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NUR 623 Final study guide - Complete A+ guide (2019/2020) Maryville University Of St. Louis.

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NUR 623 final study guide Abdominal Problems Chapter 11 p. 504 Abdominal Pain p. 504 o Common Complaint Right Hypochondriac Right lobe of liver Gallbladder Portion of duodenum Portion of righ... t kidney Suprarenal gland Epigastric Pyloric end of stomach Duodenum Pancreas Portion of liver Left hypochondriac Stomach Spleen Tail of pancreas Upper pole of left kidney Suprarenal gland Right lumbar Ascending colon Lower half of right kidney Portion of duodenum and jejumum Umbilical Omentum Mesentery Lower part of duodenum Jejunum and ileum Left lumbar Descending colon Lower half of left kidney Portions of jejunum and ileum Right inguinal Cecum Appendix Lower end of ileum Right ureter Right spermatic cord Right ovary Hypogastric Ileum Bladder Uterus in pregnancy Left inguinal Sigmoid colon Left ureter Left spermatic cord Left ovary o 90% of visits to the Emergency Department o Acute abdominal pain must be evaluated quickly & precisely o Half of patients with abdominal pain do not receive an accurate diagnosis o Extra-abdominal etiologies include: ovarian cancer, ectopic pregnancy, myocardial infarction • A common complaint that you will encounter in primary care is abdominal pain. This pain accounts for about 90% of ED visits. • The differential diagnoses for abdominal pain includes factors that can lead to significant morbidity and to mortality, so it is imperative that acute abdomen be evaluated quickly and precisely. • There may be extra-abdominal etiologies that may be the cause of abdominal pain. • Disorders such as ovarian cancer, ectopic pregnancy, and myocardial infarction need to be considered when evaluating the patient with abdominal pain. Exam & testing o Physical exam • Abdominal exam—inspection, auscultation, percussion, palpation • Digital rectal exam (May be Issues related to these areas may be the source of the abdominal pain.) • Vaginal/genital exam (May be Issues related to these areas may be the source of the abdominal pain.) o o Tests • CBC • Liver function tests (LFTs) • Chemistry profile (which should include an amylase & lipase) • Urinalysis • Stool for occult blood • Pregnancy test • Any female of childbearing years (menarche to menopause) should have a pregnancy test (even if she says “there’s no way I could be pregnant”! You do not want to set a patient up for tests such as an xray without knowing pregnancy status. Additionally, pregnancy may be the cause of the abdominal pain! • There is a flow chart on pages 505-508 in the text. • This algorithm directs you towards a differential diagnosis according to the • type of pain, locus of pain, associated symptoms, precipitating or aggravating factors, relieving factors, physical findings, and diagnostic studies. It is important to evaluate all of these factors when formulating your differential diagnoses for the patient • When performing your exam on the patient, the location of the pain per quadrant is an important clue to your differential diagnoses. • RUQ: • Cholecystitis/cholelithiasis. • RLQ: • appendicitis, • inflammatory bowel disease • ectopic pregnancy, • endometriosis. • LLQ • generalized abdominal pain, left lower quadrant (LLQ) tenderness – Differential diagnosis think GI and GYN • Diverticulitis, • Inflammatory Bowel diseases, • ectopic pregnancy, • endometriosis, • colon cancer. • PID, Ovarian cyst, • Spermatic cord Diarrhea p.512-513, 1018 • Diarrhea is a common complaint addressed in primary care. • Increased frequency and volume of fluid content of bowel movement • Knowing the classification can clue you in as to what the patient may have going on. • Acute/Chronic • Types o Osmotic  lactase deficiency,  ingestion of poorly absorbed solutes (such as magnesium sulfate),  small bowel injury. o Secretory • bacterial infections, o cholera o E. coli, • laxative abuse, • bile salt malabsorption, • endocrine tumors o diarrhea associated with morphological changes, • such as with inflammatory bowel diseases. Differential diagnoses • These factors should be considered in your differential diagnosis list. complaints of diarrhea. • ???? Irritable bowel syndrome • Inflammatory bowel disease • Ischemic bowel disease (especially with peripheral vascular disease [PVD]) • Partial bowel obstruction • Pelvic abscess • Chronic pancreatitis • Complications of diabetes mellitus Appendicitis568-570, 682 • Inflammation of the appendix • Obstruction or infection • It most commonly occurs between the ages of 10-30 • occurs more frequently in men • *****Most common cause of RLQ pain requiring surgery Clinical presentation • It most commonly occurs between the ages of 10-30 • occurs more frequently in men • acute onset of mild to severe colicky, epigastric or periumbilical pain. • Vague abdominal pain early on • localizes over the RLQ within about 24 hours • pain may be exacerbated by walking and coughing • may have nausea and vomiting and a mildly elevated temperature Physical exam • Evaluation for Rovsing’s sign, psoas sign, Obturator sign, and McBurney’s sign. vague belly pain at what point with appendicitis • Lab tests are not diagnostic for appendicitis. • history and physical exam that lead you to your diagnosis. • Be sure to rule out pregnancy in women of child bearing years. Testing • An Xray may be done & may show a fecalith or obstruction or other issues associated with appendicitis. • CT scan may be done as well. Management: • Surgery is generally indicated for appendicitis. The appendix can perforate if not treated in a timely manner, which can lead to significant morbidity and to death. ****So the patient in your office with appendicitis should take an ambulance ride to the Emergency Department STAT! [Show More]

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