Abdomen

Question 1

Pain:
RUQ/epigastric pain
Epigastric pain
Periumbilical pain
Hypogastric pain
Suprapubic/sacral pain

Answer 1

RUQ/epigastric pain- biliary tree, liver
Epigastric pain- stomach, duodenum, pancreas
Periumbilical pain- small intestine, appendix, proximal colon
Hypogastric pain- colon, bladder, uterus
Suprapubic/sacral pain- rectum

Question 2

Bowel movements - 3 factors

Answer 2

Frequency, consistency, pain

Question 3

Bloody stools

Answer 3

Hematochezia

Question 4

Black, tarry stools

Answer 4

Melena

Question 5

White/gray stools

Answer 5

Indicative of liver/gallbladder disease

Question 6

Urinary tract- 4 factors

Answer 6

Frequency, pain with urination, color, and smell

Question 7

Back pain at the costovertebral pain

Answer 7

Kidney

Question 8

In the abdomen, always _________ before ___________/_____________

Answer 8

Auscultate before palpating/percussing

Question 9

Order for examination of the abdomen

Answer 9

Inspection, auscultation, percussion, palpation

Question 10

Light palpation

Answer 10

Gentle. Identify any superficial organs/masses

Voluntary guarding or involuntary guarding

Question 11

Deep palpation

Answer 11

Palpate deeply in the periumbilical area and both lower quadrants

Question 12

Rebound tenderness

Answer 12

Occurs if pain increases when examiner decreases pressure against the abdomen

Question 13

A sign which confirms the presence of peritonitis **** TQ!

In addition, will also find ________ and ________

Answer 13

Rebound tenderness

In addition,

• rigidity
• involuntary guarding

Question 14

Peritonitis listen for

Answer 14

Friction rub over the liver/spleen

Borborygmus- rumbling bowel sound

Question 15

RUQ structures

Answer 15

Gall bladder, liver, duodenum, R kidney, abdominal aorta

Question 16

LUQ

Answer 16

Spleen, left kidney, pancreas, stomach

Question 17

LLQ structures

Answer 17

Sigmoid colon, transverse and descending colon, bladder, uterus, ovaries

Question 18

RLQ

Answer 18

Bowel loops, appendix at McBurney’s point, cecum

Question 19

Hepatitis liver edge

Answer 19

6 cm below RCM

Question 20

Rovsing’s sign

Answer 20

Palpation of LLQ increases pain felt in RLQ - acute appendicitis

Question 21

Murphy’s sign

Answer 21

Places hand under R costal margin and patient inspires. If patient winces when in contact with liver- cholecystitis

Question 22

Normal bowel sounds

Answer 22

5-34 clicks and gurgles/minute

Borborgmi- stomach growling

Question 23

Abnormal bowel sounds

Answer 23

Bowel sounds increase if diarrhea, early intestinal obstruction

Decrease if obstruction, peritonitis

Question 24

Friction rub

Answer 24

Signifies infection. Heard over liver and spleen

Question 25

Succussion splash

Answer 25

Sloshing sound when patient moves from side to side. Listen while shaking abdomen from side to side

Question 26

Bruit

Answer 26

Heard with high blood pressure. Bruits heard with systolic and diastolic indicate arterial occlusion/insufficiency. Suggest narrowing of the vessel. Listen over abdominal aorta and renal arteries

Can suggest liver cancer or alcoholic hepatitis

Question 27

Liver percussion & palpation

Answer 27

Liver size 6-12 cm

Resonance to dull- top
Tympanic to dull- bottom

Palpable during inhalation

Question 28

Spleen- percussion & palpation

Answer 28

Not percussable/not palpable

Tympanic- normal
Dull- enlarged spleen (dull = organs)
Palpate during inhalation

Question 29

Kidney palpation

Answer 29

Place below 12th ring. One had back and above. Check on exhalation

Question 30

Aorta

Answer 30

Press firmly in abdomen slightly L of midline to identify aortic pulsation

Question 31

Iliopsoas test (psoas test)

Answer 31

R hip flexion against physician’s resistance. Positive indicates abdominal pain & inflamed appendix

Question 32

Obturator test

Answer 32

R hip flexion, R knee flexion, internal rotation. Positive indicates R hypogastric pain and inflamed appendix

Question 33

Bloody/pink-ish hematuria

Answer 33

Kidney stones, UTI, tumor, STI

Question 34

Reddish urine

Answer 34

Beets

Medication

Question 35

Dark urine

Answer 35

Impaired excretion of bilirubin to GI tract

Question 36

Pale colored stools

Answer 36

Alcoholic stools

Bile not entering intestine due to blockage

Question 37

Abdominal involuntary rigidity

Answer 37

Involuntary muscle spasm

Peritoneal inflammation

Question 38

Abnormal palpating liver findings

Answer 38

Bluntness or rounding of edge

Irregular contour

Question 39

Pallor

Answer 39

Pale skin

Question 40

Jaundice

Answer 40

Yellow skin

Question 41

Peripheral cyanosis

Answer 41

Blue around extremities

Question 42

Central cyanosis

Answer 42

Blue around face, lips and tongue

Question 43

Causes of kidney enlargement

Answer 43

Cysts, tumors, hydronephrosis

Question 44

CVA tenderness

Answer 44

Pyelonephritis - infection of kidney/ureters

Question 45

Dysphasia

Answer 45

Esophageal dysphagia- mucosal rings, esophageal stricture, cancer

Motor disorders- esophageal spasm, scleroderma, achalasia

Question 46

Constipation

Answer 46

Life habits, IBS, mechanical obstruction, painful anal lesions, drugs, depression, metabolic conditions

Question 47

Ascites

Answer 47

Cirrhosis, CHF, pericarditis, IVC, Hepatic vein obstruction

Question 48

Abdominal aortic aneurysm

Answer 48

Periumbilical mass.

Expansive pulsation 3 cm or more

Question 49

Osteopathic viscera-somatic reflexes with abdominal/GI disorders

• stomach
• spleen/pancreas
• liver/gb
• SI
• kidney
• Right colon
• Left colon

Answer 49

• stomach- T5-T9 Left
• spleen/pancreas- T7-T9 left
• liver/gb- T6/7-T9 Right
• SI- T9-T10
• kidney- T10-L1
• Right colon- T10-T11 Right
• Left colon - T12-L2 left

Question 50

Liver edge in normal vs acute hepatitis patients

Answer 50

Non-tender 1 finger-breadths below RCM

Tender 4-5 finger-breadths below RCM