question

Different Parts of the Large Intestine

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Cecum
Ileal contents empty into cecum via ileocecal valve and appendix extends from base of cecum
Ascending Colon
Rises from the cecum along the right posterior abdominal wall to the undersurface of the liver, where it turns toward midline (hepatic flexure)
Transverse Colon
Crosses abdomen toward spleen, turning downward at splenic flexure
Descending Colon
Continues along the left abdominal wall to rim of pelvis, where it turns medially and inferiorly to form sigmoid colon
Rectum
Extends from sigmoid colon to the pelvic floor to the anal canal, terminating at the anus
Anus
Where poopy leaves

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Where is the pancreas located?

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Behind and beneath the stomach

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Where is the spleen located?

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Lcoated in left upper quadrant above the left kidney and below the diaphragm

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Where are the kidneys located?

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Located bilaterally in retroperitoneum of upper abdomen

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What and Where is the rectus abdominus located?

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Your 6 pack, or 4 pack, or 2 pack
Anteriorly

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Where are the internal and external obliques located?

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Laterally

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What and where is the Linea alba located?

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Tendinous band midline between the rectus abdominus muscles

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Where are the inguinal ligaments located?

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From anterior superior spine of the ilium on each side of the pubus

question

Important Organ Changes in Infants

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GI tract continues to develop after birth until 2-3 yrs of age
Liver is very large at birth
Spleen is active in blood formation during first year of birth
Kidney growth increases incrementally after birth

question

Important Organ Changes in Pregnant Women

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Abdominal wall muscles stretch and lose tone
Organs are displaced and affect functions
Heartburn
Gallstones
Urinary stasis or urgency
Constipation or flatus
Hemorrhoids

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Important Organ Changes in Geriatrics

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GI tract motility slows, secretion and absorption slows, and digestion overall decreases
Food tolerance diminishes
Diminished ability of liver to metabolize certain drugs
Delayed gastric emptying
Gallstones caused by increase in biliary lipids

question

_|1|_
_|_|_
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Regions of the Abdomen: Name position 1

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Epigastric

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_|2|_
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Regions of the Abdomen: Name position 2

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Umbilical

question

_|_|_
_|_|_
|3|

Regions of the Abdomen: Name position 3

answer

Hypogastric or Pubic

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4|_|_
_|_|_
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Regions of the Abdomen: Name position 4

answer

Right Hypochondriac

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_|_|5
_|_|_
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Regions of the Abdomen: Name position 5

answer

Left Hypochondriac

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_|_|_
6|_|_
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Regions of the Abdomen: Name position 6

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Right Lumbar

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_|_|_
_|_|7
| |

Regions of the Abdomen: Name position 7

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Left Lumbar

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_|_|_
_|_|_
8| |

Regions of the Abdomen: Name position 8

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Right Inguinal

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_|_|_
_|_|_
| |9

Regions of the Abdomen: Name position 9

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Left Inguinal

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Abdominal Distension below the umbilicus could be a sign of:

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Ovarian tumor
Uterine fibroids
Pregnancy
Distended bladder

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Abdominal Distension above the umbilicus could be a sign of:

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Carcinoma
Pancreatic cyst
Gastric dilation

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Asymmetric Abdominal Distension could be a sign of:

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Hernia
Tumor
Cysts
Bowel obstruction

question

What are bruits and where can they be heard?

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Sounds of turbulent flow rushing past an obstruction
Can be heard in aortic, renal, iliac, and femoral arteries

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What are friction rubs and where can they be heard?

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High pitched sounds in association with respiration
Indication of inflammation of peritoneal surface from tumor, infection, infarct
May be heard over spleen and liver

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What is a venous hum and where can it be heard?

