Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

N507 Exam 2 > (11) Abdomen > Flashcards

(11) Abdomen Flashcards

1
Q

bony landmarks of abdominal wall and pelvis

A 
xiphoid process
iliac crest
anterior superior iliac spine
pubis tubercle
symphis pubis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

how to make rectus abdomens muscles more prominent

A

pt raised head and shoulders
or
lifts legs from supine position

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

abdominal structures: RUQ

A

liver - lower margin palpable @ right total margin
gallbladder - inferior surface of liver
pylorus
duodenum m- deep, not palpable
hepatic flexure of colon
head of pancreas
abdominal aorta - visible pulsation, palpable in upper abdomen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

abdominal structures: LUQ

A 
spleen - lateral to and behind stomach, protected by 9-11th ribs, tip may be palpable below left costal margin in small % of healthy adults (easily palpable in splenomegaly)
splenic flexure of colon
stomach
body and tail of pancreas - not palpable
transverse colon
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

abdominal structures: RLQ (4)

A

cecum
appendix
ascending colon
right ovary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

abdominal structures: LLQ

A

sigmoid colon
descending colon
left ovary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

abdomen or abdominopelvic cavity

A
  • lies between thoracic diaphragm and pelvic diaphragm
  • contain 2 continuous cavities: abdominal and pelvic cavities enclosed by flexible multilayered wall of muscles and sheet-like tendons
  • houses most of digestive organs, spleen, parts of urogenital system
  • lining this and folding over visor such s stomach and intestines are parietal and visceral peritoneum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

CVA

A

costovertebral angle
formed by lower border of 12th rib and transverse processes of upper lumbar vertebrae
- where to check for kidney tenderness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Pelvic Cavity structures

A

terminal uterus
bladder
pelvic genital organs
loops of small and large intestine at times

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Bladder

A

hollow reservoir w/ strong smooth muscle walls composed of detrusor muscle

  • 400-500ml
  • if distended palpable above symphysis pubis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

GI: common or concerning symptoms

A
  • abdominal pain (acute/chronic)
  • indigestion, N/V including blood, loss of appetite, early satiety
  • difficulty swallowing (dysphagia), painful swallowing (odynophagia)
  • change in bowel function
  • diarrhea, constipation
  • jaundice
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Urinary/Renal: common/concerning symptoms

A
  • difficulty urinating, urgency, frequency
  • suprapubic pain
  • hesitancy, decreased stream in males
  • excessive urination or excess urination at night
  • urinary incontinence
  • blood in urine
  • flank pain and renal colic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

3 broad categories of abdominal pain

A

visceral pain
parietal pain
referred pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Visceral Pain

A
  • occurs when hollow abdominal organs (intestine, biliary tree) contact unusually forcefully or are distended/stretched
  • solid organs (liver) can also become painful when their capsules are stretched
  • difficult to localize
  • typically palpable near midlines at levels that vary according to structure involved
  • also stimulated by ischemia
  • varies in quality: gnawing, burning, cramping, aching (when severe: sweating, pallor, N/V, restlessness)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

visceral pain in RUQ suggests?

A

liver distention against its capsule from hepatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Visceral periumbilical pain suggests?

A

acute appendicitis from distention of an inflammed appendix
- gradually changes to parietal pain in the RLQ from inflammation of the adjacent parietal peritoneum

for pain disproportionate to physical findings suspect intestinal mesenteric ischemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

parietal pain

A
  • originated from inflammation of the parietal perineum (peritonitis)
  • steady, aching pain usually more severe than visceral pain and more precisely located over the involved structure
  • typically aggravated by coughing or movement
  • pts usually prefer to lie still
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

referred pain (abdominal)

A
  • felt more in distant sites which are innervated at approx the same spinal levels as the disordered structures
  • often develops as in initial pain becomes more intense and seems to radiate or travel from the initial site
  • may be palpated superficially or deeply but is usually localized
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

abdominal pain may be referred to ?

