Abdomen Flashcards
A provocative maneuver that results in RLQ pain and rebound tenderness
McBurney’s Sign
Provocative maneuvers preformed during the abdominal exam are to check for_____
Peritoneal irritation
This _____ sign is positive when the examiners places pressure in the RUQ and has the patient inhale resulting in a sudden stop in inhalation with the diaphragm descends onto an inflamed gallbladder.
Murphy’s sign
The test for pain due to intra-abdominal inflammation/peritoneal irritation; the patient lines on unaffected side and extends other leg at the hip against resistance
Iliopsoas test
In this test, the examiner observes internal rotation of the patient’s right leg with the leg flexed at 90 degrees at the hip and knee. It is positive when there is abdominal discomfort with this maneuver. It could be a sign of appendicitis or peritoneal inflammation.
Obturator test
These may be heard with Borborygmi, gastroenteritis, or early bowel obstruction.
Hyperactive bowel sounds
These sounds are suggestive of intestinal fluid and air under pressure; may also be heard in early bowel obstruction
High pitched, tinkling bowel sounds
Used to examine the interior of the colon as either a routine screening or as a diagnostic test.
Colonoscopy
History of severe knife like abdominal pain making it difficult to sit/stand upright is MOST often seen with ____?
Pancreatitis
A bruit heard during auscultation of the mid-line arterial abdominal vessel is highly suggestive of _____?
AAA
Acute knife like pain in the upper abdomen that radiates to the back; often associated with upper abdominal distention and epigastric tenderness is MOST often seen with ______?
Pancreatitis
RUQ tenderness, nausea, vomiting, fatigue, malaise, jaundices, and pruritus is MOST OFTEN associated with _____?
Hepatitis
Leading differential for a patient presenting with retrosternal burning sensation, regurgitation, cough, and hoarseness is?
GERD
The MOST likely diagnosis for a patient presenting with pain that occurs 2-4 hours after a meal that is in either the right to left quadrants, often with a history of H. Pylori infection and unexplained iron deficiency anemia is _____?
PUD
Area where minerals, electrolytes, carbohydrates, proteins, and fats are primarily absorbed
Jejunum
Area where Vitamin B12 and bile salts are primarily absorbed
Ileum
Which section of bowel is commonly affected by Crohn’s and IBD?
Ileum
Where is most of the water and electrolytes absorbed in the body?
The large instestine
What is the sequence of examination of the abdomen?
Inspection, auscultation, percussion, palpation
Are auscultation of bowel sounds a strong diagnostic tool?
No, they’re a poor diagnostic tool
Pain type: poorly localized, vague, often midline, crampy, burning, patient often restless
Visceral pain
Pain type: localized, intense, guarding, patient often still
Somatoparietal pain
DDx: pain in RUQ
gallbladder disease, liver disease, pancreatitis, pleurisy
DDX: pain in LUQ
hypersplenism, pancreatitis, pleurisy
DDx: pain in epigastric region
GERD, PUD, hiatal hernia, gastric malignancy, pancreatitis, cholecystitis, hepatitis, AAA(if symptomatic)
DDx: pain in the RLQ/LLQ
Appendicitis, ectopic pregnancy, colorectal cancer, urinary calculi, ovarian cyst/tumor, inguinal or femoral hernia, intestinal obstruction, diverticulitis, gastroenteritis
When considering a complaint of lower quadrant pain in women, what physical exam aspect should take place besides an abdominal exam?
A pelvic exam to r/o pregnancy, STIs, tumors, etc.
Flank ecchymosis is _____ sign.
Grey Turner’s sign
Umbilical ecchymosis is ____ sign.
Cullen’s sign
Grey Turner’s sign and Cullen’s sign are findings that can indicate ________:
Abdominal hemorrhage, acute pancreatitis, or ectopic pregnancy
Sister Mary Joseph’s nodule is a sign of ______
Malignancy (generally later stage)
Palpation of the abdomen by applying slow and steady pressure to the suspected area followed by an abrupt removal of the pressure with resulting positive being pain worsened upon removal of pressure is what special test?
Rebound tenderness or Blumberg’s sign
Pain ellicited from the patient laying supine, raising their right knee while the provider applies downward pressure on the leg is tested by what special test?
Psoas test
The patient standing on their toes is asked to drop to their heels suddenly resulting in a jarring RLQ sensation is what special test?
Heel drop test/Markle’s test
Which imaging is most appropriate for the assessment of appendicitis?
