Abdomen

Question 1

Order of Abdominal Exam

Answer 1

Look
Listen
Percuss
Palpate

Question 2

Prior to exam, ask patient

Answer 2

Any area of pain/tenderness

Examine these areas last

Question 3

Cause of striae

Answer 3

Previous significant weight loss

Question 4

Cause of abdominal pulsations

Answer 4

Aortic pulse

Question 5

Where to listen for bowel sounds.

Answer 5

R Lower Quadrant

hear it once

Question 6

What CV sounds should you listen for in abdominal exam?

Answer 6

Bruits in aortic artery
Renal arteries bilaterally
Illiac arteries bilaterally

Question 7

When auscultating the gut, High pitched tinkling is

Answer 7

Intestinal Fluid

Question 8

When auscultating the gut, systolic, low pitched abdominal bruit is…

Answer 8

normal in people under 40

Usually from the celiac artery

Question 9

Difference between where you percuss and where you listen

Answer 9

Purcuss all 4 quadrants and feel for specifics

Question 10

Begin percussing the liver at the…

Then what?

Answer 10

Midclavicular Line btw lower right chest and umbilicus
Repeat superiorly and proceed inferiorly
Note liver boundaries.

Question 11

How big should the liver span be (on percussion)?

Answer 11

6-12 cm span

Question 12

When percussing the liver, dull sounds mean_____.

Tympanitic sounds mean…

Answer 12

Dull – Liver (or sometimes losts of fluid or feces

Tympanitic – Gas bubble (lost with position change) or bowel gas

Question 13

What percussion technique is typically considered unreliable, but maybe worthwhile if you get really good at it

Answer 13

Bladder volume percussion

Question 14

Before palpation, ask the patient…

Answer 14

If there is anywhere that hurts

Start away from pain and work toward it

Question 15

Describe the light palpation technique

Answer 15

Use palmar surface of fingers to identify any masses or areas of tenderness by lightly palpating all four quadrants and the epigastrum

Question 16

Describe the deep palpation technique

Answer 16

One hand over the other
Press down with top hand, feel for abdominal contents with bottom hand
Hit all 4 Qs

Question 17

How to feel the liver

Answer 17

L Hand below lower R rib cage, gently press upward
R Hand on the L R quadrant of abdomen, gently press inward
Ask patient to take a deep breath when you press up to feel liver edge

Question 18

What should you note upon feeling the liver

Answer 18

Distance from right costal margin

Quality of liver (hard, nodular, tenderness, masses)

Question 19

Normal liver extends approximately _____

Answer 19

3 cm

Question 20

How to palpate a spleen

Answer 20

Turn patient on R side + flex hips and knees
L hand below patients lower L rib cage + press up
R hand goes below L costal margin

Question 21

Normal findings of spleen palpation

Answer 21

None - Generally not palpable

Question 22

Which kidney is easier to palpate

Answer 22

R

Question 23

Where do you press to assess kidney damage?

Answer 23

Percuss/Palpate the costovertebral angle on the posterior chest

Question 24

Grading the Aortic Pulse…

Answer 24

3+ = bounding
2+ = Brisk, Expected
1+ = Diminished, Weaker than expected
0 = Absent, Unable to palpate

Question 25

Normal aorta size?

Answer 25

Less than or equal to 3 cm

Question 26

Reasons for visible abdominal deformity...Distension

Answer 26

Ascites

Question 27

Reasons for visible abdominal deformity...bulging/asymmetry

Answer 27

Hernia, Inflammation, Tumor

Question 28

Reasons for visible abdominal deformity...hepatomegaly

Answer 28

Liver Disease

Question 29

Reasons for visible abdominal deformity...splenomegaly

Answer 29

Infection, Hematologic Disorder

Question 30

Reason for visible peristaltic waves on examination

Answer 30

GI Obstruction

Question 31

How to evaluate likelihood of peritonitis

Answer 31

Ask patient to do a slight sit up on the table | If painful, probably not peritonitis

Question 32

Reasons for lower adbominal tenderness on palpation

Answer 32

Salphingitis

Question 33

Reasons for masses on palpation

Answer 33

Tumor | Distnded Viscus

Question 34

Reason for LLQ pain

Answer 34

Diverticulitis

Question 35

Reason LLQ palpation to cause RLQ pain | Name this test

Answer 35

Appendicitis | Rovsing's Sign

Question 36

Why are people not excited abotu Rovsing's sign?

Answer 36

Unnecessary and cruel | Pain while barely ever adding anything new to the evidence already available

Question 37

RLQ tenderness/rigidity/guarding

Answer 37

Appendicitis

Question 38

Pain from rotating right leg internally at hip (stretching the obturator)

Answer 38

Appendicitis | Obturator Sign

Question 39

Pain from raiding light leg against resistant and then extending at hip lying on left side

Answer 39

Appendicitis | Psoas Sign

Question 40

Describe symptoms of Cholecystitis

Answer 40

Fever, Nausea, Vomiting Murphy's Sign (the patient suddenly ceases inspiration as the gallbladder is pushed down by the diaphragm against the examiners hand)

Question 41

Firm edge of liver indicates...

Answer 41

Cirrhosis

Question 42

Tenderness of the RUQ may mean...

Answer 42

Hepatitis CHF Tumor

Question 43

Palpable gallbladder is called...

Answer 43

Courvoisier's Sign

Question 44

Reasons for Courvosier's Sign?

Answer 44

Obstructive Jaundice, Gallstone, Malignant Obstruction

Question 45

Reasons for epigastric pain?

Answer 45

Pancreatitis GERD/PUD Acute Pleurisy Cholecystitis

Question 46

Reasons for a wide aorta?

Answer 46

Abdominal aortic aneurysm

Question 47

Reasons to suspect an aortic aneurysm?

Answer 47

Wide aorta Expansile pulse that pushes apart hands Patient over 50

Question 48

Reasons for enlarged kidneys

Answer 48

Cysts, Cancer, Hydronephrosis

Question 49

Reasons for tender kidneys

Answer 49

Infection (pyelonephritis)

Question 50

Reasons for back tenderness

Answer 50

Renal disease | Pancreatitis

Question 51

Causes of splenomegaly

Answer 51

``` Infection (Mono, HIV) Hematologic Disorders Portal Hypertension Splenic Infarct Lymphoma ```

Question 52

Two ways to assess ascites

Answer 52

Shifting dullness | Fluid Wave

Question 53

Reasons for increased bowel sounds

Answer 53

Diarrhea | Early Intestinal Obstruction

Question 54

Indications for a small bowel obstruction

Answer 54

Increased Sounds Visible Peristalisis May lose bowel sounds entirely if completely obstructed for over 30

Question 55

Reasons for diminished/absent bowel sounds

Answer 55

Adynamic ileus | Peritonitis

Question 56

Reasons for high pitched tinkling

Answer 56

From dilated bowel with air under tension

Question 57

Reasons for high pitched rushing

Answer 57

Intestinal obstruction

Question 58

LUQ bruits mean...

Answer 58

Pancreatic Carcinoma | Renal artery aneurysm

Question 59

Systolic or continuous, harsh RUQ/epigastric bruits mean...

Answer 59

Carcinoma of the liver

Question 60

Auscultion of abdominal friction rub is an indication of...

Answer 60

Hepatic Tumor | Splenic Infarct