A

chest
spine
pelvis
(complicates assessment of abdominal pain)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

in contrast to peritonitis, patient with colicky pain from a renal stone ?

A

move around frequently trying to find a comfortable position

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

pain of duodenal or pancreatic origin may be referred to ?

A

back

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

pain from the biliary tree may be referred to ?

A

right scapular region or right posterior thorax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

pain from pleurisy or inferior wall MI may be referred to ?

A

epigastric area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

types of visceral pain

A 
RUQ or epigastric = biliary tree, liver
Epigastric = stomach, duodenum, pancreas
Periumbilical = small intestine, appendix, proximal colon
Suprapubic or sacral = rectum
Hypogastric = colon, bladder, uterus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

doubling over with cramping colicky pain signals ?

A

renal stone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

sudden knife-like epigastric pain often radiating to back signals ?

A

pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

epigastric pain occurs with ?

A

GERD
pancreatitis
perforated ulcers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

RU and upper abdominal pain occurs with ?

A

cholecystitis

cholangitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Angina from inferior wall CAD vs indigestion

A

angina is precipitated by exertion and relieved by rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Dyspepsia

A

chronic or recurrent discomfort or pain centered in the upper abdomen, characterized by postprandial fullness, early satiety, and epigastric pain/burning

bloating, nausea, belching occurring alone do not meet criteria for dyspepsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Abdominal discomfort

A

subjective negative feeling that is non painful

can include various symptoms such as bloating, nausea, upper abdominal fullness, heartburn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

bloating may occur with ?

A

lactose intolerance
inflammatory bowel disease
ovarian cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

belching results from ?

A

aerophagia (swallowing air)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

heartburn and regurgitation together more than once a one week suggests ?

A

GERD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

heartburn

A

rising retrosternal burning pain or discomfort occurring weekly or more often

typically aggravated by ETOH, chocolate, citrus fruits, coffee, onions, peppermint, bending over, exercise. lifting, lying supine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

respiratory symptoms w/ GERD

A 
chest pain
cough
wheezing
aspiration pneumonia
pharyngeal symptoms (hoarseness, chronic sore throat, laryngitis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Upper GI alarm symptoms

A
  • difficulty swallowing (dysphagia)
  • pain w/ swallowing (odynophagia)
  • recurrent vomiting
  • evidence of GI bleed
  • early satiety
  • weight loss
  • anemia
  • risk factors for GI cancer
  • palpable mass
  • painless jaundice
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

functional (nonulcer) dyspepsia

A

3 month hx of nonspecific upper abdominal discomfort or nausea not attributable to structural abnormalities or PUD
- symptoms usually recurring and present >6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Barret esophagus

A

metaplastic change in esophageal lining from normal squamous to columnar epithelium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Patients w/ uncomplicated GERD who fail empiric therapy, >55 y/o, w/ alarm symptoms suggests ????

A

esophagitis
peptic strictures
Barret esophagus
esophageal cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

RLQ pain or pain that migrates from periumbilical region, combined w/ abdominal wall rigidity on palpation suggests ?

A

appendicitis

in women consider: pelvic inflammatory disease, ruptured ovarian follicle, ectopic pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

cramping pain radiating to RorLLQ or groin suggests ?

A

renal stone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

LLQ pain w/ palpable mass suggests ?

A

diverticulitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

diffuse abdominal pain w/ abdominal distention, hyperactive high-pitched bowel sounds, and tenderness on palpation suggests ?

A

small or large bowel obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

pain w/ absent bowel sounds, rigidity, percussion tenderness, guarding suggests ?

A

peritonitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

change in bowel habits w/ a mass lesion warns of ?

A

colon cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

intermittent pain for 12 weeks of preceding 12 months w/ relief from defecation, change in frequency of bowel movements, or change in form of stool (loose, watery, pellet like) linked to luminal and mucosal irritants that alter motility, secretion, and pain sensitivity suggests ?

