ABDOMEN- IM Flashcards
At the end of the lecture, the student must be able to: Describe the basic structures and functions of the abdomen Recognize manifestations of diseases of the abdominal system and correlate this with pathophysiologic processes Demonstrate effectively steps and manoeuvres in examining the abdomen Identify variations in the physical exam techniques and findings in different patient population Enumerate common abdominal diseases and their manifestations. Demonstrate proper technique
Purpose for doing abdominal examination
- Assess the urgency of the case
- Findings in physical examination could point to the diagnosis
- To decide on the laboratory tests to be requested
- To decide on the management
•Symptoms referable to the GI tract
- Dysphagia
- Abdominal pain
- Nausea
- vomiting
- Diarrhea
- Constipation
- GI bleeding
- Weight loss
Gastrointestinal Symptoms
- Location
- Upper GI
- Lower GI
- Others
•Conduct careful history
•timing of the onset
•Determine of life threatening
Cluster several findings
•Patterns and mechanisms
- Visceral pain
- Parietal pain
- Referred pain
•Describe Visceral pain
•hollow abdominal organs contract forcefully or distended or stretched
•Stretching of the capsule can also cause pain
•Ischemia stimulates visceral pain fibers
•Difficult to localize
•Describe Parietal pain
- Inflammation of the parietal peritoneum
- Steady, aching, more severe than visceral, precisely localized
- Aggravated by movement or coughing
•Referred pain
- Felt in more distant sites
- Develops ad the initial pain becomes more intense
For descriptive purposes, the abdomen
is often divided by imaginary
lines crossing at the umbilicus, forming
the__________, _______, _____ and ________
Another
system divides the abdomen
into nine sections. Terms for three of
them are commonly used: epigastric,
umbilical, and hypogastric or suprapubic.
- right upper,
- right lower,
- left upper,
- and left lower quadrants.
Another
system divides the abdomen
into nine sections. Terms for three of
them are commonly used
- : epigastric,
- umbilical,
- and hypogastric or suprapubic.
Examine the abdomen, moving in a
____________;
clockwise rotation
several organs are
often palpable. Exceptions are the
___________, _________ and _______
The abdominal cavity extends
up under the rib cage to the dome of
the diaphragm, placing these organs
in a protected location, beyond the
reach of the palpating hand.
stomach and much of the liver and
spleen.
In the right upper quadrant, the soft
consistency of the liver makes it difficult
to feel through the abdominal
wall.
The lower margin of the_________________, is often palpable at the right costal margin.
liver,
the liver edge
The gallbladder,
which rests against the inferior surface
of the liver, and the more deeply
lying duodenum are generally not palpable.
At a deeper level, the lower pole
of the right kidney may be felt, especially
in___________
thin people with relaxed abdominal
muscles.
Moving medially,
the examiner encounters the rib cage,
which protects the stomach; occasionally
patients misidentify the
stony hard _______________
** in the midline
as a tumor. The abdominal aorta**
often has visible pulsations and is usually
palpable in the upper abdomen
xiphoid process
In the left upper quadrant, the spleen is lateral to and behind the stomach, just above the left kidney in the left midaxillary line. Its upper margin rests against the dome of the diaphragm.
The 9th, 10th, and 11th ribs protect most of the
spleen. The_____________ may be palpable below the left costal margin in a
* *small percentage of adults.**
tip of the spleen
In healthy people the__________cannot be detected.
pancreas
What can be felt In the left lower quadrant, you can often feel the
In the lower midline are the bladder, the sacral promontory, the
bony anterior edge of the S1 vertebra, sometimes mistaken for a tumor, and,
in women, the uterus and ovaries.
- firm, narrow, tubular sigmoid colon.
- Portions of the transverse
- and descending colon may also be palpable.
In the right lower quadrant are___________ near the junction of the small and large intestines. In healthy
people, these are not palpable.
bowel loops and the appendix at the tail of
the cecum
A distended bladder may be palpable above the symphysis pubis.The bladder accommodates roughly 300 ml of urine filtered by the kidneys into the renal pelvis and the ureters.
Bladder expansion stimulates contraction of
bladder smooth muscle, the detrusor muscle, at relatively low pressures.
Rising
pressure in the bladder triggers the conscious urge to void.
