Abdomen Flashcards
SX: epigastric pain that may radiate to the back
Peptic ulcer disease
SX: epigastric pain that may radiate to the back, both steady and deep pains
Pancreatitis-if acute it’s also poorly localized
SX:
- steady, aching pain that may radiate to the scapula and shoulder
- R upper quadrant pain or upper abdominal pain
Acute Cholecystitis
SX:
- patient tries to prevent any movement,
- rebound tenderness
Peritonitis
SX:
- poorly localized umbilical pain followed by RLQ pain
- pain begins as mild with cramping, and becomes steady, more severe
Acute appendicitis
SX:
- fluid waves traveling across abdomen
- shifting dullness that could go away when the patient lies on the opposite side
- Secussion splash
Ascites
Secussion splash
hearing fluid sloshing around as a person moves–sometimes indicates fluid in the abdomen and usually associated with ascites
Diverticulitis
an outpouching of the mucosal layer of teh GI tract that pouches out through the muscular layer and pinches off. It can become huge and inflamed if bacteria gets inside of it
- leads to thickening of the colon
What are the 3 main steps (in order) of the abdominal exam?
- Inspect
- Auscultate
- Palpate/percuss
What’s a scaphoid abdomen? What is the opposite of this?
- an abdomen that’s concave instead of convex
- protuberant abdomen
Why do we auscultate before palpating?
- so we don’t move everything around and stirring it up before we listen to it
Increased bowel sounds means
diarrhea or early intestinal obstruction
some gurgling bowel sounds means
normal bowel
decreased/no bowel sounds means
adynamic ileus (paralysis of intestinal motility) and peritonitis
What’s a murmur heard in a blood vessel that corresponds to the cardiac cycle?
- what does this sound suggest when heard during an abdominal exam?
- bruits
- suggests partial occlusion of the aorta, larger arteries or renal artery
When you hear a whoosh on abdominal exam, this generally means
- hypertension
Where do you generally hear the following sounds during percussion?
- dull
- flat
- resonant
- tympanic
- hyperresonant
- dense tissue (ex: liver)
- bone
- low, hollow sounds that are characteristically heard over the lungs
- hollow drum-like sounds heard over the stomach
- can be in the lungs when they’re over-distended or in the case of a pneumothorax
The liver span should be ______
- 6-12 cm
Splenic percussion sign
- percussing at the lowest interspace in the L axillary line and it should be tympanic both on inspiration and expiration
- if dull, this is a sign of splenomegaly
Traube’s Space
semilunar space between the L lung and L lobe of the liver. Normally you should hear tympany here, but if you hear dullness suspect splenomegaly
6 F’s of abdominal distension
- Fat
- feces
- flatus
- fetus
- fatal concerns (i.e., cancer)
- fluid
Normal findings in the RUQ
- liver
- galbladder
- duodenum
- head of pancreas
Normal findings in the LUQ
- spleen
- tail of pancreas
- stomach
- transverse colon
Normal findings in the RLQ
- appendix
- ovaries
Normal findings in the LLQ
- colon
- diverticulitis ?
Involuntary continuous contraction of the abdominal wall that my only be on one side ____.
- what is this a sign of?
- guarding
- peritonitis
How do you check for rebound tenderness and what are you looking for?
- press down with fingers and quickly withdraw
- Pain induced or increased by quick withdrawal = rebound tenderness
- suspect peritoneal inflammation
Rovsing’s sign
- press deeply and evenly in the LLQ and withdraw quickly. Pain in the RLQ during LLQ pressure is a positive Rovsing’s side
- suspect appendicitis
Obturator sign
patient lies on back and flexes their R thigh at the hip with the knee bent and then rotates the leg internally at the hip
- if there’s R hypogastric pain then this is a positive obturator sign
- suggest appendicitis
Psoas sign
patient lies on their L side and extends the R leg at the hip to stretch the psoas muscle
- increased abdominal pain means a positive psoas sign
- suggest appendicitis
A positive Murphy’s sign suggests
- acute cholecystitis
How do you test for Costovertebral angle (CVA) tenderness
use the heel of the hand to hit the patient at the CVA
- a positive test indicates renal disease, pyelonephritis
