ABD

Question 1

What ribs protect most of the spleen?

Can you palpate the tail of the pancreas?

Answer 1

9-10-11

Not in a healthy adult

Question 2

Which organs can be palpitated in the LLQ?

RLQ?

Answer 2

sigmoid colon (esp if it has stool)

Portions of transfers colon and descending colon

-none in a healthy adult

Question 3

Tender CVA can indicate what?

Answer 3

kidneys tenderness, retrocecal appendicitis, hepatic abscess, acute cholecystitis

Question 4

If Pt tries very hard to stay still, this may be a sign of…

If Pt constantly tries to move a lot or can’t sit still….

Answer 4

• peritonitis

- obstruction of the colon, SI, and stones of kidney or gallbladder (these cause colicky pain)

Question 5

What syndrome may show pink-purple striae on the abdominal skin?

Answer 5

cushion’s syndrome

Question 6

What is dehiscence?

Answer 6

spontaneous wound opening
Skin dehis- not so bad
Fascial Dehis- not so good
After hernia repair, and surgery- increases infection chances

Question 7

DefSeparation
of the two rectus abdominis muscles, through which abdominal contents form a midline
ridge when patient raises his head and shoulders.
-Who will you see this with?

Answer 7

Diastasis Recti (localized bulge)

Often seen with repeated pregnancies, obesity, and chronic lung disease.
No clinical significance

Question 8

Pt presents with a
benign, fatty tumor in the subcutaneous tissues almost anywhere on the body.
It is soft, lobulated, and mobile.

Answer 8

Lipoma

Question 9

What are normal bowel sounds?

How long do you listen if there are no sounds?

Answer 9

Normal sounds include clicks and gurgles at 5-35 per minute.

Borborygmi: prolonged gurgles of hyperperistalsis (stomach growling).

Listen for 2 minutes before declaring BS absent.

Question 10

High-pitched tinkling sound in the abdomen suggest what?

Rushes of high-pitched sounds coinciding with an abdominal cramp indicate What?

Answer 10

intestinal fluid and air under tension in a dilated bowel).

intestinal obstruction.

Question 11

• Bruits that have both systolic and diastolic components over renal arteries suggest what?
• Bruits that have both systolic and diastolic components over the iliac or femoral arteries suggest what?

Answer 11

renal artery stenosis.

partial arterial occlusion or arterial insufficiency.

Question 12

Where else can you hear the renal artery for bruits?

Answer 12

at the CVA

Question 13

How large is a normal liver at the MCL

Answer 13

6-12cm

Question 14

A periumbilical or upper abdominal mass with expanding pulsation > 3 cm wide suggests______

What are the risk factors?

Answer 14

AAA

Age > 65.
History of smoking.
Male gender.
First degree relative with a h/o AAA repair.

Question 15

What is a positive murphys sign and what does it check for?

Answer 15

A sharp increase in tenderness with a sudden stop in inspiratory effort is a positive Murphy’s sign.

Acute Cholecystitis

Question 16

Wheres is McBurneys point?

Whats it look for?

Answer 16

A surgical landmark, one-third the distance from the to the umbilicus (2) on the right side.

Appendicitis

Question 17

Appendicitis shifting pain

Answer 17

Pain of appendicitis classically begins near the umbilicus, then shifts to the RLQ, where
coughing can increase pain, due to peritonitis.

Question 18

Press deeply and evenly in a site remote from the area of tenderness
Pain in the RLQ with left-sided pressure suggests ________

Answer 18

appendicitis (positive Rovsing’s sign)

Question 19

What does Psoas sign look for?

Answer 19

Retrocecal appendicitis

May also suggest abnormality in the retroperitoneum

Question 20

What does the obturator sign look for?

Answer 20

Pelvic appendicitis

Right pelvic pain with this maneuver is a positive obturator sign; suggests irritation of obturator muscle by inflammation low in the pelvis, such as inflamed pelvic appendix.

Question 21

What does the heel tap look for?

Answer 21

Movement of the peritoneum may cause pain if there is inflammation (i.e. peritonitis, not specific for
appendicitis)

Raise leg with knee locked in full extension; cupping heel in your hand, strike heel solidly with side of other fist.

Question 22

Ascites may be caused by:

Answer 22

increased hydrostatic pressure in cirrhosis, CHF, and pericarditis.

It may also be caused by decreased osmotic pressure from nephrotic syndrome or malnutrition

Question 23

Ascites test

Answer 23

With patient supine, percuss outward in several directions from the central area of tympany.

Map border between tympany and dullness

Shifting dullness

After mapping the borders of tympany and dullness, have patient turn onto one side.
Percuss and mark the borders again