Abdomen Flashcards
Name and describe the location of the abdominal regions
What conditions does each abdominal region correlate with?
The right upper quadrant includes what anatomical features?
- Liver
- Gallbladder
- Duodenum
- Head of pancreas
- R) kidney
- R) adrenal
- Hepatic flexure of colon
- Parts of ascending and transverse colon
The left upper quadrant includes what anatomical features?
- Stomach
- Spleen
- L) liver lobe
- Body of pancreas
- L) kidney
- L) adrenal gland
- Splenic flexure of colon
- Part of transverse and descending colon
The right lower quadrant includes what anatomical features?
- Caecum
- Appendix
- R) ovary
- R) fallopian tube
- R) ureter
- R) spermatic chord
The left lower quadrant includes what anatomical features?
- Part of descending colon
- Sigmoid colon
- L) ovary
- L) fallopian tube
- L) ureter
- L) spermatic chord
What are the four techniques that form the bases of abdominal examination?
- Inspection
- Palpation
- Percussion
- Auscultation
What should be noted when visualising the abdomen?
*What are you looking for?*
- Masses
- Scars
- Lesions
- Distension
- Ascites
- Herniation
- Stretch marks
- Jaundice
True or false: when palpating the abdomen, palpate deeply first in the area of complaint to determine primary concern, then palpate lightly to feel subcutaneous emphysema/crepitus/irregularities etc.
What are some signs to note when palpating the abdomen?
- Palpable mass
- Pulsatile mass
- Textures
- Fluid
- Temperature
- Guarding (controlled by pt)
- Tenderness
- Softness
- Rigidity (not controlled by pt)
What use is percussion in abdo examination?
Determines whether air or fluid is present in tissues
What are the five sounds produced by abdo percussion and their meanings?
- Flatness - bone or muscle
- Dullness - heart, liver, spleen
- Resonance - air-filled lungs (hollow)
- Hyperresonance - emphysematous lung (hyperinflated)
- Tympany - air-filled stomach (drumlike)
What qualities of sound are you listening for with abdo auscultation?
- Pitch
- Intensity
- Duration
- Quality
Describe visceral pain, its causes and some common accompanying symptoms
- Usually diffuse and difficult to localise
- Results from activation of nociceptors of the thoracic/pelvic/abdo viscera (organs)
- These organs are highly sensitive to distention (stretch), ischaemia, and inflammation
- Can be accompanied by associated symptoms, VSS changes, and emotional distress
Describe somatic pain
- Generally sharp, stabbing pain that is well localised
- Comes from the parietal peritoneum which is innervated by somatic nerves
- These nerves respond to irritation from infectious, chemical, or other inflammatory processes
What is referred pain?
Pain perceived distant from its source
Describe sudden, rapid, and gradual pain onset and give an example of each.
- Sudden onset is progression to full pain in seconds and includes PE and AMI
- Rapid onset is progression from initial sensation to full pain over minutes or hours, such as acute pancreatitis and nephrolithiasis
- Gradual onset takes hours to progress to full pain and includes appendicitis and cystitis
Which pt group commonly experiences epigastric pain referred from AMI?
Middle-aged women
Describe the regions and sources of referred pain
What is Cullen’s sign and what is it associated with?
Bluish periumbilical discolouration; retroperitoneal haemorrhage
What is Kehr’s sign and what is it associated with?
L) shoulder pain; splenic or ectopic pregnancy rupture
What is McBurney’s sign and what is it associated with?
Tenderness located 2/3 the distance from the anterior iliac spine to the umbillicus on the R); appendicitis
What is Murphy’s sign and what is it associated with?
Abrupt interruption of inspiration on palpation of RUQ; acute cholecystitis
What is Iliopsoas’s sign and what is it associated with?
Hyperextension of the R) hip causing abdo pain; appendicitis
What is Obturator’s sign and what is it associated with?
Internal rotation of flexed R) hip causing abdo pain; appendicitis
What is Grey-Turner’s sign and what is it associated with?
Discolouration of the flank; retroperitoneal haemorrhage
What is Chandler’s sign and what is it associated with?
Manipulation of cervix causes pt to lift buttocks (when supine); pelvic inflammatory disease
What is Rovsing’s sign and what is it associated with?