A

irritable bowel syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

regurgitation occurs in ?

A

GERD
esophageal stricture
esophageal cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

vomiting w/ fecal odor and pain suggests ?

A

small bowel obstruction

gastrocolic fistula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

hematemesis suggests ?

A

esophageal or gastric varices
Mallory-Weiss tears
PUD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

“food fear” w/ abdominal pain and slightly distended soft contender abdomen are hallmarks of ?

A

mesenteric ischemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

fullness or early satiety suggests ?

A

diabetic gastroparesis
anticholinergic medications
gastric outlet obstruction
gastric cancer

early satiety also suggests hepatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

globus sensation

A

sensation of a lump or foreign body in throat unrelated to swallowing (not true dysphagia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

indicators of oropharyngeal dysphagia

A

drooling
nasopharyngeal regurgitation
cough from aspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

diarrhea definition

A

painless loose or watery stools during >75% defecations for prior 3 months w/ symptom onset at last 6 months prior to diagnosis
-stool volume may increase to >200g in 24 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Acute vs Chronic Diarrhea

A

acute <2wks (food borne, infection)

chronic >4wks (crohns, ulcerative colitis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

nocturnal diarrhea is usually ?

A

pathological

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

high volume frequent watery stool are usually from ?

A

small intestine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

small volume stools w/ tenesmus or diarrhea w/ mucus, pus, blood occur in ?

A

rectal inflammatory conditions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

steatorrhea

A

oily residue, sometimes frothy or floating occurs

- from malabsorption in celiac sprue, pancreatic insufficiency, small bowel bacterial overgrowth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

diarrhea and medications

A

common w/ PCN, macrocodes, magnesium based antacids, metformin, herbal/alternative medications

consider cdiff if recent hospitalization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

types primary/functional constipation

A

normal transit
slow transit
impaired expulsion(pelvic floor disorders)
constipation-predominant irritable bowel syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

secondary constipation causes include:

A 
medications
amyloidosis
diabetes
CNS disorders
hypothyroidism
hypercalcemia
MS
Parkinsons
systemic sclerosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

thin pencil-like stool occurs in ?

A

obstructing “apple core” lesion of sigmoid colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

constipation causing medications

A

anticholinergic agents
CCB
iron supplements
opiates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

mechanisms of jaundice

A
  • increased production of bilirubin
  • decreased uptake of bilirubin by the hepatocytes
  • decreased ability of the liver to conjugate bilirubin
  • decreased excretion of bilirubin into the bile, resulting in absorption of conjugated bilirubin back into the blood

(predominately unconjugated bilirubin occurs from 1st 3 mechanisms like in hemolytic anemia (increased production) and Gilbert syndrome)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Intrahepatic jaundice

A
  • can be hepatocellular from damage to hepatocytes OR cholestatic from impaired excretion as a result of damaged hepatocytes or intrahepatic bile ducts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Extrahepatic jaundice

A

arises from obstruction of extra hepatic bile ducts most commonly the common bile ducts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

when excretion of bile into intestine becomes completely obstructed stools become ?

A

gray or light colored or “acholic” (seen in viral hepatitis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

impaired excretion of conjugated bilirubin is seen in ?

A

viral hepatitis
cirrhosis
primary biliary cirrhosis
drug induced cholestasis from oral contraceptive, methyl testosterone, chlorpromazine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

what may obstruct the common bile duct

A

gallstones

pancreatic, cholangio-, or duodenal carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

painless jaundice suggests ?

A

malignant obstruction of bile ducts seen in duodenal or pancreatic cancer

73
Q

painful jaundice suggests ?