Upper GI tract
•Chronic upper abdominal pain or discomfort
Dyspepsia
Upper GI tract
Alarm symptoms
- Alarm symptoms
- Dysphagia
- Odynophagia
- Recurrent vomiting
- Evidence of GI bleeding
- Weight loss
- Anemia
- Risk factors for gastric cancer, palpable mass or jaundice
Lower GI tract
•Acute lower GI pain
•
Localized to the right lower quadrant or left lower quadrant
- Chronic lower GI pain
- Ask about change in bowel habits and alternating diarrhea and constipation
- Diarrhea
- Duration
- Acute: 2 weeks
- Chronic ≥ 4 weeks
- Characteristic of the stool, volume, frequency, consistency
- Presence of pus, mucus, blood
- Associated tenesmus
- Constipation
- Present for at least 12 weeks of the prior 6 months with at least 2 of the following conditions:
fewer than 3 bowel movements per week;
25% or more defecation with either straining or sensation of incomplete evacuation; lumpy or hard stools; manual facilitation
Urinary tract
- Suprapubic pain
- Dysuria, urgency or frequency
- Polyuria or nocturia
- Bladder disorders cause this pain
- Bladder infection is typically dull and pressure like
•Suprapubic pain
- Dysuria, urgency or frequency
- Pain on urination
__________is an unusually intense desire to void
•Frequent voiding may occur
•Related symptoms such as blood and fever
•Urgency
•Polyuria or nocturia
– increase in 24-hour urine volume exceeding 3L
•Polyuria
__________ – urinary frequency at night awakening the patient more than once
•Nocturia
•Involuntary loss of urine typical in elderly
•Urinary incontinence
When voiding is inconvenient, higher centers in the brain
can inhibit detrusor contractions until the capacity of the bladder, approximately
____________ is exceeded
400 to 500 ml,
The integrity of the sacral nerves that
innervate the bladder can be tested by assessing perirectal and perineal sensation
in the__________
S2, S3, and S4 dermatome
The kidneys are posterior organs. The ribs protect their upper poles. The costovertebral angle, formed by the lower border of the 12th rib and the transverse processes of the upper lumbar vertebrae, defines where to examine for kidney tenderness, termed ________________
costovertebral angle tenderness, or CVAT.
Common concern symptoms in GIT
◗◗ Abdominal pain, acute and
chronic
◗◗ Indigestion, nausea, vomiting including blood, loss of appetite,
early satiety
◗◗ Dysphagia and/or odynophagia
◗◗ Change in bowel function
◗◗ Diarrhea, constipation
Common concerning do in renal
Suprapubic pain
◗◗ Dysuria, urgency, or frequency
◗◗ Hesitancy, decreased streamin males
◗◗ Polyuria or nocturia
◗◗ Urinary incontinence
◗◗ Hematuria
◗◗ Kidney or flank pain
◗◗ Ureteral colic
Before exploring gastrointestinal
and genitourinary symptoms, review the mechanisms and clinical
patterns of abdominal pain. Be familiar with three broad categories of
abdominal pain:
- Visceral
- Parietal
- Referred
________________- occurs when hollow abdominal organs such as the intestine or biliary tree contract unusually forcefully or are distended or stretched.
Visceral pain
Solid organs such as the liver can also become painful when their capsules are stretched. Visceral pain may be difficult to localize. It is typically palpable near the midline at levels that vary according to the structure involved,as illustrated on the next page. Ischemia also stimulates visceral pain fibers
Visceral pain in the right upper
quadrant may result from _________against its capsule in
alcoholic hepatitis.
liver
distention
Visceral pain varies in quality and may be __________, ___________, __________When it becomes severe, it may be associated with sweating, pallor,
nausea, vomiting, and restlessness.
:gnawing, burning, cramping, or
aching.
Visceral_______________may
signify early acute appendicitis from
distention of an inflamed appendix.
It gradually changes to parietal pain
in the right lower quadrant from
inflammation of the adjacent
parietal peritoneum.
periumbilical pain
Pain of _____________
origin may be referred to the back;
pain from the biliary tree, to the
right shoulder or the right posterior
chest.
duodenal or pancreatic
Studies suggest that neuropeptides,
such as_____________ and_______ mediate interconnected
symptoms of pain, bowel
dysfunction, and stress
5-hydroxytryptophan and
substance P,
In emergency rooms, 40% to 45% of
patients ___________but
have nonspecific pain,
15% to 30% need surgery, usually
for___________ , ____________ and ________
appendicitis, intestinal obstruction,
or cholecystitis.
Doubling over with cramping colicky
pain indicates __________.
renal stone
