Title: Primary Care IIB – Dunphy – Comprehensive Lecture Summary
and Study Guide
Chief complaint abd pain - correct answer 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 - correct answer dull and poorly localized
Burning pain is caused by - correct answer irritation from gastric contents
Parietal pain is - correct answer sharp and localized
Colicky pain - correct answer comes and goes
Aggravating factors, - correct answer what makes it worse?
Relieving factors, - correct answer what makes it better?
Physical Exam GI - correct answer 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 - correct answer Appendicitis
Intestinal perforation
Mesenteric infarction
Dissection or rupture of aortic aneurysm
Ectopic pregnancy
Burning pain- thoughts on what it would be? - correct answer Gastroesophageal reflux disease
(GERD)
Gastritis
Diverticulitis
What would you think about with constant mild to severe pain - correct answer Pancreatitis
Cholecystitis-Cholelithiasis
What would you think about with crampy or colicky pain? - correct answer Intestinal
obstruction
Inflammatory bowel dz.
Irritable bowel
Salpingitis
Urinary stones
Cholelithiasis
Constipation
Appendicitis is? - correct answer the inflammation of the variform appendix caused by an
obstruction and/or infection
,Appendicitis is the most common cause of ________ ______ pain requiring surgical
intervention? - correct answer acute right lower quadrant abdominal
How many appendectomies are done annually? - correct answer 200,000
Appendicitis occurs at any age but is most common between ages ____ and _____ - correct
answer 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. - correct answer twice
_________ will affect 10 in 100,000 people in the United States, with a lifetime risk for
individuals projected at 7%-10%. - correct answer Appendicitis
Appendicitis is more common in ________countries. - correct answer Western
Appendicitis is more common in diets that are_____ ? - correct answer 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 - correct answer Obstruction
Appendicitis is ______ of the appendix, followed by obstruction and subsequent bacterial
infection - correct answer 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) - correct answer lumen
In appendicitisn ______ continues to secrete fluid, which further distends the lumen, impairing
the venous blood flow and leading to tissue necrosis - correct answer Mucosa
Left untreated, in appendicitis _____ ______is impeded
Bacteria continue to proliferate and, in the absence of treatment, perforation of the appendix
occurs - correct answer arterial inflow
Subjective complaints of appendicitis - correct answer 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
, What starts after the onset of pain in appendcitis? - correct answer nausea and anorexia, then
vomiting after abdominal pain. Sensation of constipation is typical
Objective findings in appendicitis? - correct answer 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? - correct answer 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? - correct answer 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? - correct answer + 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. - correct answer Rosving's sign
Diagnostics for Appendicitis? - correct answer 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? - correct answer 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
and Study Guide
Chief complaint abd pain - correct answer 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 - correct answer dull and poorly localized
Burning pain is caused by - correct answer irritation from gastric contents
Parietal pain is - correct answer sharp and localized
Colicky pain - correct answer comes and goes
Aggravating factors, - correct answer what makes it worse?
Relieving factors, - correct answer what makes it better?
Physical Exam GI - correct answer 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 - correct answer Appendicitis
Intestinal perforation
Mesenteric infarction
Dissection or rupture of aortic aneurysm
Ectopic pregnancy
Burning pain- thoughts on what it would be? - correct answer Gastroesophageal reflux disease
(GERD)
Gastritis
Diverticulitis
What would you think about with constant mild to severe pain - correct answer Pancreatitis
Cholecystitis-Cholelithiasis
What would you think about with crampy or colicky pain? - correct answer Intestinal
obstruction
Inflammatory bowel dz.
Irritable bowel
Salpingitis
Urinary stones
Cholelithiasis
Constipation
Appendicitis is? - correct answer the inflammation of the variform appendix caused by an
obstruction and/or infection
,Appendicitis is the most common cause of ________ ______ pain requiring surgical
intervention? - correct answer acute right lower quadrant abdominal
How many appendectomies are done annually? - correct answer 200,000
Appendicitis occurs at any age but is most common between ages ____ and _____ - correct
answer 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. - correct answer twice
_________ will affect 10 in 100,000 people in the United States, with a lifetime risk for
individuals projected at 7%-10%. - correct answer Appendicitis
Appendicitis is more common in ________countries. - correct answer Western
Appendicitis is more common in diets that are_____ ? - correct answer 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 - correct answer Obstruction
Appendicitis is ______ of the appendix, followed by obstruction and subsequent bacterial
infection - correct answer 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) - correct answer lumen
In appendicitisn ______ continues to secrete fluid, which further distends the lumen, impairing
the venous blood flow and leading to tissue necrosis - correct answer Mucosa
Left untreated, in appendicitis _____ ______is impeded
Bacteria continue to proliferate and, in the absence of treatment, perforation of the appendix
occurs - correct answer arterial inflow
Subjective complaints of appendicitis - correct answer 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
, What starts after the onset of pain in appendcitis? - correct answer nausea and anorexia, then
vomiting after abdominal pain. Sensation of constipation is typical
Objective findings in appendicitis? - correct answer 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? - correct answer 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? - correct answer 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? - correct answer + 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. - correct answer Rosving's sign
Diagnostics for Appendicitis? - correct answer 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? - correct answer 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
