Answers Rated A+.
Abdominal Structures - Answer -RLQ: cecum, appendix, ascending colon, ileum, and right ovary
- RUQ: liver, gallbladder, pylorus, duodenum, hepatic flexure of the colon, and head of pancreas
- LUQ: spleen, splenic flexure of the colon, stomach, body and tail of pancreas
- LLQ: sigmoid colon, descending colon, and left ovary
Visceral Pain - Answer - Characteristics: gnawing, burning, cramping or aching
- Hollow organs contracting forcefully or when they are stretched
Parietal Pain - Answer - Characteristics: steady, aching, more painful than visceral
- Inflammation of the parietal peridium, aggravated by coughing or moving, patient likes to lie still
Referred Pain - Answer - Pain is felt at more distant sites which are innervated at the spinal site that is
close to the affected structure
Acute Upper Abdominal Pain - Answer - Colicky pian: renal stone
- Sudden, knife-like, epigastric: pancreatitis
- Epigastric: GERD, pancreatitis, and perforated ulcers
- RUQ/upper abdominal pain: cholecystitis and cholangitis
- Pain precipitated by exertion: consider CAD
Chronic Upper Abdominal Pain - Answer - Dyspepsia: chronic/recurrent upper abdominal pain
,- Discomfort: negative feeling that is not painful; bloating, nausea, upper abdominal fullness, epigastric
pain/burning
- Functional dyspepsia: 3 month history of nonspecific upper abdominal discomfort or nausea not
attributable to structural abnormalities or peptic ulcer disease
- Alarm symptoms: dysphagia, odynophagia, recurrent vomiting, evidence of GI bleed, early satiety,
weight loss, anemia, risk factors for GI cancer, palpable mass, painless jaundice
Acute and Chronic Lower Abdominal Pain - Answer - RLQ that migrates from periumbilical area +
abdominal wall rigidity = suspicious for appendicitis
- RLQ pain in women: consider PID, ruptured ovarian cysts, ectopic pregnancy
- LLQ + palpable mass = diverticulitis
- Diffuse abdominal pain, distention, hyperactive high-pitched bowel sounds and tenderness on
palpation = small or large bowel obstruction
- Pain, absent bowel sounds, rigidity, percussion tenderness, and guarding = peritonitis
- Change in bowel habits + mass = colon cancer
- Pain for 12 weeks in preceding 12 months, relief with defecation, change in frequency of BMs, change
in form of stool = irritable bowel syndrome (IBS)
CAGE Questionaiire - Answer - Cutting down
- Annoyance
- Guilty
- Eye opener
, - USPSTF recommends screening for all primary care patients
Colorectal Cancer - Answer Colorectal Cancer:
- 3rd most frequently diagnosed cancer
- 3rd leading cause of death in the US
- 5% risk of being diagnosed, 2% lifetime risk of dying from colorectal cancer
Risk factors:
- Strong: increasing age, personal hx of colorectal cancer, polyps, longstanding IBD, family hx
- Weak: Male sex, AA, tobacco use, excessive alcohol use, red meat consumption, obesity
- Prevention: Screening and removal of precancerous polyps
Colorectal Cancer Screening - Answer Screening tests:
- Occult fecal blood stool tests
- Colonoscopy
- Any abnormal finding on stool test, imaging study, or flexible sigmoidoscopy warrants further
evaluation with colonoscopy
- Adults 45-75: 1) High sensitivity FOBT annually 2) sigmoidoscopy every 5 years with FOBT every 3 years
3) screening colonoscopy every 10 years
- Adults 76-85: Do not screen routinely
- Adults older than 85 years: Selective screening
- High risk persons: personal hx of colorectal CA, or long-standing IBD, start earlier
Abdominal Auscultation - Answer - Normal: clicks and gurgles, 5-34 minute