Abdomen, Ascites

Question 1

What is the most important part of abdomen exam?

Answer 1

history and physical exam; 90% of diagnosis

Question 2

What do you do before palpating/percuss abdomen?

Answer 2

listen

Question 3

How many click/gurgles per minute?

Answer 3

5-34 per minute

Question 4

Borborygmi

Answer 4

prolonged gurgles

Question 5

Bruit + HTN=

Answer 5

renal artery stenosis

Question 6

Bruit + tachycardia=

Answer 6

abdominal aneurysm

Question 7

Where are most aneurysms?

Answer 7

bifurcation

Question 8

What should the GI sound like during percussion?

Answer 8

Most tympanic with scattered dullness (stool/fluid)

Question 9

Abnormal percussion sounds

Answer 9

Protuberant with increase in tympany
Large area of dullness
Dullness in flanks

Question 10

What is the size of the liver at midclavicular line?

Answer 10

6-12cm

Question 11

What are we assessing at Traube space?

Answer 11

size of spleen

Question 12

When percussing Traube space laterally what do we expect to hear for a normal size spleen?

Answer 12

tympany

Question 13

List peritoneal indicators

Answer 13

tender with movement
tender with cough 
tender with light palpitation/percussion
hyperaesthesia
rebound tenderness
tap tender

Question 14

Rebound tenderness

Answer 14

increase in pain on release

Question 15

Where do we palpate the gallbladder?

Answer 15

mid-liver body

Question 16

Who do we use the hooking technique on?

Answer 16

obese and very pregnant ladies

Question 17

Disease associated with splenomegaly

Answer 17

portal HTN, HIV, splenic infarct, hematoma, mononucleosis

Question 18

If spleen is enlarged, where is it palpable?

Answer 18

2cm below L. costal margin on inspiration

Question 19

If percussion is normal on spleen, do you palpate?

Answer 19

NO

Question 20

In order to palpate the bladder, how much fluid needs to be in the bladder?

Answer 20

400-600mL

Question 21

Symptoms associated with abdominal pain

Answer 21

anorexia, nausea, vomit, diarrhea, fever, chills, pain

Question 22

Normal size of aorta

Answer 22

less than 3cm

Question 23

Pain with distention/stretching of hollow abdominal organs (stomach and intestine). It is difficult to localize but is palpable near the midline. Pain described as gnawing, crampy and aching. If severe ptn present with pallor, N/V and restlessness.

Answer 23

Visceral pain

Question 24

Pain associated with inflammation, usually in the parietal peritoneum. Pain described as steady, aching pain. It is localized over the involved structure and can be pointed at with an index finger. It is aggravated by moving and coughing. The patient usually wants to lay still.

Answer 24

Parietal pain

Question 25

Pain felt in distant sites that are usually innervated at the same spinal level. It can be superficial or deep but is usually localized. For example, patient can feel pain in shoulder when have gallbladder pain.

Answer 25

Referred Pain

Question 26

4 cardinal signs of appendicitis

Answer 26

anorexia, periumbilical pain, pain migrating to R. side of abdomen, vomit once they eat

Question 27

When does the span of liver dullness increase?

Answer 27

liver enlarged

Question 28

Disease associated with small liver

Answer 28

hepatitis and heart failure

Question 29

What is dullness is percussed in Traub space?

Answer 29

splenomegaly or fluid/solids in the stomach

Question 30

What is a positive spleen percussion sign?

Answer 30

change in percussion note from tympany to dullness on inspiration, suggestive of splenic enlargement

Question 31

4 tests to assess for Ascites

Answer 31

Border of tympany and dullness
Shifting dullness
Fluid wave
Ballotte

Question 32

Border of tympany

Answer 32

Percuss out in several directions from the central area of tympany and map the border between tympany and dullness. Patient is in supine position

Question 33

Shifting dullness

Answer 33

After ascites border is completed, have patient turn to side and percuss the border. A normal result would be the border between tympany and dullness remain the same. Abnormal is the dullness shifts to the dependent side and the tympany shifts upward

Question 34

Fluid wave

Answer 34

Press the edge of both hands down the midline of the abdomen. The pressure helps stop transmission of the sound wave through fat. Tap one flank sharply with fingertips and feel on the opposite flank for an impulse through fluid. Not the best test, a lot of false positives and negatives.

Question 35

Ballotte

Answer 35

Straighten/stiffen fingers in one hand and jab the abdominal surface toward an anticipated structure, like the liver. The quick movement displaces the fluid so the fingertips can feel the organ surface.

Question 36

4 tests for appendicitis

Answer 36

McBurney point, Rovsing sign, Poas, Obturator

Question 37

McBurney point

Answer 37

Line two inches from the anterior superior spinous process of the ilium to the umbilicus. Check for guarding, rigidity and rebound tenderness.

Question 38

Rovsing

Answer 38

Test for referred rebound tenderness. Press deep and even in the LLQ and quickly redraw. A positive is if pain is in the RLQ during L. side pressure.

Question 39

Psoas

Answer 39

Two ways:
1. Place hand above patient R. knee and ask patient to raise thigh against hand.
2. Patient lays on left side and you extend R. leg to the hip.
Flexion= psoas will contract
Extension= psoas stretch
Increase in abdominal pain when test is done is a positive result and due to the irritation of the muscle by inflammation of appendix

Question 40

Obturator

Answer 40

Flex the patients R. thigh at hip with knee bent and rotate the leg internally at the hip. This stretches the internal obturator muscle. If R. hypogastric pain is present, then it is a positive sign and due to the irritation of obturator muscle by inflammation of the appendix.

Question 41

What does Murphy sign assess for?

Answer 41

acute cholecystitis

Question 42

Clinical signs ascites

Answer 42

• anterior abdomen tympanic
• flanks dull
• fluid shifts