abd abnormal Flashcards
What conditions can cause large purple colored striae (stretch marks)
- Cushing’s disease
- steroid use
what conditions can cause large normal colored stretch marks
- pregnancy
- weight gain
- rapid growth
what is the dark line of hyperpigmentation
linea nigra of pregnanct
normal venous flow in abdomen
- upward above the umbilicus
- downwards below umbilicus
inferior vena cava and/or portal venous obstruction causes what type of venous flow
- “shunting” with an upward flow from the lower abdomen
superior vena cava venous obstruction causes what venous flow in abd
- “shunting” with a downward flow from the upper abd
what is Diastatis recti
- seperation of rectus abdominus muscles
- obvious with flextion of neck: “lift head up”
what is ascites
free intraperitoneal fluid
increased peristaltic activity (visible waves of movement seen beneath the skin) is present in what conditions
- intestinal obstruction
- gastro-enteritis
what is a Gridiron surgical incision
- Muscle splitting
- McBurney’s point (appy)
what is a Pfannenstiel surgical incision
suprapubic
What are Borborygmi bowel sounds and what condition are they associated with?
- loud, active bowel sounds
- associated with bowel obstruction
if you hear high-pitched, tinkling bowel sounds, what should you be concerned for
- obstruction
- intestinal fluid under pressure, with rushes of fluid moving through bowel
if you hear hypoactive bowel sounds after several minutes of listening, what condition should you be suspicious for?
paralytic “ileus”
what bowel condition presents with bowel sounds that are hyperactive initially, but eventually become hypoactive due to progressively severe inflammation
Peritonitis
What vessels in the abdomen do want to listen for bruits?
- aorta
- renal arteries
- iliac arteries
- femoral arteries
how do you percuss for ascites
“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
- with the patient supine, percuss the border of tympany and dullness
- have patient roll on their side, then percuss the border again
- an obvious shift in the location of the border suggests free intraperitoneal fluid
how do you palpate for ascites
- check for “fluid wave”
- patient or assistant applied pressure down middle of abdomen to stop transmission of impulse through fat
- tapping on one side will send a pressure wave to the other side if there is fluid
what is the succussion splash technique
- “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
the succussion splash techniques may be indicative of what conditions?
- bowel obstruction
- gastric outlet obstruction
- intestinal perforation
- ascites
what is a paracentesis
tap to remove free fluid from peritoneal space
How do you perform superficial abdominal reflexes?
Use sharp end of reflex hammer and touch abdomen at umbilicus and swipe outward in four directions
in the superficial abdominal reflex, upper abdomen relfex tests for which nerves?
- T -7,8,9
in the superficial abdominal reflex, lower abdomen relfex tests for which nerves?
T-11,12
in the superficial abdominal reflex, cremasteric relfex tests for which nerves?
T-12, L1, L2
what is a common site of pain from diverticulitis
LLQ
“explosive, excruciating abdominal pain.” What is your differential diagnosis?
- coronary occlusion
- biliary colic
- ruptured viscus
- peptic ulcer
- ruptured aneurysm
- renal colic
“severe, constant abdominal pain.” what is your differential diagnosis?
- acture pancreatitis
- bowel strangulation
- Mesenteric thrombosis
“gradual onset, steady abdominal pain.” What is your differential diagnosis?
- acute cholecystitis
- acute appendicitis
- diverticulitis
- pelvic inflammatory disease
“Intermittent, colicky pain.” What is your differential diagnosis?
- early, subacture pancreatitis
- mechanical small bowel obstruction
What are the “Peritoneal signs”
- Guarding
- abdominal wall rigidity
- rebound/contralateral rebound tenderness
What is obturator sign
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
what is psoas sign
test appendiceal inflammation
- two acceptable techniques
- place your hand above patient’s right knee and have patient raise thigh against resistance
- picture
What is rebound tenderness
- technique: over site of most tenderness, press in, then suddenly release
- classical sign of peritoneal irritation
what is Rovsing’s sign
- 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
What is murphy’s sign
- 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
- lay left hand flat against liver and use fist to percuss