Ultrasound
Key history/Physical findings:
Dried, hard, small stools; infrequent bowel movements; straining with bowel movements; incomplete evacuation of stool
Constipation
Key history/Physical findings:
Loose, watery stools; frequent bowel movements; cramping due to inflammation; increased intestinal motility of the GI tract; gas formation; diffuse abdominal pain; dehydration
Diarrhea
Key history/Physical findings:
Queasy sensation including an urge to vomit, vomitus
Nausea/vomitting
Key history/Physical findings:
RUQ or epigastric pain; pain characterized by piercing/penetrating; pain radiating to the back; N/V; fever; tachycardia; shallow respirations; postural HTN; diaphoresis
Acute pancreatitis
Key history/Physical findings:
Acute, colicky RUQ with radiation to the back or R shoulder; anorexia; N/V; low-grade fever; increased neutrophilic leukocyte count; jaundice in later presentation; positive Murphy’s sign
Cholecystitis/Cholelithiasis
Female, Fat, Forty, and Fertile are known as…
The 4 F’s of gallbladder disease
Key history/Physical findings:
Abnormal LFTs; thrombocytopenia; jaundice; hepatomegaly on US; portal HTN; ascites; encephalopathy (later stage)
Hepatitis
Key history/Physical findings:
Pain that can be vague and around the umbilicus (early) or more intense to the RLQ (later); low-grade fever; elevated WBC count; constipation feeling; N/V; positive McBurney’s point tenderness; Rovsing’s sign tenderness; rectal tenderness; Psoas sign positive; cough/hop pain
Appendicitis
Key history/Physical findings:
Often initiated with coughing/bending over/lifting heavy objects; N/V; palpable mass in the abdomen; acute pain; fever
Strangulated hernia
Key history/Physical findings:
Intermittent, cramping, abdominal pain; severe diarrhea usually with blood, pus, or mucus; fatigue and malaise; fever; weight loss; arthralgias; decreased H/H; ESR elevated (with exacerbations); skip lesions on colonoscopy
Crohn’s/regional ileitis
Key history/Physical findings:
Generally asymptomatic; pain or fullness of the LUQ with possible radiation to the L shoulder; fatigue; frequent infections; anemia
Splenomegaly
Key history/Physical findings:
Sudden onset abdominal pain; splenomegaly and/or tenderness to the LUQ; hemodynamic instability; confusion; lightheadedness; dizziness
Splenic rupture
Key history/Physical findings:
Gradually worsening abdominal pain; board-like abdominal distention; fever; N/V; elevated WBC
Perforated colon
Key history/Physical findings:
Abdominal pain in LLQ; history of chronic constipation or diarrhea; fever; N/V; tenderness to LLQ palpation; leukocytosis
Diverticulitis
Key history/Physical findings:
Abdominal pain to LLQ; diarrhea with blood or pus; rectal pain and bleeding; weight loss; cobblestoning on colonoscopy; anemia; WBC in stool
Ulcerative colitis
Key history/Physical findings:
Diarrhea, bloating, flatulence, fatigue, weight loss, iron-deficiency anemia, constipation, depression
Celiac disease
Key history/Physical findings:
Abdominal pain in the epigastric region (can also be LUQ or RUQ); burning/gnawing pain; pain can radiate to the back; pain worsens with immediate OR 2-5 hours after eating; heartburn, belching, bloating, nausea, positive guaiac test, H. pylori positive or history of; gastroduodenal lesions on EGD
PUD
Key history/Physical findings:
Burning sensation in the chest, symptoms worsen at night/lying supine, chest pain, difficulty swallowing, abdominal bloating, regurgitation of food, globus sensation, aggravated by specific foods/meds/meals, relieved by antacids, cough, hoarseness, pain with palpation to the epigastric region
GERD
Key history/Physical findings:
Recurrent abdominal pain (1 day/week for 3 months), altered bowel patterns; diarrhea or constipation or alternating; bowel movements during waking hours in the morning or after meals; abdominal bloating; increased gas production; exacerbated by emotional stress/eating; periods of exacerbations and remissions
Irritable bowel syndrome
Key history/Physical findings:
Hx of abdominal surgery; stools that have decreased in diameter or frequency; abrupt onset of periumbilical abdominal pain; N/V; abdominal distention; obstipation; dehydration; tachycardia; orthostatic hypotension; reduced urinary output; hernias
Small bowel obstruction
Key history/Physical findings:
Hx of cirrhosis; fever, guarding, diffuse abdominal pain, rigidity and distention of the abdomen, rebound tenderness, AMS, leukocytosis
Peritonitis
Key history/Physical findings:
Dysuria; urinary frequency; urinary urgency; suprapubic pain; lower back pain; gross hematuria; appearance of turbid urine; low-grade fever; AMS in the elderly; uretheral discharge; positive nitrates, pyuria, hematuria, and UC
Lower UTI
Key history/Physical findings:
Hx of untreated UTI, sudden onset of systemic symptoms (chills, fever, malaise); urinary frequency/urgency; dysuria; unilateral flank pain; abdominal pain; N/V; gross hematuria; unilateral costovertebral angle tenderness; enlarged kidney; US with pyuria, bacteruria, nitrites, WBC casts, UC
Pylenonephritis