A

infectious origin: hep A or cholangitis

74
Q

risk factors for liver disease

A
  • hepatitis
  • alcoholic hepatitis / alcoholic cirrhosis
  • toxic liver damage from meds, industrial solvents, environmental toxins, anesthetic agents
  • gallbladder disease/surgery: may result in extra hepatic biliary obstruction
  • hereditary
75
Q

Hep A

A

travel/meals in areas poor sanitation

ingestion of contaminated water/food

76
Q

Hep B

A

parenteral or mucous membrane exposure to infectious body fluids (blood, serum, semen, saliva - sex, IV needles)

77
Q

Hep C

A

illicit IV drug use or blood transfusion

78
Q

involuntary voiding or lack of awareness suggests

A

cognitive or neurosensory deficits

79
Q

stress incontinence arises from ?

A

decreased intraurethral pressure

80
Q

Pain from sudden over distention accompanies ?

A

acute urinary retention

81
Q

disorders in the urinary tract may cause pain in ?

bladder disorders cause pain in ?
- bladder infection pain location ?

A

abdomen or back

suprapubic pain
- lower abdomen, typically dull and pressure-like

82
Q

sudden bladder over distention pain vs. chronic bladder pain

A

sudden - agonizing

chronic - usually painless

83
Q

painful urination accompanies

A 
cystits
urethritis
UTIs
bladder stones
tumors
acute prostatitis
84
Q

women report internal burning in ?

external burning in ?

A

urethritis

vulvovaginitis

85
Q

urinary urgency suggests

A

UTI

irritation from urinary calculi

86
Q

urinary frequency suggests

A

UTI

bladder neck obstruction

87
Q

in men, painful urination w/o frequency suggests

A

urethritis

88
Q

urinary symptoms w/ flank/back pain suggests

A

pyelonephritis

89
Q

where is prostatic pain usually felt

A

perineu and occasionally in rectum

90
Q

Polyuria

A

significant increase in 24 hr urine volume
>3000ml

(urinary frequency can be high volume: polyuria or low volume: infection)

91
Q

Nocturia

A

urinary frequency at night, awakens pt more than once

- urine volumes may be large or small

92
Q

causes of polyuria

A

high fluid intake of psychogenic polydipsia
poorly controlled diabetes
decreased secretion of ADH of DI
decreased renal sensitivity to ADH of nephrogenic DI

93
Q

stress incontinence

A

increased abdominal pressure causes bladder pressure to exceed urethral resistance - there is poor support of bladder neck

94
Q

urge incontinence

A

urgency is followed by involuntary leakage d/t uncontrolled detrusor contractions that overcome urethral resistance

95
Q

overflow incontinence

A

neurologic disorders or anatomic obstruction from the pelvic organs or the prostate lift bladder emptying until the bladder overcomes distention

96
Q

functional incontinence

A

arises from impaired cognition, musculoskeletal problems, immobility

97
Q

mixed incontinence

A

stress + urge incontinence

98
Q

pink urine in absence of red cells suggests

A

myoglobin from rhabdomyolosis

99
Q

flank pain, fever, chills signal

A

actue pyelonephritits

100
Q

renal or ureteral colic is caused by

A

sudden obstruction of a ureter

ex: renal/urinary stones or blood clots

101
Q

kidney pain vs ureteral pain

A

kidney “flank”: at or below posterior costal margin near CVA, may radiate anteriorly toward umbilicus, visceral pain usually produced by distention of the renal capsule and typically dull, aching, steady

ureteral: severe colicky pain radiating toward trunk into lower abdomen and groin or into upper thigh, testicle, or labrum (results from sudden distention of ireter and renal pelvis)

102
Q

abdomen: important topics for health promotion and counseling

A
  • ETOH abuse screening
  • viral hepatitis: risk factors, vaccines, screening
  • screening for colon cancer
103
Q

Addiction

A

chronic relapsing behavioral disorders w/ substance-induced alterations of brain neurotransmitters resulting in tolerance, physical dependence, sensitization, craving, relapse

104
Q

exam findings of alcoholism

A

liver disease: hepatosplenomegaly, ascites, caput medusae (dilated abd vessels)

  • janudice
  • spinder angiomas
  • palmar erythema
  • Dupuytren contractures
  • asterisks
  • gynecomastia
105
Q

initial drinking screening question

A

how many times in the pst year have you had 4(W)/5(M) or more drinks a day?

