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Physical Assessment > Abdomen > Flashcards

Abdomen Flashcards

1
Q

Visceral Pain

A 
Inflamed/distended/stretched
Deep organs
Frequently along midline
Achy, gnawing, cramping, DULL
Ex: distention from organomegaly
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2
Q

Parietal Pain

A

Inflammation of parietal peritoneum
More severe/localized
Worsens with movement, coughing
Ex: peritonitis, appendicitis

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3
Q

Referred Pain

A

Pain @ site distant from injury
Sites innervated at same level in spinal cord
Ex: flank pain from kidney issues

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4
Q

Abdominal pain- associated symptoms/risk factors

A

Risk factors: food, meds (opioids), position (GERD)

Symptoms: bloating, bowel issues, fever, dysuria

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5
Q

Abdominal pain- atypical presentations

A

Respiratory symptoms: regurg
N/V: MI
Migraines: seen in kids with GI issues

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6
Q

Causes of early satiety

A

Ascites, tumor, gastroparesis

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7
Q

Cancer Red Flags

A 
Dysphagia (difficulty)
Odynophagia (pain)
Recurrent vomiting
Weight loss
GI bleed
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8
Q

Hepatitis Risk Factors

A

HepA: travel
HapB: unsafe sex, blood exposure
HepC: blood exposures, transfusion pre-1987

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9
Q

Risk factors for GI cancers

A 
Family history
PMH of cancer
H/o adenomatous polyp
Crohn's disease
Ulcerative colotis
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10
Q

Scaphoid abdomen

A

Concave/sunken in in middle

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11
Q

Order for abdominal examination

A
  1. Inspection
  2. Auscultation
  3. Percussion
  4. Palpation
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12
Q

Abdominal Auscultation

A

Diaphragm of stethoscope

30 seconds in each quadrant

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13
Q

Abnormal Abdominal Sounds: Bruit

A

Murmur-like sounds over arteries may suggest partial occlusion
Ex: vascular occlusive disease, atherosclerotic disease, renal artery stenosis

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14
Q

Abnormal Abdominal Sounds: venous hum

A

Rare

Indicates collateral circulation between portal and venous system

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15
Q

Abnormal Abdominal Sounds: hepatic bruit

A

suggests CA or ETOH cirrhosis

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16
Q

Abnormal Abdominal Sounds: hepatic or splenic friction rub

A

Grating sound suggests inflamed peritoneum in area

Ex: hepatoma, gonococcal infection around liver, splenic infarct, pancreatic carcinoma

17
Q

Borborygmi

A

High pitched gurgles of hyper-peristalsis due to colon obstruction or diarrhea
Due to hyper-motility

18
Q

Abdominal Tympany: normal

A

Percussing over gas
Ex. stomach, lung (resonance)
Sometimes bowel

19
Q

Abdominal Tympany: abnormal

A

Percussing over trapped air

Ex: obstruction

20
Q

Abdominal Dullness: normal

A

Percussing over solid or fluid

Ex: liver, ribs

21
Q

Abdominal Dullness: abnormal

A

Percussing over frank ascites, full bladder, hepatomegaly, a baby

22
Q

Normal liver vertical span

A

6-12 cm at right midclavicular line

4-8 cm at midsternal line

23
Q

Causes of positive CVA tenderness

A

Pyelonephritis

MSK problem

24
Q

Assessing for ascites

A
  1. Shifting dullness: sitting up, dullness around flanks and lower abdomen; lying on side, tympany on upper side and fullness on side closer to bed
  2. Fluid wave- will transmit through fluid (not fat)
25
Q

Rebound tenderness cause

A

peritoneal inflammation/parietal pain

Ex. appendicitis

26
Q

Causes of splenomegaly

A

Portal HTN, infarct, HIV, malaria, hematologic malignancy

27
Q

How to palpate for kidney

A

On inspiration, catch between hands, on expiration let it slide back.
L flank mass may be spleen
Normal tympany or can place fingers between mass and costal margin = kidney

28
Q

Murphy’s sign

A

pain under costal margin with inspiration

Dx: acute choleycystitis

29
Q

Appendicitis: typical presentation

A

Starts as vague per-umbilical deep, gnawing pain
Shifts to RLQ
+ peritoneal signs = rebound tenderness, hurts when coughing
Accompanying fever, N/V

30
Q

McBurney’s point

A

2” from anterior superior spinous process of ilium

(+) = localized tenderness in RLQ

31
Q

Rovsing’s sign

A

Referred rebound tenderness: press deeply on LLQ and quickly withdraw
+ = pain in RLQ

32
Q

Psoa’s sign

A

irritation of Psoa’s muscle by inflamed appendix: place hand above R knee and have pt raise thigh against hand (or lay on L side, extend R leg at hip)
(+) = pain

33
Q

Obturator sign

A

R hip flexion with bent knee and internal rotation of knee (foot goes outwards)
(+) = RLQ pain

34
Q

Cutaneous hyperesthesia

A

Light lifting of skin on abdominal wall

(+) = pain

35
Q

Abdomen PE

A
  1. Inspect for distention, color, symmetry, movement, scars, veins
  2. Diaphragm- all 4 quadrants for bowel sounds and arteries for bruits
  3. Percuss all 4 quadrants
  4. Percuss for shifting dullness
  5. Percuss and measure liver span
  6. Percuss for splenic enlargement
  7. Palpate abdomen and suprapubic/epigastric areas lightly and then deeper
  8. Assess for fluid wave
  9. Assess for rebound tenderness
  10. Palpate kidneys (2 hands)
  11. Palpate spleen (2 hands)
  12. Palpate liver edge
  13. Assess for Murphy’s sign, Psoa’s sign, obturator sign
  14. Assess for CVA tenderness

Physical Assessment (5 decks)

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