Abdomen Flashcards
RUQ Organs
liver
gall bladder
duodenum
pancreas head
r kidney and adrenal gland
hepatic flexure
ascending colon
transverse colon
LUQ Organs
liver left lobe
spleen
stomach
pancreas body
l kidney and adrenal gland
splenic flexure
transverse colon
descending colon
RLQ Organs
r kidney
cecum
appendix
ascending colon
r ovary and fallopian tube
r ureter
r spermatic cord
uterus & bladder (IF ENLARGED)
LLQ Organs
left kidney
sigmoid colon
descending colon
l ovary and fallopian tube
l ureter
l spermatic cord
uterus & bladder (IF ENLARGED)
Intraperitoneal Organs
liver, spleen, colon, small intestine
Retroperitoneal Organs
pancreas, kidneys, ureters, aorta, vena cava
Colon Cancer Risks
- >50
- FH- colon CA, adenomtous polyps
- PMH- colon CA, polyps, IBD, ovarian/endometrail CA
- AA
- Jewish, Eastern European
- diet: low fiber, high red meat/processed, low F&V
- obesity
- smoking
- low physical activity
- alcohol
- Type II diabetes
Abdomen PE Order
- inspection
- ascultation
- percussion
- palpation
- always on right side of pt
ecchymosis around umbilicus
(pancreatitis, ectopic pregnancy)
Cullen’s sign
ecchymosis of the flanks
(pancreatitis)
Grey Turner sign
Venous blood flow patterns
- normal
- above naval flows upward
- below naval flows downward
- portal hypertension
- flows in all directions from naval
- Caput Medusae
- inferior vena cava obstruction
- all flow is upward
Abdomen Contours
- flat
- rounded
- scaphoid/concave
weak areas between abdominal areas commonly caused by pregnancy
diastasis recti
9 F’s of Abdominal Distention
- fat
- fluid
- feces
- fetus
- flatus
- fibroids
- full bladder
- false pregnancy
- fatal tumor
bowel sound ranges
- normal: irregular 5-35/min
- Borborygmi: loud, prolonged gurbles- “stomach growling”
- abscent for 5 min- medical emergency
- increased/high-pitched sounds: diarrhea, early obstruction, hunger
decreased sounds: peritonitis, paralytic ileus
auscultation sites
- aoritc artery
- renal arteries
- iliac arteries
- femoral arteries
- bruits
- venous hum- portal HTN
percussion notes
- tympany: air-filled spaces
- hyperresonance: base of left lung
- resonance: lung tissue and sometimes abdomen
- dullness: solid organs
percussion areas
- 4 quadrants
- liver span (6-12cm WNL)
- spleen
- Traube’s space: 6th rib - costal margin
- suspect enlargement if dullness
- kidneys: CVA tenderness
palpation areas
- light to deep in all 4 quadrants
- guarding- voluntary tension
- rigidity- involuntary tension (peritoneal irritation)
- liver edge
- gall bladder
- Murphy sign- pain halts inspiration
- spleen
- Kehr sign- pain radiating to left sholder
- appendix
- McBurney sign- rebound tenderness @ McBurney point
- kidneys
- right more palpable than left
- aorta
- inguinal lymph nodes
- masses:
- location, size, shape, consistency (firm, soft, spongy), tenderness, pulsation, mobility, movement w/ respiration
ascites assessment
- tympany in central abdomen, dullness around border
- fluid wave- tap one side and see fluid wave
- shifting dullness- tympany in center shifts to side when patient turns to side
rebound tenderness
press and let go- pain no release: peritoneal inflammation
Blumberg sign- peritonitis
Kehr sign
abdominal pain from spleen radiating to left shoulder
Murphy sign
deep breath when palpating gall bladder causes pain- cholecystitis
Iliopsoas and Obturator test
iliopsoas- lift straightened leg against resistance
obturator- bent leg abduction
tests for appendix pain
McBurney and Rovsing signs
McBurney- appendix pain
Rovsing: LLQ pushed away from appendix causes RLQ pain
Peritonitis signs
- Ballance- fixed dullness to percussion of left and right flank disappears w/ change in position (splenic rupture)
- Blumburg- rebound tenderness
- Markle- pt standing on toes then heels hit floor, or bed jarred
Epigastric pain
- cholecystitis
- diverticulitis
- intestinal obstruction
- GERD
Generalized abdominal pain
peritonitis
Umbilical pain
- intestinal obstruction
- volvulus (twisting of bowel)
Pelvic pain
- ectopic pregnancy
- PID
- ruptured ovarian cyst
Back and flank pain
- leaking AAA
- renal calculi (radiates to groin/genitals)
