Abdomen Flashcards
What’s in the RUQ?
right lobe of liver, gallbladder, duodenum, head of pancreas, right adrenal gland, right kidney, superior part of ascending colon, right of transverse colon
What’s in the RLQ?
cecum, appendix, most of ileum, inferior part of right uterine tube, right ovary, ascending colon, right ureter, right spermatic cord
What’s in the LUQ?
left lobe of liver, spleen, most of stomach, jejunum and proximal ileum, body and tail of pancreas, left adrenal gland, left kidney, superior part of descending colon, left half transverse colon
What’s in the LLQ?
sigmoid colon, inferior part of descending colon, left ovary, left uterine tube, left ureter, left spermatic cord
What’s the top quadrants?
hypochondriac (R&L) with epigastric in the middle
What are the middle quadrants?
lumbars (R&L) and umbilical
What are the bottom quadrants?
iliacs (R&L), with hypogastric in the middle
Where does the colon travel between?
peritoneal space and retroperitoneum
What are retroperitoneal structures?
SAD PUCKER
Suprarenal (adrenal glands)
Aorta/IVC
Duodenum
Pancreas (except tail)
Ureters
Colon (ascending and descending)
Kidneys
Esophagus
Rectum
What area should you save for last in the exam?
area of complaint
What is visceral pain?
pain when hollow organs contract forcefully, distended/stretched, become ischemic, pain is also present when solid organs are stretched, but often difficult to localize
What is parietal pain?
originating from inflammation in the parietal peritoneum, usually more severe and precisely localized, aggravated by movement
What is referred pain (nociception)?
felt more at distant sites innervated by the same spinal levels at the disordered structures
What are alarm symptoms?
dysphagia, odynophagia, recurrent emesis, GI bleeding, early satiety, weight loss, anemia, palpable mass, jaundice
What is pain that migrates from the periumbilical region combined with N/V and loss of appetite?
appendicitis
What should you consider in women with abdominal pain?
PID, ruptured ovarian follicle, ectopic pregnancy
What could cramping pain radiating to the flank or groin be?
renal stone
What is fever, loss of appetite, and diarrhea with constipation?
diverticulitis
What is diffuse abdominal pain with absent bowel sounds and firmness, guarding, or rebound?
bowel obstruction
What is severe diffuse abdominal pain with guarding and rigidity?
peritonitis
What is obstipation?
no passage of gas or feces
What is melena?
black tarry stools
What is hematochezia?
red or maroon colored stools
What is flatus?
passing excessive gas
why does jaundice occur?
increased production of bilirubin or decreaed uptake, decreased liver ability
What should you ask with patients with jaundice?
color of urine, color of stool (bile obstruction/impaired GI tract), itching, painless, or painful
What are risk factors for liver disease?
hepatitis, alcoholic hepatitis or cirhosis, toxic liver damage, gallbladder disease, hereditary disorders
What are men-based urinary questions?
straining, force/caliber, dribbling, hesitancy
Where is flank pain?
at the costovertebral angle and associated with kidney pain and dull,aching and steady
What is uretral colic?
severe originating at angle and radiating to upper thigh due to sudden distension of uereter and with fever, chills , hematuria
What’s the order of abdominal examination?
inspect, auscultate, percuss, palpate
What are you inspecting in the abdomen?
surface, contours, movement, bulges, skin, peristalsis (skinny), pulsations (normal or from abdominal aortic aneurism)
How do you auscultate?
listen for BRUITS, clicks and gurgles, borborygmi (growling)
Where can you hear friction rubs?
liver and spleen
What do you percuss?
liver, costal margins, four quadrants, spleen
What’s important in palpation?
finding tenderness or guarding, rigidity, masses. light and deep pressures
What can help make the diagnosis?
cough test (identify pain, then palpate)
guarding (reflex contraction)
rigidity (involuntary reflex contraction)
rebound tenderness
What should you always observe while palpating?
the face
What’s a normal liver span?
6-12cm. Can find this percussing up umbilical and down from nipple or above nipple line
How do you feel the liver?
Place hands low below rib’s edge and ask patient to breathe in
What is the hooking technique?
preferred if patient is obese, partially curl you fingers and ask patient to take a deep breath
What is Traube’s Space percussion?
medial to lateral and should be resonant throughout
What is a splenic percussion sign?
start percussion at anterior axillary line and ask patient to take a deep breath, if it remains, normal. Dull, is palpation
How can you feel the spleen better?
patient rolling on right lateral decubitus, moving spleen forward, feeling on right side of abdomen
What else should you palpate?
bladder, aorta (sides of umbilicus) >50 yrs
how do you assess ascites?
percussion - looking for central tympany surrounded by dullness (moon-like circle)
shifting dullness and marking with moving patient, fluid wave (tap one flank sharply and feel for a wave; this implies ascites)
What indicates appendicitis?
guarding, Rosving’s sign, psoas sign, McBurney’s point tenderness, localized pain in RLQ
What is Rosving’s sign?
palpating opposite side in same spot with pain surfacing in RLQ
What is the psoas sign?
moving leg back elicits pain
What is obturator sign?
flex pts right thigh at hip
What is Murphy’s sign?
suspicious for acute cholecystitis, hook your left thumb under costal margin of right rectus muscle and have patient take a deep breath palpate, if there is pain, positive
What visceral manifestation causes central-right upper quadrant epigastric pain?
biliary tree and liver
What visceral manifestation causes central epigastric pain?
stomach, duodenum, pancreas
What visceral manifestation causes periumbilical pain?
small intestine, appendix, proximal colon
What visceral manifestation causes subrapubic pain?
colon, bladder, uterus, sacral pain from rectum
When patients report acute pain in the LLQ, what should you investigate?
fever and loss of appetite
When patients report chronic pain in the quadrants of the lower abdomen, what should you ask?
about bowel habit change and diarrhea/constipation
What’s the difference between radiation of kidney pain and ureteral pain?
Ureteral pain extends entirely down to the groin whereas the kidney just wraps around to the hypochondriac region