RLQ pain on palpation of LLQ; appendicitis
What symptoms correlate with acute abdomen conditions?
- N+V+D
- Anorexia
- Constipation
- Stool changes
- Fevers
- Distension
True or false: opioids should not be used for pain relief in acute abdomen as it can conceal significant symptoms
False - actually aids dx by facilitating physical examination and relaxing abdo musculature
What is dysphagia?
- Difficulty swallowing
- Commonly occuring in elderly pts but possible at any age
- May present with odynophagia (pain on swallowing)
What is gastroenteritis and what is it characterised by?
An acute viral infectious syndrome of the stomach lining and intestine that is characterised by N+V+D, abdo cramps, fever, and chills
What is the WHO definition of gastroenteritis?
Three or more abnormally loose or fluid stools over 24 hours
Who are at greater risk of contracting gastroenteritis?
- Children
- Elderly
- Immunosuppressed
- Those attending large gatherings
True or false: gastroenteritis is usually benign and self-limiting
Describe the mx of gastroenteritis
Anti-emetic (ondansetron), replace fluid and electrolyte losses
What is a hernia?
Protrusion of organs or fatty tissue through a weakened spot in a surrounding muscle or fascia (connective tissue)
Name and describe the five types of hernia
- Inguinal - most common; occurs in area where skin of thigh meets the groin; can be direct or indirect
- Femoral - abdo contents protrude through the femoral canal
- Umbilical - part of the small intestine passes through the abdo wall near the naval
- Incisional - intestine pushes through the abdo wall at a previous surgical site
- Hiatus - occurs when the upper stomach squeezes through the hiatus of the diaphragm
What is haematemesis?
Vomiting bright red blood with or without clots in significant quantity (not just flecks or streaks)
Describe ascites/hydroperitineum
Accumulation of ascetic (protein-containing) fluid within the abdomen that represents a state of total body sodium and water excess, mostly occuring as a result of portal hypertension in the setting of liver cirrhosis (the rest due to infective, inflammatory, and infiltrative conditions)
Describe bowel (intestinal) obstruction
Blockage that keeps food or liquid from passing through; without rx the blocked parts can die, leading to serious issues including tissue death, intestinal wall perforation and infection (peritonitis)
What are some possible causes of bowel obstruction?
- Intestinal adhesions
- Intussusception (telescope effect; most common cause of blockage in children)
- Colon cancer
- Hernias
- Inflammatory bowel disease
- Diverticulitis
- Volvulus (twisting of the colon)
- Impacted faeces
What is intestinal pseudo-obstruction (paralytic ileus)?
Signs and symptoms of intestinal obstruction without a physical blockage
What are the signs of bowel obstruction?
- Cramping abdo pain that comes and goes
- Appetite loss
- Constipation
- N+V
- Note: vomiting faecal matter indicates the blockage has been there for considerable time and may have perforated
- Inability to defecate or pass gas
- Abdo swelling
Biliary (gallbladder) disease encompasses a variety of disorders caused by abnormalities in what three things?
- Bile composition
- Biliary anatomy
- Biliary function
True or false: the chemical composition of bile is determined by the stomach then modified by the gallbladder.
False - the chemical composition of bile is determined by the liver, and this can be later modified by the gallbladder and biliary epithelium
What is choledocholithiasis?
Presence of a gallstone in the common bile duct; it is the most common cause of extra-hepatic biliary obstruction
What is primary sclerosing cholangitis?
A disease of unknown aetiology characterised by an irregular inflammatory fibrosis of both the intra-hepatic and extra-hepatic bile ducts
What is cholecystitis?
Inflammation of the gallbladder, commonly accompanied by biliary colic (pain) and usually caused by cholelithiasis (gallstone)
Describe some biliary tract diseases in general terms
- Cholecyctitis - gallbladder inflammation
- Cholelithiasis - gallstones
- Chronic acalculous gallbladder disease - natural movements needed to empty the gallbladder don’t work well
- Abscesses or gangrene
- Polyps (growths of tissue) in the gallbladder
- Congenital gallbladder defects
- Gallbladder and bile duct tumours
Cholelithiasis typically form from ____ or ____.
