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Physical Diagnosis Module II > Abdomen > Flashcards

Abdomen Flashcards

1
Q

parietal peritoneum

A

lines internal surface of the abdominal wall

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2
Q

visceral peritoneum

A

lines organs within the abdominal cavity

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3
Q

Retroperitoneal organs

A
  • Kidneys
  • Ascending and descending colon (portions)
  • Pancreas
  • Duodenum (portions)
  • Aorta
  • Vena cava
  • Periaortic lymph nodes

-Will present with back pain if there is a problem with these

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4
Q

appendicitis pain

A

epigastric pain that goes through to the back, does not wrap around
-visceral at first from distention of inflamed appendix - periumbilical then changes to pain in RLQ from inflammation of adjacent parietal peritoneum

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5
Q

visceral pain innervation

A

autonomic

Ex) liver when stretched

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6
Q

parietal pain innervation

A

skeletal

-Steady, aching pain - usually more sever than visceral pain and precisely localized over structure

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7
Q

referred pain

A

often develops as initial pain as initial pain becomes more intense
described as radiating or traveling from initial site

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8
Q

direct tenderness

A

when you push something it hurts

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9
Q

guarding

A

voluntary and involuntary

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10
Q

rebound tenderness

A

tenderness is when you let go, not when you push in

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11
Q

referred tenderness

A

when you push on some place, another place hurts

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12
Q

position for abdominal exam

A 
Patient should be lying supine on table
Hands at sides
Head against table
Knees bent with feet on table
Drape above and below abdomen
Respect patient’s comfort and modesty
Keep the patient warm
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13
Q

Order of abdominal exam

A

inspection
auscultation
percussion
palpation

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14
Q

Inspection of abdomen

A
  • skin (scars, striae, varicosities, rashes/lesions)
  • umbilicus
  • contour (round, flat, protuberant, distended, symmetry, visible masses)
  • Peristalsis
  • pulsations
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15
Q

mary joseph nodule

A

-aka sister mary joseph sign

palpable nodule bulgin into umbilicus due to metastasis of cancer in pelvis or abdomen

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16
Q

cause of protuberant abdomen

A
  • sticks out farther than usual

- could be due to excess subcutaneous fat, loss of muscle tone, buildup of substances

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17
Q

distention of abdomen

A

air or fluid in abdominal space

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18
Q

Auscultation for bowel sounds

A

(diaphragm)

  • Borborygmi – prolonged growling
  • Obstructive bowel sounds
  • Absent bowel sounds: wait, wait, wait!
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19
Q

typical quadrant to listen for bowel sounds

A

LLQ

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20
Q

percussion of abdomen

A
  • Percuss all four quadrants
  • -Tympany vs dullness
  • -Distinguish gas from liquid from solid contents
  • -Assess for peritoneal tenderness
  • Percuss abdominal organs
  • -Liver
  • -Spleen
  • -Gastric air bubble
  • -Bladder

fluid sounds more dull than air filled spaces
all four quadrants should be slightly tympanic

21
Q

palpation of the abdomen

A
  • Light palpation
  • -In all 4 quadrants
  • -Assess for guarding, tenderness, obvious masses
  • Deep palpation
  • -In all 4 quadrants
  • -Assess for tenderness, masses, organs
  • Assess for rebound tenderness or peritoneal inflammation
  • Palpate abdominal organs: liver, spleen, kidneys, aorta, bladder
  • Be systematic and thorough
22
Q

What is normally palpable

A
  • sigmoid colon (LLQ)
  • Liver edge (RUQ)
  • Abdominal aorta (above umbilicus)
  • Spleen (if enlarged) (LUQ)
  • Kidneys (if enlarged) (either/both flanks)
23
Q

Percussion of liver

A
  • Liver span: R MCL nipple to umbilicus, normally 6-12cm

- tenderness

24
Q

Palpation of liver

A
  • RUQ, on patient’s right

- liver border at/below costal margin

25
Q

percussion of spleen

A
  • LUQ below costal margin in Traube’s space

- Splenic percussion sign @ L ant axillary line

26
Q

palpation of spleen

A
  • LUQ, on patient’s right

- patient in RLD position

27
Q

Palpation of kidneys

A
  • left kidney from patient’s left or right side

- right kidney from patient’s right side

28
Q

CVA tenderness

A

pain with percussion suggests inflammation (pyelonephritis)

29
Q

Auscultation of aorta

A

listening for bruits with bell

30
Q

palpation of aorta

A
  • mid abdomen for pulsations

- measure size (normal <3cm)

31
Q

Percussion of bladder

A

dullness above pubic symphysis

32
Q

palpation of bladder

A
  • if distended above pubic symphysis, smooth and round
  • tenderness may indicate infection
  • beware of full bladder
33
Q

inguinal lymph nodes

A
  • superficial and deep nodes; only superficial are palpable
  • superficial inguinal nodes;
  • -horizontal group (drains superficial portions of lower abdomen, et.)
  • -vertical group (drains region of leg)
34
Q

Murphy’s sign

A
  • Palpate deeply in RUQ
  • Ask pt to inhale fully
  • Positive Murphy’s sign = ARREST OF BREATHING and sharp increase in tenderness as inflamed gallbladder bumps into examiner’s hand
  • Note that tenderness alone does not equal a positive Murphy’s sign, but should be noted
  • Test for acute cholecystitis
35
Q

Acute abdomen: peritoneal inflammaiton

A
  • Appendicitis and other causes of acute peritonitis can be evaluated with several special techniques
  • -Rovsing’s sign (referred rebound tenderness)
  • -Psoas sign
  • -Obturator sign
  • Rebound tenderness, jar tenderness (smacking the side of the bed or asking if they experience pain going over bumps in the car), involuntary guarding, and other signs will likely be present in patients with acute abdomen
36
Q

ascites

A
  • Ascites can be present in a distended abdomen from many different causes
  • Abdomen will be dull to percussion
  • Special techniques can be used to confirm ascites
  • -Fluid wave test
  • -Shifting dullness
37
Q

Fluid wave

A
  • Ask the patient to press the hand down the midline of the abdomen and tap the side of the abdomen
  • A positive fluid wave will be felt on the opposite hand
38
Q

Shifting dullness

A
  • Percuss abdomen with patient supine, and then with patient lying on one side
  • In ascites, dullness shifts to the dependent position and tympany shifts to the top (air is lighter than fluid)
39
Q

the ticklish patient

A
  • Never take your hand off the abdomen
  • Have warm hands and firm touch
  • No sudden moves
  • Distract patient with conversation
  • Put patient’s own hand against abdomen, put your hand over theirs to palpate
40
Q

Examining a child’s abdomen

A
  • If child is apprehensive, it’s mostly an indirect exam
  • Ask child to hop up and down or skip
  • Ask them to show you their belly button
  • Have parent do the palpation
  • Use stethoscope to palpate
41
Q

GU and Rectal Exams

A
  • Part of the abdominal examination
  • Generally performed after abdominal exam
  • GU and pelvic problems often present with abdominal symptoms
42
Q

pain

A

a patient’s experience, what they tell you

43
Q

tenderness

A

objective measurement of the patients experience of pain

44
Q

Pleurisy or acute MI Referred Pain

A

chest, spine, or pelvis

45
Q

Pancreatic or duodenal Referred Pain

A

back

46
Q

Biliary tree referred pain

A

right shoulder or right posterior chest

47
Q

Auscultate for Bruits

A

(bell)

  • Aorta
  • Renal
  • Iliac
  • Femoral
48
Q

shifting dullness or flank dullness can mean?

A

ascites

Physical Diagnosis Module II (10 decks)

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