106
Q

moderate drinking

A 
W = 1 or less drinks/day
M = 2 or less drinks/day
107
Q

unsafe drinking levels

A 
W = >3/day and >7/wk
M = >4 / >14
108
Q

binge drinking

A

W = 4 or more on one occasion

M 5 or moe

109
Q

Hepatitis A

A
  • transmission fecal-oral
  • fecal shedding followed by poor hand washing contaminates water and foods, leading to infection of household and sexual contacts
  • infected kids often asymptomatic increasing spread
  • diluted bleach to clean surfaces
  • rarely fatal, doesn’t cause chronic hepatitis
110
Q

Hep A vaccination recs

A
  • all kids 1 yr old
  • chronic liver disease
  • increased risk: travel, gay, IV drugs, work w/ nonhuman primates, clotting factor disorders
111
Q

Hep A postexposure prophylaxis

A
  • give Hep A vaccine or dose of immune globulin w/in 2 weeks
112
Q

Hepatitis B

A
  • more fatal than Hep A and can become chronic
  • usually self limiting and develop immunity
  • risk highest in kids (immature immune system)
113
Q

Hep B screening

A
  • high risk country
  • HIV
  • IV drug user
  • gay
  • household contacts
  • pregnant
114
Q

Hep B vaccination recs

A
  • childhood immunization
  • sexual contacts
  • blood expsoure
  • travel
  • high risk lifestyles
115
Q

Hepatitis C

A
  • no vaccine, prevention targets high risk groups
  • most prevalence blood borne pathogen in US
  • sexual transmission rare
  • chronic illness
  • risk factor for cirrhosis, hepatocellular carcinoma, liver transplant, liver failure
116
Q

Colorectal Cancer: risk factors

A 
age
personal hx of colon CA
adenomatous polyps
IBS
family hx
male
black
tobacco, ETOH use
red meat
obesity
117
Q

Colorectal Cancer: prevention

A

most effective = screen and remove pre-cancerous adenomatous polyps

physical activity
ASA, NSAIDS
estrogen/progesterone postmenopause

118
Q

Colorectal Cancer: screening guidelines

A

50-75 routine screenings
76-85 individualized
>85 stop

119
Q

arching the back: does what to abdominal muscles

A

pushes abdomen forward and tightens abdominal muscles

120
Q

arms above head: does what to abdominal muscles

A

stretches abdominal wall and tightened muscles which inhibits palpation (keep arms at side)

121
Q

abdominal pink-purple striae suggest?

A

Cushing syndrome

122
Q

dilated abdominal veins suggest ?

A

portal hypertension from cirrhosis (caput Medusa) or inferior vena cava obstruction

123
Q

ecchymosis of abdominal wall is seen in

A

intraperitoneal or retroperitoneal hemorrhage

124
Q

normal aortic palpation is frequently visible is? (abdominal exam)

A

epigastrium

125
Q

bulging flanks suggest ?

A

ascites

126
Q

abdominal asymmetry suggests ?

A

hernia
enlarged organ
mass

127
Q

increased peristaltic waves suggest ?

A

intestinal obstruction

128
Q

increased epigastric pulsations suggest ?

A

AAA

increased pulse pressure

129
Q

abdominal bruits suggest ?

A

vascular occlusive disease

130
Q

altered bowel sounds are common in ?

A

diarrhea
intestinal obstruction
paralytic ileum
peritonitis

131
Q

bruit w/ both systolic and diastolic components in epigastrium or upper quadrants suggests

A

renal artery stenosis as cause of HTN

132
Q

bruits w/ both systolic and diastolic components over abdominal arteries suggests ?

A

turbulent blood flow from atherosclerotic arterial disease

133
Q

friction rub over liver or spleen suggests ?