Cholesterol or bilirubin
What causes cholelithiasis?
Bile contains too much cholesterol and not enough bile salts
Stones formed of calcium bilirubinate are usually associated with ____ ____.
Biliary infection
True or false: most people with gallstones never have symptoms
People with cholelithiasis symptoms typically report…
- Pain lasting longer than 5 hours
- Fever
- Jaundice
- N+V
What are the risk factors for cholelithiasis?
- Contraception medication
- Pregnancy
- Family hx
- Obesity
- Diabetes
- Liver disease
- Rapid weight loss
What are the signs and symptoms of cholecystitis?
- Severe pain in R) upper abdomen
- Pain radiating to R) shoulder or back
- Abdo tenderness on palpation
- N+V
- Fever
- Note that signs and symptoms often occur after meals, particularly those that are large or high in fat
What is pancreatitis?
Inflammation of the pancreas with associated escape of the pancreatic enzyme into surrounding tissues; can be mild acute, severe acute, or chronic; most are caused by cholelithiasis and EtOH abuse
Describe the pathophysiology of acute pancreatitis
- Exact initial event is unknown but primary cause seems to be escape of pancreatic enzymes into surrounding tissue due to compromised pancreatic function
- Compromised pancreatic function causes trypsin inhibitor to accumulate and activates the secretions that escape into surrounding tissue, causing inflammation
What are the symptoms of acute pancreatitis?
- Severe epigastric pain (may radiate to back)
- N+V
- Fever
- Abdo tenderness/guarding/distension
- Decreased or absent peristalsis
- Paralytic ileus
- Steatorrhoea (fatty stools)
- Haemorrhage (severe acute pancreatitis can cause fluid shifts and disrupt blood vessels around the pancreas)
What is acute appendicitis?
Inflammation of the appendix, usually due to bacterial or viral infection or an obstruction
Inflammatory bowel disease is an umbrella term used to describe what kind of disorders?
Chronic inflammation of the GIT
What is ulcerative clolitis?
Inflammation of the lining (mucosa) of the large intestine (colon), usually located in the rectum and lower colon but may involve other parts of the colon. Ulcers form on the surface of the lining and these may bleed. The inflamed lining also produces excessive mucus which sometimes contains pus. Inflammation in the colon reduces its ability to reabsorb fluid from the faeces which causes diarrhoea. Inflammation in the rectum can lead to a sense of urgency to have a bowel movement.
What is Crohn’s disease?
Crohn’s disease has an autoimmune origin and can be hereditary; it most commonly affects the small intestine and/or colon but can involve any part of the GIT. Within a diseased section the disease can affect all layers of the intestinal wall and can lead to the development of complications specific to this condition:
- strictures (intestinal obstruction or narrowing of the intestinal wall)
- abscesses (boils) and skin tags (swollen lumps or ‘flaps’ of thickened skin occurring just outside the anus)
- fistulae (abnormal channels connecting different loops of intestine to itself or to other body organs)
- fissures (ulcerated tears or cracks in the lining of the anal canal)
- malabsorption and malnutrition
What is diverticulosis?
- A condition in which diverticula (pouches) form in the wall of the large intestine
- It is common in elderly pts and is associated with a low fibre diet
- Inflammation of the diverticula is called diverticulitis
- Obstruction of the diverticulae can lead to perforation
True or false: most people with diverticulosis are asymptomatic
What is haematochezia?
Passage of bright red blood stools from the rectum, commonly associated with lower GIT haemorrhage; not to be confused with malena (stool with blood that appears black/tarry/offensive)
What can cause acute liver failure?
- Paracetamol OD
- Prescription meds
- Herbal supplements
- Hepatitis and other viruses
- Autoimmune disease
- Budd-Chiari syndrome (occlusion of hepatic veins that drain the liver)
- Metabolic diseases
- Cancer
What are the possible signs of acute liver failure?
- Fatigue
- Bleeding and bruising easily/bleeding disorders
- Itchy skin
- Jaundice
- Ascites
- Appetite loss
- Nausea
- Lower limb oedema
- Weight loss
- Hepatic encephalopathy
- Nevus araneus
- Palmar erythema
- Testicular atrophy and breast enlargement in males
- Kidney failure
