Visceral pain is dull and poorly localized
Parietal pain is sharp and localized
Colicky pain comes and goes
Burning pain is caused by irritation from gastric contents
Aggravating factors, what makes it worse?
Relieving factors, what makes it better?
Treatment, what med./tx has been tried?
Visceral pain is - Answers- dull and poorly localized
Burning pain is caused by - Answers- irritation from gastric contents
Parietal pain is - Answers- sharp and localized
Colicky pain - Answers- comes and goes
Aggravating factors, - Answers- what makes it worse?
Relieving factors, - Answers- what makes it better?
Physical Exam GI - Answers- Heart and Lungs
Abdominal exam—inspection, auscultation, percussion, palpation
Digital rectal exam
Vaginal exam
Tests
CBC
Liver function tests (LFTs)
Serum chemistries/CMP
Urinalysis
Stool for occult blood
Pregnancy test
what would you think about with sudden severe pain - Answers- Appendicitis
Intestinal perforation
Mesenteric infarction
Dissection or rupture of aortic aneurysm
,Ectopic pregnancy
Burning pain- thoughts on what it would be? - Answers- Gastroesophageal reflux
disease (GERD)
Gastritis
Diverticulitis
What would you think about with constant mild to severe pain - Answers- Pancreatitis
Cholecystitis-Cholelithiasis
What would you think about with crampy or colicky pain? - Answers- Intestinal
obstruction
Inflammatory bowel dz.
Irritable bowel
Salpingitis
Urinary stones
Cholelithiasis
Constipation
Appendicitis is? - Answers- the inflammation of the variform appendix caused by an
obstruction and/or infection
Appendicitis is the most common cause of ________ ______ pain requiring surgical
intervention? - Answers- acute right lower quadrant abdominal
Appendicitis is more common in diets that are_____ ? - Answers- low in fiber, high in
fat, and high in refined sugars and other carbohydrates
__________ of the appendix by a variety of pathological processes is the cause of the
majority of appendicitis - Answers- Obstruction
Appendicitis is ______ of the appendix, followed by obstruction and subsequent
bacterial infection - Answers- Dilation
In appendicitis ______, is obstructed by hardened feces (fecalith), inflammatory
processes (including parasites, viruses, or bacteria), strictures, neoplasms, or foreign
bodies (including vegetable or fruit seeds or barium) - Answers- lumen
In appendicitisn ______ continues to secrete fluid, which further distends the lumen,
impairing the venous blood flow and leading to tissue necrosis - Answers- Mucosa
Left untreated, in appendicitis _____ ______is impeded
Bacteria continue to proliferate and, in the absence of treatment, perforation of the
appendix occurs - Answers- arterial inflow
,Subjective complaints of appendicitis - Answers- Acute onset of mild to severe colicky,
epigastric, or periumbilical pain
Vague at first, but within 24 hours it localizes over the right lower quadrant
Exacerbated by walking or coughing
In male patients the pain may radiate into the testicles
May be associated with abdominal muscle spasm in male or female patients
How many appendectomies are done annually? - Answers- 200,000
Appendicitis occurs at any age but is most common between ages ____ and _____ -
Answers- 10 and 30
Men are ______ as likely to be diagnosed with appendicitis between 10 and 30 years
than women, but this equalizes over the life span. - Answers- twice
_________ will affect 10 in 100,000 people in the United States, with a lifetime risk for
individuals projected at 7%-10%. - Answers- Appendicitis
Appendicitis is more common in ________countries. - Answers- Western
What starts after the onset of pain in appendcitis? - Answers- nausea and anorexia,
then vomiting after abdominal pain. Sensation of constipation is typical
Objective findings in appendicitis? - Answers- Mildly elevated temperature of 99-100°F
Physical examination-
Distress - Hypertension and tachycardia proportionate to the degree of fever and pain
Abdomen:
Psoas sign
Obturator sign
McBurney's sign (rebound tenderness)
Rovsing's sign
What is the psoas sign? - Answers- Pain on passive extension of the right thigh. Patient
lies on left side. Examiner extends patient's right thigh while applying counter resistance
to the right hip
What is the obturator sign? - Answers- Pain on passive internal rotation of the flexed
thigh. Examiner moves lower leg laterally while applying resistance to the lateral side of
the knee resulting in internal rotation of the femur.
What is McBurney's point? - Answers- + rebound pain peritoneal inflammation, RLQ
If palpation of the left lower quadrant of a patient's abdomen increases the pain felt in
the right lower quadrant, the patient is said to have a positive ______ _____and may
have an acute appendicitis. - Answers- Rosving's sign
, Diagnostics for Appendicitis? - Answers- Laboratory findings are not diagnostic
Diagnosis is made from the history and physical exam (clinical diagnosis)
CBC usually reveals a mild to moderate leukocytosis (WBC 10 to 20,000 mcg/L) with a
left shift
Urinalysis show microscopic hematuria or pyuria in 25% of patients
Urine human chorionic gonadotropin (hCG) test completed to rule out (ectopic)
pregnancy
What might x-rays show of appendicitis? - Answers- X-ray studies become more
important as appendicitis progresses
Plain x-ray films of the abdomen may show evidence of a fecalith, a gas-filled appendix,
small bowel ileus, a deviation in the bowel gas pattern, or a loss of the right iliopsoas
shadow
what might a CT of the abdomen help with regarding Appendicitis? - Answers- ruling
out other diagnostic possibilities
Abdominal ultrasound helps visualize the inflamed appendix and is also useful in ruling
out other potential diagnoses
What might happen with a female patient related to appendicitis? - Answers- Diagnostic
laparoscopy may be considered in female patients to rule out ectopic pregnancy, tubo-
ovarian processes, or pelvic inflammatory disease (PID)
What should be included in DDX for appendicitis? - Answers- Urinary tract infection
Ectopic pregnancy
Ovarian cyst
Pneumonia
Gastroenteritis
Crohn's disease
Diverticulitis
Mesenteric adenitis
Pancreatitis
Pelvic inflammatory disease
Cholelithiasis
Appendicitis management- what antibiotics? - Answers- Third-generation
cephalosporins are the antibiotics of choice
Ampicillin, gentamicin, clindamycin, metronidazole (Flagyl), ampicillin-sulbactam
(Unasyn), and ticarcillin/clavulanate (Timentin)
_______ should be avoided in appendicitis because they mask any developing
symptoms that might indicate a complication, such as perforation - Answers- Narcotics
Constipation- definition - Answers- change in bowel pattern
Decrease in frequency or increase in difficulty of defecation
Common in Western society
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