A

hepatoma
gonococcal infection around liver
splenic infarction
pancreatic carcinoma

134
Q

protuberant abdomen that is tympanitic throughout suggests ?

A

intestinal obstruction or paralytic ileus

135
Q

abnormal abdominal dullness suggests ?

A

pregnant uterus
ovarian tumor
distended bladder
larger liver or spleen

136
Q

dullness in both flanks suggests ?

A

ascites

137
Q

normal costal margin palpation

A

left - liver dullness
right - tympany over gastric air bubble and splenic flexure of colon
(situs inverses its opposite b/c organs reversed)

138
Q

involuntary abdominal rigidity that persists despite relaxation maneuvers suggests

A

peritoneal inflammation

139
Q

abdominal masses may be categorized in several ways:

A
  1. physiologic: pregnancy
  2. inflammatory: diverticulitis
  3. vascular: AAA
  4. neoplastic: colon cancer
  5. obstructive: distended bladder, dilated loop of bowel
140
Q

signs of peritonitis

A

positive cough test
guarding - voluntary contraction of abdominal wall w/ pt grimace, may diminished if pt distracted
rigidity - involuntary reflex contraction of abd wall that persists
rebound tenderness - pain after pressing then removing hand
percussion tenderness

141
Q

span of liver dullness is ? when liver is enlarged

A

increased

142
Q

percussion: lower liver border

A

start at level well below umbilicus in RLQ (in tympany not dullness), percuss upward toward liver along midclavicular line

143
Q

percussion: upper liver border

A

starting at nipple line, percuss downward in midclavicular line until lung resonance shifts to liver dullness

144
Q

liver span measurements

A

midclavicular line: 6-12cm

midsternal line: 4-8 cm

145
Q

span of liver dullness decreased when ?

A

liver is small

free air below diaphragm (perforated bowel, hollow viscus)

146
Q

liver span may decrease w/

A

resolution of hepatitis, heart failure

or progression of fulminant hepatitis

147
Q

liver dullness may be displaced downward by

A

low diaphragm of COPD

-but span remains normal

148
Q

what may falsely increase estimated liver size

A

dullness from right pleural effusion or consolidated lung if adjacent to liver dullness

149
Q

gas in colon and liver percussion

A

may produce tympany in RUQ, obscuring liver dullness and falsely decreasing estimated liver size

150
Q

in chronic liver disease, finding an enlarged palpable liver edge roughly doubles the likelihood of ?

A

cirrhosis

151
Q

measurements of liver span are more accurate when liver is ?

A

enlarged w/ palpable edge

152
Q

Liver Palpation

A

left hand: support and press forward 11th/12th ribs and adjacent soft tissues
right hand: right abdomen lateral to rectus muscle w. fingertips well below lower border of liver dullness, point fingers towards face or oblique, press in and up when asking pt to take a deep breath

  • on inspiration liver is palpable 3cm below right costal margin in midclavicular line
153
Q

normal liver edge

A

soft, sharp, regular w/ smooth surface

154
Q

liver palpation suspicious for liver disease

A

firmness, hardness of liver, bluntness or rounding of its edge, surface irregularity

155
Q

liver hooking technique

A

helpful for liver palpation when obese

156
Q

tenderness over liver suggests

A

inflammation (hepatitis)

congestion (heart failure)

157
Q

when a spleen enlarges it expands:

A

anteriorly, downward, and medially often replacing tympany of stomach and colon w/ dullness of a solid organ

158
Q

2 percussion techniques to detect splenomegaly

A
  1. percuss lower left anterior chest wall from border of cardiac dullness (6th rub) to anterior axillary line and down to costal margin (Traube space)
    - dullness = splenomegaly, tympany prominent esp. lateral - splenomegaly unlikely
    - more accurate
  2. percuss lower interspace in left anterior axillary line (usually tympanic), ask pt to take a deep breath and percussion agin (should remain tympanic)
159
Q

what may cause dullness in Traube space

A

splenomegaly

fluid or solids in stomach or colon

160
Q

how to palpate spleen

A

pt supine, arms at side, flex neck/legs (repeat w/ pt on tight side, legs flexed at hips/knees - gravity might help)

left hand: support and press forward lower left rib cage and sift tissue

right hand: below costal margin press in toward spleen, start low enough so can detect enlarged spleen (if too close to costal margin can’t reach under rib cage)

