Abdomen Flashcards
For abdomen, order of exam?
1) inspection
2) AUSCULTATION
3) percussion
4) palpation
Percussion looks for what? (4)
1) size/density of organs
2) fluid
3) air distribution
4) masses
Percuss for liver span, start where?
umbilicus and MCL -> move up
4th ICS and MCL -> move down
Liver upper border U where?
5-7th ICS
Liver span U how big?
6-12 cm at MCL
4-8 cm at mid sternal line
Palpation of abdom looking for what? (4)
1) mm spasm
2) masses
3) fluid
4) tenderness
Aorta >3 cm may indicate?
AAA
Abdom aortic aneurysm
What is PQRST
rating of abdom pain:
Provocative/Palliative (makes better/worse) Quality Region/Radiation Severity Temporal pattern/assoc sxs
What is BRBPR?
Bright Red Blood Per Rectum
Linea Nigra?
hyperpigmented line down pregnant abdomen
Normal venous flow in abdom?
Upward above umbilicus
Downward below umbilicus
Shunting of blood from lower abdom to upper abdom may mean?
IVC or portal vein obstruction
Caput medusae is what?
Caused by what?
Radiating venous flow from umbilicus (network of visible blue veins)
portal venous obstruction with ascites (serous fluid accumulation)
Shunting from up abdom to low abdom may mean?
SVC obstruction
Diastasis recti is?
separation of rectus abdom mm
seen as ridge in abdomen when pt lifts head in supine position
Bulging flanks may mean?
ascitic fluid
Suprepubic bulge may mean? (3)
1) full bladder
2) tumor
3) pregnancy
Ascites is?
free intraperitoneal fluid accumulated in dependent part of abdom cavity
Gas-filled loops float to top
Visible peristaltic activity may mean?
intestinal obstruction
gastroenteritis
What is a gridiron incision?
muscle-splitting
What is pfannenstiel incision?
suprapubic
Purpose of auscultation? (2)
Bowel Sounds (intestinal activity) Narrowing of vascular structures (bruits)
Hyperactive BS may mean? (3)
Gastroenteritis Early obstruction Early peritonitis (infection)
Borborygmi is?
Cause by?
Absence means?
(bawr-buh-RIG-me)
gurgling, splashing sound over the large intestine
caused by passage of gas through liquid
absence = (P) paralytic ileus or obstruction
High-pitched Tinkling BS may indicate? (2)
Mechanical small bowel obstruction
Intestinal fluid under pressure
Hypoactive BS, I must determine what?
quite vs silent (listen for several minutes)
Hypoactive BS may indicate? (2)
Paralytic ileus
Late Peritonitis
What arteries should be auscultated for bruits? (4)
Aorta
Renal aa
Iliac aa
Femoral aa
Purcussion for ascites sounds like?
tympanic over air-filled loops
dullness heard lower in abdomen (shifting dullness)
Shifting dullness exam?
Pt supine, percuss for border of dullness
Pt roll to side, if border of dullness shifts = ascites
Palpation for ascites?
Looking for fluid wave:
Use hand to wall-off one side of abdom fat from other
Tap on one side sends wave of fluid to other
Paracentesis is?
needle (tap) removal of fluid
Splenomegaly may indicate? (6)
mono (tender, fragile) hematologic disorders cirrhosis cysts hypersplenism other infections
Superficial abdmoninal reflexes exam?
draw line out from umbilicus:
Up abdom: T7-9
Low abdom: T11-12
Cremaster: T12-L2
Diverticulitis (large bowels) pain (U) seen where?
LLQ
Explosive, excruciating pain in abdomen may mean? (5)
coronary occlusion biliary colic ruptured viscus ruptured aneurysm renal colic
Severe, constant pain may mean? (3)
acute pancreatitis
bowel strangulation
mesenteric thrombosis
Gradual onset, steady pain may mean? (4)
acute cholecystitis
acute appendicitis
diverticulitis
pelvic inflammatory dx (PID)
Intermittent, colicky pain may mean? (2)
early/subacute pancreatitis
mechanical small bowel obstruction
Peritoneal Signs are? (3)
Guarding: rigidity and tenderness of abdom wall when touched
Abdom wall rigidity, generalized
Reboud/contralateral rebound tenderness
Acute appendicitis may have + results for what tests? (5)
1) rebound
2) psoas sign
3) obturator sign
4) rovsing sign
5) rectal exam
Rebound tenderness exam?
over site of tenderness,
press in then suddenly release
classic sign of peritoneal irritiation
Psoas Sign exam?
Hand on pt’s knee, have pt lift against resistance (tenses iliopsoas)
+ result detects appendix inflammation
Obturator Sign exam?
Pt supine, R knee bent
Passive internal rotation of hip (stretches internal obturator)
pain in RLQ = appendix inflamm
Rovsing’s Sign exam?
Referred, rebound pain:
Press LLQ, quickly withdraw
suddend pain in RLQ = append inflamm
Murphy’s Sign exam?
R hand under R costal margin Pt takes deep breath OR L hand flat over liver percuss w/ R fist
+ = gallbladder or liver inflamm
