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PCM 2.1 > Abdomen and Rectum PE > Flashcards

Abdomen and Rectum PE Flashcards

1
Q

common symptoms of abdominal disease

A 
Pain
Nausea and vomiting
Change in bowel habits (constipation & diarrhea)
Rectal bleeding
Jaundice
Abdominal distention
Abdominal mass
Indigestion
Anorexia
Dysphagia
Hematemesis
Melena
Change in stool size
Weight loss
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2
Q

types of abdominal pain

A
  • visceral pain (colic pain) - source is usually hollow organ caused by distention or stretching. comes and goes, crescendo/decrescendo pattern. not well localized
  • parietal pain - caused by inflamm of the peritoneum, steady aching pain that is usually well localized
  • referred pain - from a distant site. R shoulder - gallbladder; L shoulder - spleen; back - pancreas or aorta
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3
Q

adequate exposure of ab

A

xiphoid to pubis

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4
Q

inspection of ab

A

skin - scars, striae, superficial veins

umbilicus - hernia, caput medusa

contour - flat, scaphoid, protuberant

pulsations or peristalsis

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5
Q

auscultation of ab

A
  • listen for bowel sounds before palpation and percussion (all 4 quadrants, RLQ best place to listen d/t cecum)
  • normal bowel sounds - high pitched “tinkle” about every 3-5 sec
  • no bowel sounds after 2 min - report as absent
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6
Q

borborygmi

A
  • increased, hyperactive bowel sounds
  • low pitched rumbling
  • hyperperistalsis
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7
Q

abdominal bruits

A

soft sound made by disrupted arterial flow through a narrowed artery

aortic - b/w umbilicus and xiphoid
renal - lateral to aorta
femoral - along inguinal ligament

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8
Q

percussion of ab

A

helps eval presence of: gaseous distention, fluid, solid masses, size and location of the liver and spleen

best done with pts in supine

percuss all 4 quadrants

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9
Q

tympany

A
  • most common percussion note

- presence of gas in the stomach and small bowel

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10
Q

percussion of liver

A
  • percuss along the R MCL from top to bottom
  • resonant (lungs) to dull (liver) to tympanic (intestine)
  • normal size <10cm
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11
Q

ascites - fluid wave

A

place pt’s or assistant’s hand in midline. tap on one flank and palpate with the other hand. an easily palpable impulse suggests ascites

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12
Q

ascites - shifting dullness

A

percuss the pt on their back and then their side. note where the sound changes from tympany to dull and the shift of the sound when the pt is turned to the side

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13
Q

light palpation

A
  1. detect tenderness and areas of muscular spasm or rigidity

2. use finger tips with a gentle motion

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14
Q

deep palpation

A
  1. used to eval organ size, abnormal masses, aorta, deep pain
  2. one hand placed on top of the other
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15
Q

rebound tenderness

A

eval for peritoneal tenderness and inflamm

tech: in the suspected area of the ab, slowly, gently, and deeply palpate. then, quickly remove the palpating hand

pt exp pain = + rebound tenderness

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16
Q

Rovsing’s sign

A

referred rebound tenderness. press on the LLQ and release, pos if pain in the RLQ

17
Q

palpation of the liver

A
  1. L hand under R 11th and 12th rib
  2. R hand in the RUQ
  3. instruct pt to breath deeply as examiner gently presses inward and upward with the R hand
18
Q

hooking technique

A
  1. stand near the pt’s head
  2. with both hands, hook your fingers around the lower R costal margin
  3. instruct the pt to breath deeply while gently pulling inward and upward with both hands to palpate the liver
19
Q

palpation of the spleen

A
  1. place L hand under the 11th and 12 ribs
  2. place R hand in the LUQ under the costal margin
  3. instruct pt to breath deeply as the examiner gently presses inward and upward

spleen not palpated in normal conditions

20
Q

palpation of the aorta

A

press firmly and deep in the upper abdomen with 2 hands

normal aorta - 2.5-3cm wide

21
Q

aortic aneurysm

A

pathologic dilation of the aorta. can be assoc with a bruit

assess with an ultrasound or CT scan

22
Q

palpation of the kidneys

sandwich method

A
  1. place hand above and below the costal margins just lateral to the midline
  2. deep and gently palpation attempts to palpate the lower pole of each kidney

kidneys not palpated under normal conditions

23
Q 
percussion of kidneys 
CVA tenderness (Lloyd's sign)
A

with fist, gently hit the area over the costovertebral angle on each side of the spine

pain over a kidney may indicate an inflamm or infectious process of the kidney

examiner may also place a flat hand over the CVA and strike hand

24
Q

rectal exam

palpation or DRE

A
  1. inform pt of what is going to happen
  2. lubricate your gloved index finger
  3. place your finger on the external sphincter and ask the pt to relax the sphincter mm
  4. slowly insert the finger as the sphincter relaxes as far as possible
  5. rotate your hand to palpate as much of the rectal surface as possible (in male, palpate prostate gland)
  6. gently withdraw the glove and note the color of the fecal material and test for occult blood

note: nodules, irregularities, masses, tenderness, induation

25
Q

fecal occult blood testing

A

pt with pos FOBT req a thorough eval for CRC

colonoscopy is the study of choice
sigmoidoscopy and air contrast barium enema are acceptable alt

26
Q

anal warts

A

condyloma acuminata - HPV

condylomata lata - syphili

27
Q

appendicits - etiology

A

obstruction of the appendicular lumen, fecal or foreign matter, tumors or lymphomas

28
Q

appendicits - hx

A

pain starts peri-umbilical then shifts to the R lower quadrant
nausea and vomiting
anorexia
fever

29
Q

appendicits - PE

A 
RLQ pain and RLQ rebound tenderness
decreased or absent bowel sounds
\+ Rovsing's sign
\+ psoas sign
\+ obturator sign
always do rectal exam and pelvic exam on female
30
Q

appendicitis - diagnostic work up

A

CBC - moderate leukocytosis with L shift
urine - may contain a few WBC or RBC, helps R/O any GU condition
plain x-ray - rarely helpful
ultrasound - enlarged and thick walled appendix
CT scan - most sensitive
female pt - must do pregnancy test to R/O ectopic pregnancy
BMP - eval electrolytes and renal functions, esp if pt has been vomiting

31
Q

acute cholecystitis - etiology

A

obstruction of the cystic duct usually by a gallstone, sometimes a neoplasm

32
Q

acute cholecystitis - hx

A

RUQ postprandial pain, biliary colic pain
pain radiating to the R shoulder
nausea and vomiting
anorexia
obesity
dever
5 Fs - female, fat, fertile, fair, flatulent

33
Q

acute cholecystitis - PE

A

RUQ pain and rebound tenderness
decreased or absent bowel sounds
abdominal distention
+ Murphy’s sign - RUQ pain and sudden arrest of inspiration during palpation of the liver and gallbladder
diagnostic triad - RUQ pain, fever and leukocytosis

34
Q

acute cholecystitis - diagnostic work up

A 
CBC - leukocytosis with L shift
serum bilirubin - mildly elevated
AST/ALT - elevated
ultrasound - detect stones, thicken GB wall, dilated bile duct and fluid
HIDA scan - radionuclide biliary scan
CT scan

PCM 2.1 (5 decks)

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