-ask pt to take deep breath, note contour, any tenderness

5% adults have normal palpable spleen tip

161
Q

causes of splenomegaly

A 
portal HTN
hetologic malignancies
HIV
infiltrative dz: amyloidosis
splenic infarct or hematoma
162
Q

palpating kidneys

A

usually not palpable

- CVA parallel to 12th rib

163
Q

left flank mass suggests

A

splenomegaly ( suspect if palpable notch on medial border, the edge extends beyond midline, percussion is dull, fingers can probe deep to medial and lateral borders but not between mass and costal margin)

enlarged L kidney (normal tympani in LUQ, can probe fingers between mass and costal margin but not deep to its medial and lower borders)

164
Q

causes of kidney enlargement

A

hydronephrosis
cysts
tumors

bilateral - polycystic kidney disease

165
Q

CVA pain w/ pressure or fist percussion suggests

A

pyelonephritis (w/ fever an dysuria) but also may be musculoskeletal

166
Q

when is the bladder palpable

A

distended above symphysis pubis

- percuss for dullness, >400-600ml urine must be present

167
Q

causes of bladder distention

A

outlet obstruction from urethral stricture or prostatic hyperplasia
meds
neuro disorders: stroke, MS

168
Q

suprapubic tenderness is common in

A

bladder infection

169
Q

risk factors for AAA

A

> 65
smoker
male
first degree relative

170
Q

periumbilical or upper abdominal mass w/ expansile pulsations >3cmm suggests

A

AAA (pain may signal rupture) - USPSTF recommended US screen for any male who ever smoked >65

171
Q

average width of aorta (abdominal exam)

A

2.5 cm

palpate slightly left of midline deep in epigastrium

172
Q

protuberant abdomen w/ bulging flanks suggests

A

ascites

-dullness in dependent areas b/c sinks w/ gravity

173
Q

Ascites suggests

A 
increased hydrostatic pressure in cirrhosis
heart failure
constrictive pericarditis
inferior vena cave
hepatic vein obstruction
decreased osmotic pressure in nephrotic syndrome
malnutrition
ovarian cancer
174
Q

how to test for ascites

A
  1. shifting dullness - dullness shifts to dependent side, tympany shifts to top when rolls to side
  2. fluid wave - tap one flank and feel for fluid on opposite flank
175
Q

Ballotte

A

brief jabbing motion used to displace ascites fluid during abdominal palpation

176
Q

assessing for appendicitis

A

peritoneal signs of acute abdomen

McBurney point tenderness - 2” from anterior spinous process of ilium on a line drawn from that process to umbilicus

Rovsing sign - press deeply in LLQ + pain in RLQ

psoas sign - place hand above R knee and have pt raise thigh to hand = increased abd pain OR pt on L side extend R leg at hip

obturator sign - flex R thigh at hip w/ knee bent, rotate leg internally at hip = R hypogastric pain (low sensitivity)

177
Q

localized tenderness anywhere in RLQ even in R flank suggests

A

appendicitis

178
Q

assessing for acute cholecystitis

A

(RUQ pain and tenderness)
Murphy Sign - hook L thumb or fingers of R hand under costal margin where lateral border of rectus muscle intersects w/ costal margin, take deep breath = sharp increase in tenderness w/ inspiratory effect

179
Q

assessing ventral hernias

A

abdominal hernia not in groin
- pt supine, ask to raise head and shoulders off table

(same technique to assess for abdominal masses)

N507 Exam 2 (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions