Abdomen Flashcards
Anatomic Divisions, Abdomen
(2 methods)
- 4 Quadrants
- RUQ
- LUQ
- RLQ
- LLQ
- 9 Sections
- Epigastric
- Umbilical
- Hypogastric/suprapubic
- Hypochondriac (L, R)
- Lumbar (L, R)
- Iliac (L, R)
Internal Abdominal Anatomy
Common GI Symptomatic Complaints
(11)
- Heartburn - a burning sensation in the epigastric area radiating into the throat; often asst c regurgitation
- Excess air - gas, flatus, needing to belch or pass gas by the rectum, bloating
- Fullness/early satiety - gastroporesis asst c diabetes
- Anorexia
- Vomit, wretching
-
Quality
- Visceral pn
- Parietal pn
- Referred pn
- Related medical problems
- Hepatitis
- Cirrhosis
- Gallbladder
- Pancreatitis
- Prior abdo surgeries
- Travel/Occupational hazards
-
Substance use
- Tobacco
- Alcohol
- Illegal drugs
- Medications
- Heredity
Regurgitation
Reflux of food and stomach acid into the mouth
Brine-like taste
Visceral Pain
(2 causes, 4 s/sx)
- Causes
- Hollow organ (stomach, colon) forceful contraction/distention
- Solid organs (liver, spleen) swell against capsules
- S/Sx
- gnawing
- cramping
- aching
- difficult to localize
Parietal Pain
(def, asst conditions)
- Def - inflammation from hollow/solid organs that affect parietal peritoneum
- Asst Condition - severe prognosis, easily localized (appendicitis)
Referred Pain
(def, 1 example)
def - originates at different sites but share innervation fro the same spinal level
ex - gallbladder pn in the shoulder
Periumbilical Pn Causes
(3)
- Small Intestine
- Appendix
- Proximal colon
RUQ/Epigastric Pn Causes
(2 organs)
- Liver
- Biliary Tree
Suprapubic/Sacral Pn Cause
(1 organ)
Rectum
Epigastric Pn Causes
(3 organs)
- Stomach
- Duodenum
- Pancreas
Hypogastric Pn Causes
(3 organs)
- Colon (more diffuse)
- Bladder
- Uterus
Pain Description Questions, GI
(9)
- Describe in your own words
- Point with one finger to the area of pn
- Rank severity (1-10)
- What birngs on the pain, timing
- Pain fequency
- Pain duration
- Pain radiation
- Aggrevating/relieving factors
- Associated S/Sx
Bowel Movement Historical Questions
(6)
- Frequency
- Consistency (diarrhea vs constipation)
- Pn c bowel movements
- Blood
- hematochezia - blood in stool
- melena - black, tarry stool
- Stool color
- white/gray may indicate liver/GB disease
- red/purple may indicate beets/dyes
- Associated signs
- jaundice
- icteric sclerae
Urinary Tract History Questions
(8)
- Fequency
- Urgency
- Dysuria - suprapubic pn *bladder cancer until proven otherwise *
- Describe urine
- color
- smell
- Difficulty starting to urinate
- Incontinence
- CVA pain - kidney
- Low back pn - prostate
Abdomen Inspection Components
(5, 6/3/4/0/2 specifics)
- Skin
- scars
- striae (stretch marks)
- venous pattern
- hair distribution
- rashes
- lesions
- Umbilicus
- contour
- location
- signs of umbilical hernia
- Contour
- flat
- rounded
- protuberant
- scaphoid
- Symmetry
- Signs of movement
- peristalsis
- pulsations
Auscultation
(rule, procedure)
Rule: always auscultate before palpating or percussing, only in abdomen
Procedure:
- Place diaphragm over abdomen
- Listen for gurgles
- Move stethescope to multiple places only if sounds are absent
- Listen for two minutes before concluding absent
Vascular Bruit Locations
(3)
- Aorta (midline)
- Renal arteries (above umbilicus off midline)
- Bifurcation of common iliac arteries (below umbilicus, off midline)
Pathologic Liver Sounds
(2, indications)
- Bruit - heptocellular carcinoma or alcoholic hepatitis
- Venous hum: portal hypertension
Abodminal Percussion Procedure
- Percuss over all 4 quadrants
- Tympany (hollow, normal)
- Dullness (large stool or mass)
- Percuss liver
- Lower border
- Start below umbilicus (tympanic)
- Percuss upwards in right MCL or MSL until liver dullness
- Upper border
- Start from lung in MCL or MSL
- Percuss downward to liver dullness
- Measure span
- Male: 8-12 cm
- Female: 6-10 cm
- Lower border
Ascites, Shifting Dullness Eval
(5 steps)
- Determine border of tympany and dullness by percussion in supine position, beginning at the umbilicus and moving laterally (mark the spot c a pen)
- Repeat percussion in the same direction c pt rolled on that same side
- *In the presence of ascites, *tympany-dullness margin will move upward towards umbilicus, as ascitis fluid pools in dependent side of peritoneal cavity
- In absence of ascites, margain remains stationary
Ascites, Fluid Wave Eval
- Position ulnar side of hand in midline of abdomen
- prevents false negative from fat/flatus
- Tap lateral side of abdomen and assess transmission of a wave to contralateral side using other hand
- + = palpable thrill
- = no palpable thrill
Ascites Phys Exam Tests
(2)
- Fluid Wave
- Shifting Dullness
Light Palpation
(4 techniques)
- Start palpating the abdomen using gentle probing c hands
- This reassures and relaxes the patient
- Identify superficial organs/masses
- Assess for voluntary guarding vs involuntary guarding
- voluntary - patient consciously flinches when you touch him
- involuntary - muscles spasm when you touch the pt but he canot control his rxn
- Use relaxation techniques to assess voluntary guarding
- tell pt to breathe out deeply
- tell pt to breathe through outh c jaw dropped open
- distract pediatric pts, play a game c hands
Deep Palpation, General
Deeply palpate in periumbilical area and both lower quadrants.
