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Clin Skills > Abdomen > Flashcards

Abdomen Flashcards

1
Q

What’s in the RUQ?

A

right lobe of liver, gallbladder, duodenum, head of pancreas, right adrenal gland, right kidney, superior part of ascending colon, right of transverse colon

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2
Q

What’s in the RLQ?

A

cecum, appendix, most of ileum, inferior part of right uterine tube, right ovary, ascending colon, right ureter, right spermatic cord

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3
Q

What’s in the LUQ?

A

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

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4
Q

What’s in the LLQ?

A

sigmoid colon, inferior part of descending colon, left ovary, left uterine tube, left ureter, left spermatic cord

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5
Q

What’s the top quadrants?

A

hypochondriac (R&L) with epigastric in the middle

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6
Q

What are the middle quadrants?

A

lumbars (R&L) and umbilical

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7
Q

What are the bottom quadrants?

A

iliacs (R&L), with hypogastric in the middle

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8
Q

Where does the colon travel between?

A

peritoneal space and retroperitoneum

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9
Q

What are retroperitoneal structures?

A

SAD PUCKER
Suprarenal (adrenal glands)
Aorta/IVC
Duodenum
Pancreas (except tail)
Ureters
Colon (ascending and descending)
Kidneys
Esophagus
Rectum

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10
Q

What area should you save for last in the exam?

A

area of complaint

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11
Q

What is visceral pain?

A

pain when hollow organs contract forcefully, distended/stretched, become ischemic, pain is also present when solid organs are stretched, but often difficult to localize

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12
Q

What is parietal pain?

A

originating from inflammation in the parietal peritoneum, usually more severe and precisely localized, aggravated by movement

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13
Q

What is referred pain (nociception)?

A

felt more at distant sites innervated by the same spinal levels at the disordered structures

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14
Q

What are alarm symptoms?

A

dysphagia, odynophagia, recurrent emesis, GI bleeding, early satiety, weight loss, anemia, palpable mass, jaundice

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15
Q

What is pain that migrates from the periumbilical region combined with N/V and loss of appetite?

A

appendicitis

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16
Q

What should you consider in women with abdominal pain?

A

PID, ruptured ovarian follicle, ectopic pregnancy

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17
Q

What could cramping pain radiating to the flank or groin be?

A

renal stone

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18
Q

What is fever, loss of appetite, and diarrhea with constipation?

A

diverticulitis

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19
Q

What is diffuse abdominal pain with absent bowel sounds and firmness, guarding, or rebound?

A

bowel obstruction

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20
Q

What is severe diffuse abdominal pain with guarding and rigidity?

A

peritonitis

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21
Q

What is obstipation?

A

no passage of gas or feces

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22
Q

What is melena?

A

black tarry stools

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23
Q

What is hematochezia?

A

red or maroon colored stools

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24
Q

What is flatus?

A

passing excessive gas

25
Q

why does jaundice occur?

A

increased production of bilirubin or decreaed uptake, decreased liver ability

26
Q

What should you ask with patients with jaundice?

A

color of urine, color of stool (bile obstruction/impaired GI tract), itching, painless, or painful

27
Q

What are risk factors for liver disease?

A

hepatitis, alcoholic hepatitis or cirhosis, toxic liver damage, gallbladder disease, hereditary disorders

28
Q

What are men-based urinary questions?

A

straining, force/caliber, dribbling, hesitancy

29
Q

Where is flank pain?

A

at the costovertebral angle and associated with kidney pain and dull,aching and steady

30
Q

What is uretral colic?

A

severe originating at angle and radiating to upper thigh due to sudden distension of uereter and with fever, chills , hematuria

31
Q

What’s the order of abdominal examination?

A

inspect, auscultate, percuss, palpate

32
Q

What are you inspecting in the abdomen?

A

surface, contours, movement, bulges, skin, peristalsis (skinny), pulsations (normal or from abdominal aortic aneurism)

33
Q

How do you auscultate?

A

listen for BRUITS, clicks and gurgles, borborygmi (growling)

34
Q

Where can you hear friction rubs?

A

liver and spleen

35
Q

What do you percuss?

A

liver, costal margins, four quadrants, spleen

36
Q

What’s important in palpation?

A

finding tenderness or guarding, rigidity, masses. light and deep pressures

37
Q

What can help make the diagnosis?

A

cough test (identify pain, then palpate)
guarding (reflex contraction)
rigidity (involuntary reflex contraction)
rebound tenderness

38
Q

What should you always observe while palpating?

A

the face

39
Q

What’s a normal liver span?

A

6-12cm. Can find this percussing up umbilical and down from nipple or above nipple line

40
Q

How do you feel the liver?

A

Place hands low below rib’s edge and ask patient to breathe in

41
Q

What is the hooking technique?

A

preferred if patient is obese, partially curl you fingers and ask patient to take a deep breath

42
Q

What is Traube’s Space percussion?

A

medial to lateral and should be resonant throughout

43
Q

What is a splenic percussion sign?

A

start percussion at anterior axillary line and ask patient to take a deep breath, if it remains, normal. Dull, is palpation

44
Q

How can you feel the spleen better?

A

patient rolling on right lateral decubitus, moving spleen forward, feeling on right side of abdomen

45
Q

What else should you palpate?

A

bladder, aorta (sides of umbilicus) >50 yrs

46
Q

how do you assess ascites?

A

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)

47
Q

What indicates appendicitis?

A

guarding, Rosving’s sign, psoas sign, McBurney’s point tenderness, localized pain in RLQ

48
Q

What is Rosving’s sign?

A

palpating opposite side in same spot with pain surfacing in RLQ

49
Q

What is the psoas sign?

A

moving leg back elicits pain

50
Q

What is obturator sign?

A

flex pts right thigh at hip

51
Q

What is Murphy’s sign?

A

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

52
Q

What visceral manifestation causes central-right upper quadrant epigastric pain?

A

biliary tree and liver

53
Q

What visceral manifestation causes central epigastric pain?

A

stomach, duodenum, pancreas

54
Q

What visceral manifestation causes periumbilical pain?

A

small intestine, appendix, proximal colon

55
Q

What visceral manifestation causes subrapubic pain?

A

colon, bladder, uterus, sacral pain from rectum

56
Q

When patients report acute pain in the LLQ, what should you investigate?

A

fever and loss of appetite

57
Q

When patients report chronic pain in the quadrants of the lower abdomen, what should you ask?

A

about bowel habit change and diarrhea/constipation

58
Q

What’s the difference between radiation of kidney pain and ureteral pain?

A

Ureteral pain extends entirely down to the groin whereas the kidney just wraps around to the hypochondriac region

Clin Skills (9 decks)

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