Abdomen Flashcards
Situs Inversus Totalis
All organs on the opposite side of the body
Dextrocardia
Situs Inversus Totalis (organs flipped to other side) but involving only the heart
The 9 regions of the abdomen
- Epigastric
- Umbilical
- Hypogastric (suprapubic)
- R hypochondriac
- L hypochondriac
- R lumbar
- L lumbar
- R inguinal
- L inguinal
What organs to consider in the RUQ
Liver
gallbladder
duodenum
(pancreatic head)
What organs to consider in the RLQ
Cecum
appendix
right ovary and tube
What organs to consider in the LUQ
Stomach
spleen
pancreas
What organs to consider in the LLQ
Sigmoid colon
left ovary and tube
What organs to consider in the epigastrium?
Stomach
pancreas
Order of abdominal exam
- Inspect
- Auscultate
- Percuss
- Palpate
Special tests- test for ascites
Shifting dullness
fluid wave
Special test for peritoneal signs associated with appendicitis
Rosving’s sign
Psoas sign
Obturator sign
Murphy’s sign
Special test for gallbladder inflammation
What side do you stand on during an abdominal exam
The patients right side
What does percussion assess?
Size and density of organs
areas of tenderness
presence of solid/fluid vs air
distribution of air (ex bowel obstruction)
organomegaly
masses
How to percuss for liver size
upper border: start at 4th ICS percuss down
Lower border: start at umbilicus at MCL and percuss up
What palpable size of the aorta suggests a AAA?
>3cm
Encarcerated hernia
no pain, not reducible
strangulated hernia
+pain, not reducible
emergency**
What does an acute abdomen usually result from?
bowel obstruction or peritonitis
Mechanical bowel obstruction vs ileus
mechanical- results from
a physical barrier
Ileus- due to bowel not functioning properly but no barrier in the way
Renal calculi
kidney stones
Common cause of pain in the LLQ
Diverticulitis (inflamed/infected diverticulum of the colon)
diverticulum
Abnormal sac or pouch formed at a weak point in the wall of the alimentary tract
visceral pain
when organs (ex: intestine, biliary tree) contract forcefully or distend or stretch abnormally
Quality: gnawingk, burning, cramping, aching
Parietal abdominal pain
peritonitis
inflammation of the parietal peritoneum
movement increases pain
Referred pain to the back
could be caused by pancreas, ulcer or GB
Possible causes of referred right shoulder or scapula pain
GB, biliary tree
what causes severe constant pain
pancreatitis
what causes pain that is steady and gradual in onset
Appendicitis, cholecystitis
What causes intermittent (colicky) pain?
Mechanical small bowel obstruction
What causes severe colicky pain
ureteral stone
Purple striae
indicates cushings dz and steroid use
normal colored/white striae= stretch marks
Cullen’s sign
Discoloration over the umbilicus
Grey Turner’s sign
Ecchymosis over the flanks
Diastasis recti
separation of rectus abdominus
check by asking pt to lift up neck
increased peristaltic activity
may be seen with bowel obstruction or gastroenteritis
can be normal
borborygmi
loud, active bowel sounds
What do hyperactive bowel sounds indicate?
early peritonitis
early bowel obstruction
gastroenteritis
high pitched, tinkling bowel sounds
early bowel obstruction
intestinal fluid under pressure
ileus
little to no bowel sounds
Peritonitis starts as hyperactive and then can progress to ileus
what are the possible causes of hepatomegaly?
cirrhosis
hepatitis
abscess
cyst
CHF
tumor