Look for rebound tenderness - inc pn when examiner dec pressure against abdomen
Liver Palpation Procedure
Average-sized person
- With left hand, support back @ ribs 11 and 12
- With right hand, press abdomen inferior to liver border
- Palpate superiorly until liver is realized
- Ask pt to take deep breath
- Painful in liver/GB disease
- Find inferior liver border
- Diaphragm lowering during inspiration forces liver downward
Obese person - “hooking” technique”
- Place both hands, side by side, on right abdomen below border of liver dullness
- Press in c fingers going up towards costal margin
- Ask pt to take a deep breath
- Liver should be palpable under fingertips of both hands
Spleen Palpation
- Position pt on left side
- Support back c left hand, palpate c right hand
- Have pt inspire
*Note - usually only palpable in the presence of splenomegaly *
Kidney Palpation
Left Kidney
- Place patent on left side
- Position right hand under 12th rib
- Lift up, trying to displace kidney anteriorly
- Position left hand on LUQ
- Ask patient to inhale
- At peak of inspiration, place left hand deeply into upper quadrant trying to “capture” kidney between hands
Right Kidney
- Place patient on right side
- Lift back with left hand
- Position right hand on RUQ
- Repeat procedure for left kidney
Both Kidneys
- Palpate costovertebral angle on each side of back for kidney tenderness
- Palpate over suprapubic area for bladder tenderness
Ascites-Specific Tests/Results
- Inspection: protuberant abdomen c bulging flanks
- Percussion: lateral dullness c anterior tympany (fluid accum pattern)
-
Special Tests:
- Shifting dullness
- Fluid wave
Appendicitis-Specific Tests/Results
- Palpation: involuntary guarding and rebound tenderness in RLQ during LLQ palpation (Rovsing’s Sign)
-
Special Tests:
- Rectal exam in both sexes, pelvic exam in females (or at least offer it)
- Psoas Sign - supine pain when pt flexes thigh against examiner’s hand
- Obturator Sign - pain with passive internal (and external) leg rotation c flexed up
Rovsing’s Sign
(description, possible pathology)
Description: RLQ pn on LLQ palpation
Pathology: Appendicitis
McBurney’s Sign
(Description, Possible Pathology)
Description: tenderness @ McBurney’s point (1/3 along line extending from ASIS to umbilicus)
Pathology: Appendicitis
Rebound Tenderness
(Description, Possible Pathology)
Description: Pn on quick withdrawal of palpation. Check for peritonitis before asssessing rebound tenderness by asking pt to cough or lightly jar bed; if this reproduces abdo pn then there is no need to maximize pn by demonstrating rebound tenderness
Pathology: peritonitis
Murphy’s Sign
(Description, Possible Pathology)
Description: Arrest of deep inspiration on RUQ palpation (hand contact c gallbladder ellicits pn)
Pathology: Cholecystitis
Courvoisier’s Sign
(description, possible pathology)
Description: Painless, palpable distended gallbladder
Pathology: Pancreatic cancer
Cullen’s Sign
(description, pathology)
Description: Blue discooration of periumbilical area caused by retroperitoneal hemorrhage tracking around anterior abdominal wall
Pathology:
- Acute hemorrhagic pancreatitis
- Ectopic pregnancy
Grey-Turner’s Sign
(description, possibl pathology)
Description: Blue discoloration of flank caused by retroperitoneal hemorrhage
Pathology:
- Acute hemorrhagic pancreatitis
- Ruptured abdominal aortic aneurysm
- Strangulated bowel
Kehr’s Sign
(description, possible pathology)
Description: left shoulder pn exacebated by elevating foot of bed (referred pn; diaphragmatic involvement)
Pathology: splenic rupture
Psoas Test
(description, pathology)
Description: pn on flexion of hip against resistance
Pathology:
- Appendicitis
- Psoas inflammation (ex - retroperitoneal abscess)
Obturator Test
(Description, Possible Pathology)
Description: Pn c 90 degree hip and knee flxn, gently rotate hip; first internally then externally
Pathology:
- Pelvic appendicitis
- Diverticulitis
- PID
- Other cuases of inflammation in obturator internus region
Positive Carnett’s Sign
(Description, Possible Pathology)
Description: Abdominal pn/tenderness exacerbated when pt lifts feet above bed without bending knees
Pathology: Abdominal wall pn (sprain/strain/hernia) because stretching abdo wall worsens any intra-muscular lesion
Negative Carnett’s Sign
(Description, Pathology)
Description: Abdominal wall pn/tenderness alleviated when pt lifts feet above bed without bending knees
Pathology: Source of pn is inside abdominal cavity because stabalizing abdo wall protects organs within
