abd abnormal

Question 1

What conditions can cause large purple colored striae (stretch marks)

Answer 1

• Cushing’s disease
• steroid use

Question 2

what conditions can cause large normal colored stretch marks

Answer 2

• pregnancy
• weight gain
• rapid growth

Question 3

what is the dark line of hyperpigmentation

Answer 3

linea nigra of pregnanct

Question 4

normal venous flow in abdomen

Answer 4

• upward above the umbilicus
• downwards below umbilicus

Question 5

inferior vena cava and/or portal venous obstruction causes what type of venous flow

Answer 5

• “shunting” with an upward flow from the lower abdomen

Question 6

superior vena cava venous obstruction causes what venous flow in abd

Answer 6

• “shunting” with a downward flow from the upper abd

Question 7

what is Diastatis recti

Answer 7

• seperation of rectus abdominus muscles
• obvious with flextion of neck: “lift head up”

Question 8

what is ascites

Answer 8

free intraperitoneal fluid

Question 9

increased peristaltic activity (visible waves of movement seen beneath the skin) is present in what conditions

Answer 9

• intestinal obstruction
• gastro-enteritis

Question 10

what is a Gridiron surgical incision

Answer 10

• Muscle splitting
• McBurney’s point (appy)

Question 11

what is a Pfannenstiel surgical incision

Answer 11

suprapubic

Question 12

What are Borborygmi bowel sounds and what condition are they associated with?

Answer 12

• loud, active bowel sounds
• associated with bowel obstruction

Question 13

if you hear high-pitched, tinkling bowel sounds, what should you be concerned for

Answer 13

• obstruction
  
  • intestinal fluid under pressure, with rushes of fluid moving through bowel

Question 14

if you hear hypoactive bowel sounds after several minutes of listening, what condition should you be suspicious for?

Answer 14

paralytic “ileus”

Question 15

what bowel condition presents with bowel sounds that are hyperactive initially, but eventually become hypoactive due to progressively severe inflammation

Answer 15

Peritonitis

Question 16

What vessels in the abdomen do want to listen for bruits?

Answer 16

• aorta
• renal arteries
• iliac arteries
• femoral arteries

Question 17

how do you percuss for ascites

Answer 17

“shifting dullness” test

• gas filled bowel loops will always float to the top and the percussion sound will be tympanic under the fluid level is reached during percussion at which time, it will switch to dullness

1. with the patient supine, percuss the border of tympany and dullness
2. have patient roll on their side, then percuss the border again
3. an obvious shift in the location of the border suggests free intraperitoneal fluid

Question 18

how do you palpate for ascites

Answer 18

• check for “fluid wave”

1. patient or assistant applied pressure down middle of abdomen to stop transmission of impulse through fat
2. tapping on one side will send a pressure wave to the other side if there is fluid

Question 19

what is the succussion splash technique

Answer 19

• “shaking” the abd with the examiners hands or a brief thrust with one hand to create a “splash” sound
• may be heard without a stethoscope

Question 20

the succussion splash techniques may be indicative of what conditions?

Answer 20

• bowel obstruction
• gastric outlet obstruction
• intestinal perforation
• ascites

Question 21

what is a paracentesis

Answer 21

tap to remove free fluid from peritoneal space

Question 22

How do you perform superficial abdominal reflexes?

Answer 22

Use sharp end of reflex hammer and touch abdomen at umbilicus and swipe outward in four directions

Question 23

in the superficial abdominal reflex, upper abdomen relfex tests for which nerves?

Answer 23

• T -7,8,9

Question 24

in the superficial abdominal reflex, lower abdomen relfex tests for which nerves?

Answer 24

T-11,12

Question 25

in the superficial abdominal reflex, cremasteric relfex tests for which nerves?

Answer 25

T-12, L1, L2

Question 26

what is a common site of pain from diverticulitis

Answer 26

LLQ

Question 27

“explosive, excruciating abdominal pain.” What is your differential diagnosis?

Answer 27

• coronary occlusion
• biliary colic
• ruptured viscus
  
  • peptic ulcer
• ruptured aneurysm
• renal colic

Question 28

“severe, constant abdominal pain.” what is your differential diagnosis?

Answer 28

• acture pancreatitis
• bowel strangulation
• Mesenteric thrombosis

Question 29

“gradual onset, steady abdominal pain.” What is your differential diagnosis?

Answer 29

• acute cholecystitis
• acute appendicitis
• diverticulitis
• pelvic inflammatory disease

Question 30

“Intermittent, colicky pain.” What is your differential diagnosis?

Answer 30

• early, subacture pancreatitis
• mechanical small bowel obstruction

Question 31

What are the “Peritoneal signs”

Answer 31

• Guarding
• abdominal wall rigidity
• rebound/contralateral rebound tenderness

Question 32

What is obturator sign

Answer 32

test for acute appendicitis

• with patient supine and right knee bent, internally rotate the right leg at the hip
• this stretches the internal obturator muscle which produces RLQ pain from obturator muscle irritation due to an inflammed appendix

Question 33

what is psoas sign

Answer 33

test appendiceal inflammation

• two acceptable techniques
  
  1. place your hand above patient’s right knee and have patient raise thigh against resistance
  2. picture

Question 34

What is rebound tenderness

Answer 34

• technique: over site of most tenderness, press in, then suddenly release
• classical sign of peritoneal irritation

Question 35

what is Rovsing’s sign

Answer 35

• tests for referred rebound tenderness
• press deeply and evenly in the LLQ, then quickly withdraw your fingers
• sudden pain in the RLQ is a + sign suggestive of appendiceal inflammation

Question 36

What is murphy’s sign

Answer 36

• used to test for GB or liver inflammation
  1. position fingers of right hand under right costal margin and ask patient to take a deep breath

OR

1. lay left hand flat against liver and use fist to percuss