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The Abdomen: 2 nd Edition. Presented by Guy Havice. Quick Review. The majority of a persons organs are located within the abdominal cavity. To help organize organ placement, the abdomen is split into quadrants. Anatomy of the 4 quadrants…. Abdominal Exam. Percussion

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The abdomen 2 nd edition l.jpg

The Abdomen:2nd Edition

Presented by

Guy Havice






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Abdominal Exam quadrants

  • Percussion

  • Tone in all quadrants

  • Liver and spleen borders

  • Solid masses

    Palpation

  • Tenderness /muscle guarding

  • Size and shape of organs

  • Solid masses

Observation

  • General appearance of the abdomen

  • Patient's movement (or lack thereof)

    Auscultation

  • Performed before percussion or palpation

    • Bowel sounds – Diaphragm

    • Vascular sounds – Bell



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Abdominal Disorders need for diagnosis.

Bowel

  • Inflammatory Bowel Disease

  • Irritable Bowel Syndrome

  • Peptic Ulcer Disease

  • Gastroesophageal Reflux Disease


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Inflammatory bowel disease is comprised of two major disorders:

  • Ulcerative Colitis

  • Crohn’s Disease


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Ulcerative Colitis disorders:


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Signs / Symptoms of Ulcerative Colitis the colon and rectum characterized by bloody diarrhea

  • Mild – disease is confined to the rectum

    • occasional rectal bleeding associated with passage of mucus

    • mild diarrhea

  • Moderate – inflammation extending to the splenic flexure

    • frequent loose, bloody stools (up to 10 per day)

    • abdominal discomfort

    • low grade fever

  • Severe – extensive colon involvement

    • frequent loose, bloody stools (greater than 10 per day)

    • severe cramps

    • rapid weight loss

    • fever


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    Crohn’s Disease the colon and rectum characterized by bloody diarrhea


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    Signs / Symptoms of Crohn’s Disease normal bowel separating diseased bowel

    • Clinical presentation is more variable than ulcerative colitis because of the irregular pattern of lesion, and deeper tissue involvement

      • diagnosis is usually established with endoscopic findings

  • Typical S/S include:

    • fatigue, weight loss, and fever

    • prolonged diarrhea with crampy abdominal pain, with or without gross bleeding

  • Physical exam may show nonspecific S/S, be sure to review the patients medical history, including family history


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    Ulcerative Colitis vs. Crohn’s Disease normal bowel separating diseased bowel

    • Ulcerative Colitis – large intestine involvement

    • Crohn's Disease – small intestine involvement


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    Irritable Bowel Syndrome (IBS) normal bowel separating diseased bowel


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    Signs / Symptoms of IBS and altered bowel habits (constipation, diarrhea, or alternating pattern of both) in the absence of any structural or chemical factors which might explain the symptoms.

    • Vague S/S – lower abdominal pain, and altered bowel habits in the absence of any factors which might explain the symptoms

    • Criteria methods for diagnosis of IBS

      • Manning Criteria

      • Rome Criteria


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    Manning Criteria




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    Endoscopy showing duodenal ulcer


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    Two common forms of peptic ulcers: abdominal pain

    • Helicobacter pylori – associated

    • NSAID – induced


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    Signs / Symptoms of Peptic Ulcers abdominal pain

    • Epigastric burning pain

    • Abdominal fullness or cramping

    • Nocturnal pain – circadian stimulation of acid secretion

    • Ulcer location

      • Gastric ulcer – food may precipitate ulcer pain

      • Duodenal ulcer – pain usually occurs 1-3 hours after meals



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    Signs / Symptoms of GERD the esophagus.

    • Typical

      • heartburn

      • belching

      • regurgitation

  • Atypical

    • asthma

    • chronic cough

    • chest pain


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    Abdominal Disorders the esophagus.

    Liver

    • Hepatitis

    • Cirrhosis


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    Hepatitis the esophagus.


