ABD Exam Lectures Flashcards
What causes visceral pain?
- distention, stretching, or contracting of hollow organs
- stretching the capsule of solid organs
- organ ischemia
Where is visceral pain usually felt?
in the midline at the level of the structure involved; not localized
What causes parietal (somatic) pain?
inflammation in the parietal peritoneum
How is parietal (somatic) pain described?
usually more constant/severe than visceral pain; localized; aggravated by movement and alleviated by remaining still
What is referred pain?
pain that originates in the ABD but is felt at distant site which are innervated at approximately the same spinal levels as the disordered structure
What 2 questions from OLDCAAARTS are most important to ask about w/ ABD pain?
Location and alleviating/aggravating factors
What are each of the following associated w/ in the ABD: blood thinners, NSAIDs, narcotics, and steroids?
- blood thinners: GI bleed
- NSAIDs: risk factor for gastritis and PUD
- Narcotics: constipation
- Steroids: perforated viscus
Why are smoking, alcohol, and drug use important to ask about with a GI complaint?
- smoking: irritates lining of stomach -> PUD or gastritis
- alcohol: liver disease
- Drugs: HTC can cause hyperemesis
What 4 additional questions should you ask with a GI complaint in the SHx?
- stress
- travel
- well water
- ingestion of undercooked meat
What are the 4 steps to an ABD exam?
- inspection
- auscultation
- percussion
- palpation
What are 4 landmarks you should inspect on the ABD?
- xiphoid process of sternum
- costal margins
- umbilicus
- ASIS
Name 5 organs that could cause RUQ pain
liver, gallbladder, stomach, SI, LI
Name 4 organs that could cause RLQ pain
appendix, ovary, SI, LI
Name 4 organs that could cause LLQ pain
sigmoid colon, ovary, SI, LI
Name 4 organs that could cause LUQ pain
spleen, stomach, SI, LI
Name 6 organs that could cause epigastric pain
pancreas, liver, gallbladder, stomach, SI, LI
Name an organ that could cause suprapubic pain
bladder
Name 6 things you should inspect the surface of the ABD for
surgical scars, striae, skin colon, dilated veins, rash, ecchymosis
What side of the stethoscope would you use to listen for bowel sounds and bruits?
bowel sounds: diaphragm
bruits: bell
What could absent bowel sounds indicate?
long lasting intestinal obstruction, mesenteric ischemia
What could decreased bowel sounds indicate?
post-surgical ileus, peritonitis
What could increased bowel sounds indicate?
diarrhea, early bowel obstruction
What are high pitched bowel sounds and what do they indicate?
sounds like raindrops on a metal pipe -> suggests early bowel obstruction
Where would you hear bruits in the ABD and what do they indicate?
ABD aorta, renal A., iliac A., femoral A. -> suggest vascular obstruction
What is a friction rub? Where would you hear it and what does it indicate?
grating sounds w/ respiratory variation heard over the liver and spleen -> suggests inflammation of the peritoneal surface of an organ
What is venous hum? Where would you hear it and what does it indicate?
soft humming nose heard over the epigastric and umbilical region -> increased collateral circulation between portal and canal venous systems
What 2 sounds should you hear when you percuss the ABD? Which one is heard more?
tympany (heard more): air filled organs
dullness: solid organs or masses
When would you consider tympany or dullness abnormal?
- large dull areas from a mass or enlarged organ
- protuberant ABD tympanitic throughout may indicate bowel instruction
When the spleen enlarges, in what direction does it expand?
anteriorly, downward, and medially
What is the normal vertical span of the liver?
6-12 cm
When palpating the liver, what does it mean if you feel an irregular edge/nodules or firmness/hardness?
- irregular edge/nodules = hepatocellular carcinoma
- firmness/hardness = cirrhosis, hemachromatosis, amyloidosis, or lymphoma
What can cause splenomegaly?
portal HTN, blood malignancies, HIV, splenic infarct, hematoma, mononucleosis
Explain the shifting dullness test
- tests for ascites
- percuss for tympany and dullness w/ pt supine then have pt lay on their side and percuss again
- Positive = dullness shifts to dependent side and tympany to top side
Explain the fluid wave test
- tests for ascites
- assistant places hand midline of pt’s ABD
- tap one flank sharply w/ finger tips and feel impulse transmitted to other flank (positive)
What is guarding?
voluntary contraction of ABD wall to protect inflammed organs from pressure of palpation
What is rigidity?
involuntary reflex contraction of ABD wall; stiff board-like muscle contraction and may not seen ABD move w/ respirations
What is rebound tenderness?
occurs when you push deep into ABD and release quickly (positive pain when letting go)
What 3 systems should you be thinking about when dx ABD pain?
GI, GU, GYN (if female)
What are 3 typical sxs of GERD?
heartburn, regurgitation, and dysphagia
What are 5 atypical sxs of GERD?
coughing, hoarseness, otitis media, noncardiac chest pain, enamel erosion
What are 5 lifestyle modifications for someone w/ GERD?
- lose weight
- avoid trigger foods
- avoid large meals
- wait 3 hours after meal before lying down
- elevate head of bed 8 inches
What is the Rome III criteria for constipation?
must have at least 2 sxs over 3 months:
- fewer than 3 BMs/week
- straining
- lumpy/hard stools
- sensation of incomplete defecation
- manual maneuvering required to defecate
What is the Bristol stool scale? Which levels are more common w/ constipation? Which levels are considered more normal?
- a scale to agree on the look and feel of stool; levels 1-7
- type 1 and 2 more common in constipation
- type 3 and 4 considered more normal
What are 4 sxs associated w/ constipation?
bloating, low back pain, tenesmus (act of body pushing stool involuntarily), pain on defecation
What are 4 concerning sxs of constipation?
rectal bleeding, ABD pain, inability to pass flatus, vomiting
What 3 exams should you perform for a pt w/ constipation?
ABD exam
anorectal exam
pelvic exam (for females)
What is the purpose of the pelvic exam for constipation?
to check for internal prolapse or rectocele
Name 5 lifestyle modifications for someone w/ constipation?
- increase fiber
- increase water intake
- use bathroom when needed
- increase exercise
- schedule uninterrupted time everyday for BM
What is gastroenteritis?
nonspecific term that mainly manifests as diarrhea, N/V, and ABD pain
Name 2 viral causes of gastroenteritis and exposure
- norovirus: uncontrolled vomiting, some diarrhea -> cruise ship or casino outbreaks
- rotavirus: seen in children by age 5 if not immunized
Name 3 bacterial causes of gastroenteritis and exposure
- salmonella: 12-36 hours after eating contaminated food
- C Diff: hospital acquired after exposure to Abx
- E. Coli: food, water, person-to-person transmission; most common cause of traveler’s diarrhea
Name 1 parasitic cause of gastroenteritis and exposure
giardia: causes diarrhea (greasy stools tend to float); most commonly gotten from infected water (campers, hikers, travelers)
Name 4 drugs associated w/ diarrhea?
- antibiotics
- laxatives
- sorbitol
- PPIs (proton pump inhibitors)
Difference between IBS and IBD
IBS: altered bowel habits, ABD pain, and bloating
IBD: usually Crohn’s disease or ulcerative colitis
What history should you ask a pt w/ constipation?
- normal defecation pattern
- hardness of stools
- straining
- what have the tried to help
- duration of the problem
- relation to any changes in diet, water, or exercise
What history should you ask a pt w/ diarrhea?
- frequency
- large vs small amounts
- blood present?
- travel
- changes in meds
- recent hiking/camping
What is copious rice water diarrhea associated w/?
cholera
