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CPA > abdomen > Flashcards

abdomen Flashcards

1
Q

what are the 9 regions of the stomach and what would you find in each region

A

right iliac fossa (appendix, cecum), suprapubic (bladder, uterus), left iliac fossa (sigmoid colon), left lumbar (kidney), umbilical (small bowel, retroperitoneal structures), right lumbar (kidneys), right hypochondriac (gall bladder), epigastric (stomach, duodenum,) , left hypochondriac (pancreas)

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2
Q

where is the spleen

A

intraperitoneal organ, left hypochondriac region, inbetween ribs 9-11

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3
Q

what are the causes of splenomegaly?

A

portal HTN secondary to liver cirrhosis, haemolytic anaemia, splenic metastases

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4
Q

why would both kidneys be enlarged

A

polycystic kidney disease,

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5
Q

why would only 1 kidney be enlarged?

A

renal tumour.

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6
Q

what is pathological when palpating the abdominal aorta

A

when your hand moves outwards- suggest expansile mass.

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7
Q

when does abdominal aorta bifourcate?

A

L4

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8
Q

what are you looking for in inspection

A

skin abnormalities, surgical scars, masses, hernias, assymetry. movement of abdo wall

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9
Q

what are some pathological changes to the abdomen

A

obesity- umbillicus is sunken

hernia: umbillicus is distended and everted

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10
Q

why would there be abnormally large veins on abdominal wall

A

portal HTN/ obstructed IVC.

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11
Q

why would there be assymetry in abdominal wall?

A

localised mass

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12
Q

tenderness on palpation

A

minimal presure over wide area due to peritonitis, and sometimes anxiety)

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13
Q

guarding

A

contract voluntarily when palpation causes pain

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14
Q

ridgidity

A

inflammation of parietal peritoneum, reflex contraciton (involuntary guarding). abdominal wall may not show any sign of movement

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15
Q

rebound tenderness

A

generalised or localised peritonitis, if abdominal wall is compressed slowly, then shapr stabbing pain when released

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16
Q

transpyloric plane

A

L1: pylorus of stomach, neck of pancreas, renal hilum

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17
Q

subcostal plane

A

L3: origin of IMA, lower edge of 10 CC

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18
Q

Supracristal plane

A

L4: bifourcation of aorta,

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19
Q

intertuburcular plane

A

L5: tubercle of crest of ilium

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20
Q

interspinous plane

A

S2: ASIS.

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21
Q

umbilicus plane

A

between L3-L4

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22
Q

what do you expect to hear from percussing the liver

A

resonant–> dull (Costal margin), dull–> resonant (4th rib ish). to find the upper border, tap above to the 4th rib and then come back down. could also palpate to find the upper border

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23
Q

when would you percuss hyperresonant

A

air-not good

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24
Q

ascites

A

accumulation of fluid in peritoneal cavity due to liver cirrhosis, as dec metabolism of aldosterone and ADH, so more salt and water retention in the body. also less albumin, so then less oncotic pressure, so less pull of fluid into tissue so more fluid in peritoneal cavity

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25
Q

absent bowel sounds

A

paralytic ileus/peritonitis

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26
Q

high pitched bowel sounds

A

intestinal obstruction

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27
Q

abdominal aorta bruits

A

above and left of umbillicus

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28
Q

SMA bruits

A

epigastrium

29
Q

renal A bruits

A

2cm superior and lateral to umbillicus

30
Q

liver tumours and iliac arteries

A

over liver and iliac fossa

31
Q

surface marking of kidney:

A

4-5 cm from posterior median line–> supra cristal plane. hilum at L1 transpyloric plane

32
Q

how big is the kidney

A

height: 9-12 cm, width: 5-7 cm

33
Q

ureter surface marking

A

renal hilum is 5cm lateral to posterior median line at L1 (transpyloric plane) and goes through posterior superior iliac spine

34
Q

surface marking of kidney

A

right 5th rib MCL, lower end of sternum, left 5th rib MCL (upper border), CM at right mid axillary line, (oblique/ diagonal border- left 5th ICS MCL to left 8th CC then to right 9th CC then to right mid axillary line in right costal margin) and then back up to right 5th rib MCL= right border

35
Q

gall bladder surface marking

A

lateral border of rectus abdominis (transpyloric plane=L1) and right MCL

36
Q

sites of kidney stones

A

pelvic-ureteric junction, pelvic brim, vesico-ureteric junction. US. small: pass in urine, large: stenting/ lithotripsy