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Soft, low-pitched, continuous sounds
Can be heard over epigastric region and around umbilicus

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Appendicitis: Usual Pain Characteristics and Location of pain

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Initial: Preumbilical or Epigastric
May become localized to RLQ

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Appendicitis: Possible Findings

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Guarding
Tenderness
Anorexia
Nausea or vomiting after pain onset
Low-grade fever

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Renal calculi: Usual Pain Characteristics and Location of pain

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Intense
Flank, extending to groin and genitals
May be episodic

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Renal calculi: Possible Findings

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Fever
Hematuria

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Cholecystitis: Usual Pain Characteristics and Location of pain

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Severe
Unrelenting RUQ or epigastric pain
May be referred to right subscapular area

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Cholecystitis: Possible Findings

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RUQ tenderness and rigidity
Palpable gallbladder
Anorexia
Vomiting
Fever

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Pancreatitis: Usual Pain Characteristics and Location of pain

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Dramatic, sudden, excruciating LUQ, epigastric, or umbilical pain
Present in one or both flanks
May be referred to left shoulder

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Pancreatitis: Possible Findings

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Epigastric tenderness
Vomiting
Fever
Shock

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Diverticulitis: Usual Pain Characteristics and Location of pain

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Epigastric
Radiating down left side of abdomen especially after eating
May be referred to back

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Diverticulitis: Possible Findings

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Flatulence
Borborygmi
Diarrhea
Dysuria
Tenderness on palpation

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Ectopic Pregnancy: Possible Findings

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Hypogastric tenderness
Symptoms of pregnancy
Spotting
Irregular menses
Soft abdominal wall
Mass on bimanual pelvic exam
Rupture: shock, rigid abdominal wall, distention

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Ectopic Pregnancy: Usual Pain Characteristics and Location of pain

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Lower quadrant
Referred to shoulder
With rupture is agonizing

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Splenic Rupture: Usual Pain Characteristics and Location of pain

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Intense
LUQ, radiating to left shoulder
May worsen with foot of bed elevated

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Splenic Rupture: Possible Findings

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Shock
Pallor
Lower temperature

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Irritable Bowel Syndrome: Usual Pain Characteristics and Location of pain

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Hypogastric
Crampy, variable, infrequent, associated with bowel function

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Irritable Bowel Syndrome: Possible Findings

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Negative physical exam
Pain with gas, bloating, distension
Relief with passage of flatus or feces

question

Lactose Intolerance: Usual Pain Characteristics and Location of pain

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Crampy pain after ingesting dairy products

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Lactose Intolerance: Possible Findings

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Associated diarrhea
Negative physical exam

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Diverticular Disease: Usual Pain Characteristics and Location of pain

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Localized pain

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Diverticular Disease: Possible Findings

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Abdominal tenderness
Fever

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Constipation: Usual Pain Characteristics and Location of pain

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Colicky or dull and steady pain that does not progress or worsen

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Constipation: Possible Findings

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Fecal mass palpable
Stool in rectum

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Uterine Fibroids: Usual Pain Characteristics and Location of pain

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Pain related to menses, intercourse

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Uterine Fibroids: Possible Findings

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Palpable myoma(s)

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Hernia: Usual Pain Characteristics and Location of pain

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Localized pain that increases with exertion or lifting

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Hernia: Possible Findings

answer

Hernia on physical exam

question

GERD: Usual Pain Characteristics and Location of pain

answer

Burning, gnawing pain in mid-epigastrum
Worsens with recumbency

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GERD: Possible Findings

answer

Negative Physical Exam

question

Peptic Ulcer: Usual Pain Characteristics and Location of pain

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Burning or gnawing pain

question

Peptic Ulcer: Possible Findings

answer

May have epigastric tenderness on palpation

question

Gastritis: Usual Pain Characteristics and Location of pain

answer

Constant burning pain in epigastrum

question

Gastritis: Possible Findings

answer

+ Nausea, vomiting, diarrhea
Fever
Physical exam negative

question

Auscultate with stethoscope diaphragm to listen for:

answer

Bowel sounds
Friction rubs over liver and spleen

question

Auscultate with bell of stethoscope to listen for:

answer

Venous hums in epigastric area and around umbilicus
Bruits over aorta, renal, and femoral arteries

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