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    Signs / Symptoms infection, but sometimes from toxic agents

    • Jaundice – yellow discoloration of the skin

    • Icterus – yellow discoloration of the sclera

    • Fatigue

    • Upper abdominal pain

    • Loss of appetite

    • Nausea

    • Fever


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    Three main types of viral hepatitis: infection, but sometimes from toxic agents

    • Hepatitis A, B and C

      Transmission

    • Hepatitis A – transmitted through human feces ingestion

    • Hepatitis B & C – transmitted through body fluids of an infected person (sex, needle sharing, childbirth)


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    CDC Fact Sheet – Hepatitis A infection, but sometimes from toxic agents

    • No chronic infection

    • About 15% of people infected will have prolonged symptoms over a 6-9 month period

    • One-third of Americans have evidence of a past infection


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    Average yearly reported cases of hepatitis A infection, but sometimes from toxic agentsper 100,000 population, 1987-1997

    White <5

    Yellow 5-10

    Orange 10-20

    Red >20


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    CDC Fact Sheet – Hepatitis B infection, but sometimes from toxic agents

    • Highest rate of disease occurs in 20-49-year-olds

    • Estimated 30% of infected persons have no signs or symptoms

    • Estimated 1.25 million chronically infected Americans

    • Death from chronic liver disease occurs in 15-25%


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    CDC Fact Sheet – Hepatitis C infection, but sometimes from toxic agents

    • Estimated 80% of infected persons have no signs or symptoms

    • Estimated 3.9 million (1.8%) Americans have been infected with HCV

    • Death from chronic liver disease occurs in 1-5%

    • Leading indication for liver transplant

    www.cnn.com 3/21/02


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    Cirrhosis infection, but sometimes from toxic agents


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    Portal Hypertension signs and symptoms resulting from diminishing functional hepatocytes and accumulation of fibrous tissue within the liver

    • It becomes difficult for blood to flow through a cirrhotic liver . As a result, esophagus veins not accustomed to carrying large volumes of blood become engorged


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    Esophageal Varices signs and symptoms resulting from diminishing functional hepatocytes and accumulation of fibrous tissue within the liver

    • The risk of bleeding from esophageal varices is ~30% in the first year after identification

    • Patients who have bled once have a 70% chance of rebleeding, and approximately one third of further bleeding episodes are fatal

      Signs / Symtpoms

      • Vomiting blood

      • Black tarry stools

      • Light-headedness


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    Ascites signs and symptoms resulting from diminishing functional hepatocytes and accumulation of fibrous tissue within the liver

    • Ascites is accumulation of fluid in the peritoneal cavity

      • ~50% of patients will develop ascites within 10 years of the diagnosis of cirrhosis

  • The fluid retention is due to several vascular and biochemical abnormalities relating to a cirrhotic liver


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    • Ask the patient to place their hand over the center of the abdomen. They should press firmly so that the subcutaneous tissue and fat do not jiggle.

    • Place your hands on opposite sides of the umbillicus. Next, firmly tap on the abdomen with your right hand while your left remains against the abdominal wall.

    • If there is a lot of ascites present, you may be able to feel a fluid wave

    Assessing for a fluid wave


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    Abdominal Disorders abdomen. They should press firmly so that the subcutaneous tissue and fat do not jiggle.

    Spleen

    • Mononucleosis


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    Mononucleosis abdomen. They should press firmly so that the subcutaneous tissue and fat do not jiggle.


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    • Its due to the Epstein-Barr virus (EBV) – a widely disseminated herpesvirus

      • EBV is associated with a number of infections, complications, and a variety of malignancies

      • The majority of primary EBV infections go unnoticed

      • Approximately 90 to 95 percent of adults are EBV-seropositive


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    Material Covered On Last Two Lectures complication

    Kidney

    • Kidney Stones

    • Pyelonephritis

      Gallbladder / Pancreas

    • Pancreatitis

    • Bile stones

      Misc.

    • Constipation

    • Appendicitis

    • Peritonitis

    Bowel

    • Inflammatory Bowel Disease

    • Irritable Bowel Syndrome

    • Peptic Ulcer Disease

    • Gastroesophageal Reflux Disease

    • Bowel Obstruction

      Liver

    • Hepatitis

    • Cirrhosis

      Spleen

    • Mononucleosis



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