37
Q

surface marking of spleen

A

ribs 9-11, in between posterior mid axillary line and lateral border of erector spinae muscles

38
Q

dermatomes of abdomen

A

T5: xiphoid process, T10: umbillicus. butt: S3

39
Q

pneumoperitoneum

A

air under diaphragm due to perforation of abdo organ (trauma/iatrogenic causes)

40
Q

SBO on xray

A

step ladder, more than 3 cm, centrally located, valvulae conniventes (go through the whole bowel), striations

41
Q

LBO on xray

A

peripherally located, haustra

42
Q

where does pain from 9 regions radiate to

A

right hypochondriac: through to the back and right. epigastric: straight to the back, left hypochondriac: through to the back and the left. kidneys: in loin and radiate to groin

43
Q

what seperates the 9 regions horizontally:

A

subcostal plane-L3. intertuburcular plane: L5

44
Q

causes of colicky pain

A

stones in urinary tract, gall stones in CBD, SBO/LBO

45
Q

what caues constant pain

A

hepatitis, gastritis, any itis

46
Q

what cases pain in right hyopchondriac region

A

gall stones, cholangiits, hepatitis, liver abscess

47
Q

what causes pain in epigastric

A

oesophagitis, peptic ulcer, perforated ulcer, pancreatitis

48
Q

what causes pain in left hypochondriac region

A

splenic abscess, acute splenomegaly, splenic rupture

49
Q

what causes pain in umbillical

A

appendicitis (early), mesenteric adenitis

50
Q

what causes pain in lumbar region

A

renal colic, ovarian cyst, ovarian mass, ovarian torsian

51
Q

what causes pain in left iliac region

A

diverticulities, ulcerative collitis, hernia

52
Q

what causes pain in right iliac region

A

appendicitis, crohn’s disease, renal colic

53
Q

what causes pain in suprapubic region

A

urinary retention, cystitis, endometriosis

54
Q

when do you use IV contrast

A

evaluate vascular disease, common, evaluate inflammation, masses, malignancies

55
Q

when do you use oral contrast

A

allows distention of the bowel in order to distinguinsh the bowel from other sturctures. helpful in imaging the bowel wall/lumen

56
Q

PC: appendicitis

A

acute RIF pain, dull periumbilical pain that shifts to RLQ pain (initially viseral peritoneum so poorly localised, then to parietal peritoneum which is better localised). anorexia, nausea, vomiting, constipation

57
Q

Abdominal aortic aneurysm

A

wall of abdominal aorta is weakened, pt presents with shock and loss of consciousness.

58
Q

signs of unruptured AAA

A

palpation of AAA will be pulsatile and laterally expansile. may hear bruits due to turbulent blood flow

59
Q

signs of ruptured AAA

A

retroperitoneal haemorrhage: cullen’s sign (bruising around umbillicus), greys sign: bruising in flank/ iliac fossa

60
Q

SBO

A

I: distension, more central. ausculation: high pitched tinkling sound= early sign, absent= late sign. bilous vomitin (early sign)

61
Q

LBO:

A

gross distension, peripheral, high pitched tinkling bowel sounds (early sign), absent bowl sounds (late sign), faeculent vomitig (late sign)

62
Q

PC: peritonitis:

A

diffuse abdo pain, tenderness esp on palpation, guarding, ridgidity, rebound tenderness, pt lying still

63
Q

sigmoid volvulus

A

coffee bean sign, originates from LIF, sigmoid colon has rotated on its mesentery, causing it to become obstructed and very enlarged. high risk of perforation or bowel ischaemia (due to strangualted blood supply)

64
Q

McBurney point tenderness

A

1/3 distance from right ASIS to umbillicus

65
Q

rovsing sign

A

deep palpation of LLQ causes RLQ referred pain

66
Q

psoas sign

A

RLQ pain with extension of the right leg against resistance (secondary to inflammation of a retrocaecal appendix)

67
Q

cope’s obturator sign

A

RLQ pain with flexion and internal rotation of right leg

68
Q

blumberg’s sign

A

rebound tenderness caused by suddenly ceasing deep palpation of RLQ

69
Q

when do you use IV urogram

A

renal colic- radioopaque contrast medium injected into vein, radiograpg taken at intervals as the contrast medium is filtered through the kidneys.

CPA (7 decks)

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