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Physical Diagnosis > Abdomen > Flashcards

Abdomen Flashcards

1
Q

Order of Abdominal Exam

A

Look
Listen
Percuss
Palpate

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2
Q

Prior to exam, ask patient

A

Any area of pain/tenderness

Examine these areas last

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3
Q

Cause of striae

A

Previous significant weight loss

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4
Q

Cause of abdominal pulsations

A

Aortic pulse

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5
Q

Where to listen for bowel sounds.

A

R Lower Quadrant

hear it once

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6
Q

What CV sounds should you listen for in abdominal exam?

A

Bruits in aortic artery
Renal arteries bilaterally
Illiac arteries bilaterally

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7
Q

When auscultating the gut, High pitched tinkling is

A

Intestinal Fluid

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8
Q

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

A

normal in people under 40

Usually from the celiac artery

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9
Q

Difference between where you percuss and where you listen

A

Purcuss all 4 quadrants and feel for specifics

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10
Q

Begin percussing the liver at the…

Then what?

A

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

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11
Q

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

A

6-12 cm span

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12
Q

When percussing the liver, dull sounds mean_____.

Tympanitic sounds mean…

A

Dull – Liver (or sometimes losts of fluid or feces

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

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13
Q

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

A

Bladder volume percussion

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14
Q

Before palpation, ask the patient…

A

If there is anywhere that hurts

Start away from pain and work toward it

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15
Q

Describe the light palpation technique

A

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

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16
Q

Describe the deep palpation technique

A

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

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17
Q

How to feel the liver

A

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

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18
Q

What should you note upon feeling the liver

A

Distance from right costal margin

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

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19
Q

Normal liver extends approximately _____

A

3 cm

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20
Q

How to palpate a spleen

A

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

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21
Q

Normal findings of spleen palpation

A

None - Generally not palpable

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22
Q

Which kidney is easier to palpate

A

R

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23
Q

Where do you press to assess kidney damage?

A

Percuss/Palpate the costovertebral angle on the posterior chest

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24
Q

Grading the Aortic Pulse…

A 
3+ = bounding
2+ = Brisk, Expected
1+ = Diminished, Weaker than expected
0 = Absent, Unable to palpate
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25
Q

Normal aorta size?

A

Less than or equal to 3 cm

26
Q

Reasons for visible abdominal deformity…Distension

A

Ascites

27
Q

Reasons for visible abdominal deformity…bulging/asymmetry

A

Hernia, Inflammation, Tumor

28
Q

Reasons for visible abdominal deformity…hepatomegaly

A

Liver Disease

29
Q

Reasons for visible abdominal deformity…splenomegaly

A

Infection, Hematologic Disorder

30
Q

Reason for visible peristaltic waves on examination

A

GI Obstruction

31
Q

How to evaluate likelihood of peritonitis

A

Ask patient to do a slight sit up on the table

If painful, probably not peritonitis

32
Q

Reasons for lower adbominal tenderness on palpation

A

Salphingitis

33
Q

Reasons for masses on palpation

A

Tumor

Distnded Viscus

34
Q

Reason for LLQ pain

A

Diverticulitis

35
Q

Reason LLQ palpation to cause RLQ pain

Name this test

A

Appendicitis

Rovsing’s Sign

36
Q

Why are people not excited abotu Rovsing’s sign?

A

Unnecessary and cruel

Pain while barely ever adding anything new to the evidence already available

37
Q

RLQ tenderness/rigidity/guarding

A

Appendicitis

38
Q

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

A

Appendicitis

Obturator Sign

39
Q

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

A

Appendicitis

Psoas Sign

40
Q

Describe symptoms of Cholecystitis

A

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

41
Q

Firm edge of liver indicates…

A

Cirrhosis

42
Q

Tenderness of the RUQ may mean…

A

Hepatitis
CHF
Tumor

43
Q

Palpable gallbladder is called…

A

Courvoisier’s Sign

44
Q

Reasons for Courvosier’s Sign?

A

Obstructive Jaundice, Gallstone, Malignant Obstruction

45
Q

Reasons for epigastric pain?

A

Pancreatitis
GERD/PUD
Acute Pleurisy
Cholecystitis

46
Q

Reasons for a wide aorta?

A

Abdominal aortic aneurysm

47
Q

Reasons to suspect an aortic aneurysm?

A

Wide aorta
Expansile pulse that pushes apart hands
Patient over 50

48
Q

Reasons for enlarged kidneys

A

Cysts, Cancer, Hydronephrosis

49
Q

Reasons for tender kidneys

A

Infection (pyelonephritis)

50
Q

Reasons for back tenderness

A

Renal disease

Pancreatitis

51
Q

Causes of splenomegaly

A 
Infection (Mono, HIV)
Hematologic Disorders
Portal Hypertension
Splenic Infarct
Lymphoma
52
Q

Two ways to assess ascites

A

Shifting dullness

Fluid Wave

53
Q

Reasons for increased bowel sounds

A

Diarrhea

Early Intestinal Obstruction

54
Q

Indications for a small bowel obstruction

A

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

55
Q

Reasons for diminished/absent bowel sounds

A

Adynamic ileus

Peritonitis

56
Q

Reasons for high pitched tinkling

A

From dilated bowel with air under tension

57
Q

Reasons for high pitched rushing

A

Intestinal obstruction

58
Q

LUQ bruits mean…

A

Pancreatic Carcinoma

Renal artery aneurysm

59
Q

Systolic or continuous, harsh RUQ/epigastric bruits mean…

A

Carcinoma of the liver

60
Q

Auscultion of abdominal friction rub is an indication of…

A

Hepatic Tumor

Splenic Infarct

Physical Diagnosis (2 decks)

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