Abdomen - Lecture portion Flashcards
The most common complaint for an abdominal visit is…
Abdominal Pain
Visceral abdominal pain differs from parietal pain in that visceral pain is (more precisely/difficult) to localize whereas parietal pain is (more precisely/difficult) to localize
- Difficult
- More precisely
What category of abdominal pain develops as the initial pain worsens and is felt both superficially or deep?
Referred Abdominal Pain
Which organ is not located in the peritoneum and is what we call, “retroperitoneal”?
They Kidneys
Abdominal Pain History is done using what mneumonic?
OPQRST
Onset, Prior episodes, progression, palliate/provoke, quality of symptoms, quantity of symptoms, region, radiation, associated symptoms, timing, treatment
When documenting, the anatomic landmarks you can use are either the ________ which are lines that cross at the umbilicus or the nine regions that usually just get the medial portions documented which are the 1. ________ region, 2. ________ and the 3. ________ region
- Four quadrants
- Epigastric
- Umbilical
- Hypogastric
The Epigastric region contains what three structures?
- Abdominal Aorta
- Stomach
- Pancreas
The Hypogastric/Suprapubic region contains what two structures?
- Bladder
- Uterus
The main 3 organs in the RUQ are the:
- Liver
- Gallbladder
- Right Kidney
The main 3 organs in the RLQ are the:
- Cecum
- Appendix
- Right Ovary
The main 2 organs in the LUQ are the:
- Spleen
- Stomach
The main 2 organs in the LLQ are the:
- Sigmoid colon
- Left ovary
What major disease should always be on the differential for abdominal pain until proven otherwise?
Cancer
The initial screening question for alcohol abuse is: “”
How many times in the past year have you had 3+ drinks in a day (female) or 4+ drinks in a day (male)
The CAGE questionnaire used for screening alcohol abuse stands for:
C - have you ever felt you should Cut down on your drinking?
A - have people Annoyed you by criticizing your drinking?
G - Do you ever feel bad or Guilty about your drinking?
E - Have you ever had a drink first thing in the morning to make you feel less nervous or get rid of a hangover? Eye opener
What is considered more than moderate alcohol consumption?
For both males and females
- Females = >1 drink per day
- Males = >2 drinks per day
What age is considered a risk factor for Colorectal cancer?
> 50 years old
What 4 lifestyle habits are a risk factors for Colorectal cancer?
- Obesity
- Lack of exercise
- Smoking
- Alcohol consumption
Alcohol consumption when it is more than the “moderate” amount
What are the Personal and Family history criteria to be considered a risk factor for Colorectal cancer?
- Personal or Family history of colorectal cancer or FAP
- Personal history of intestinal polyps or inflammatory bowel disease (Crohn’s or ulcerative colitis)
Familial Adenomatous Polyposis
What is the MUST-DO order when performing an abdominal exam?
- Inspection
- Auscultation
- Percussion
- Palpation
When you see Ecchymosis such as the Grey-Turner’s Sign or Cullen’s sign, what should we see and what should we assume happened to result in this?
What two defining words should we think of?
There is bleeding underneath the skin that is visible and we assume some sort of TRAUMA and RUPTURE that occured to the patient (due to the patient bleeding)
When listening for bowel sounds, what part of the stethoscope should we be using?
Diaphragm
When listening for bruits, what two structures do we listen over and what part of the stethoscope do we use?
- Abdominal aorta
- Renal arteries
- Bell
Hearing increased bowel sounds could indicate what 3 things?
- Gastroenteritis
- Early obstruction
- Hunger - so just being fasted could also result in this
High-pitched tinkling bowel sounds could indicate what?
Small bowel obstruction ((food is being blocked and cannot enter intestines)
Decreased bowel sounds could indicate what 2 things?
- Constipation - VERY COMMON
- Peritonitis (inflammation of peritoneum)
Absent bowel sounds are when you have listened for what length of time and what does that indicate?
- 2 minutes of listening
- Surgical emergency!
Percussing the abdomen helps assess what 3 things?
What does it give us an idea of what is happening in the abdomen?
- Distribution of Gas
- Possible masses
- Size of liver and spleen
A distended (swollen) abdomen that is diffusely tympanic suggests what condition?
An intestinal obstruction
Something is blocking the intestines and food cannot pass through
Tympany notes when percussing should be heard in what type of organs?
What healthy organs should have this sound?
Air-filled viscera
Hyperresonant notes when percussing should be heard over what organ and where?
The base of the lungs
Resonance notes when percussing should be heard over what organ and where?
Over tissue of the lungs
so actually in the lungs
Dullness notes when percussing should be heard over what organs?
What healthy organs would have this sound?
Solid organs
I.e. liver and spleen
Measuring the vertical liver span of a patient using percussion should be done using what anatomical landmark?
What side of the body and what bone do we use as a guide as to where we
Right, midclavicular line
What is the normal liver span of a patient?
6-12 centimeters
Detecting splenomegaly is done by percussing the (lowest/highest) intercostal space in the (left/right) anterior axillary line
- Lowest
- Left
When percussing to check for splenomegaly, you should hear what percussion note? If you hear a different note, why are you hearing that?
- Tympany
- Patient has an enlarged spleen because you are percussing in an area where the spleen shouldn’t be and dullness indicates the spleen has gotten larger and is encroaching on that area
How should the patient’s knees be situated when palpating the abdomen?
Flexed so the abdominal muscles are relaxed
General palpation of the abdomen should be done both light with ____ hand(s) and deep with ____ hand(s)
- One
- Two
When palpating the liver, one option is to place your nondominant hand under the rib cage of what rib numbers and on what side of the patient? Why do you have the patient take a deep breath in when doing this?
- Ribs 11 and 12
- Right side
- Upon inhalation is when you should feel the liver
When palpating the liver using the “one-hand” technique, the liver is palpable in line with what landmark?
The midclavicular line
When palpating the liver, one option is the “hooking” technique, this technique is more helpful in what demographic of patients?
Obese patients
When palpating the spleen, the this technique is done with your nondominant hand lifting the rib cage and your dominant hand pressing in as you ask the patient to ________. This is similar to palpating what other organ?
- Inhale
- Liver with the “one-hand” technique
You can repeat the exam with the patient on the right side with legs flexed if there is concern for splenomegaly
What 3 conditions can cause the liver to be enlarged?
- Hepatitis
- Non-alcoholic Steatohepatitis AKA fatty liver disease - **very common in diabetic patients **
- Cirrhosis
What 3 conditions can cause the spleen to be enlarged?
- Portal hypertension
- Leukemia
- Mono
When palpating the kidneys, one hand is under the ribs and the other hand is placed in either what 2 quadrants? The goal of palpating the kidneys is to “________” the kidneys between your hands
- RUQ or LUQ
- “Capturing”/”trap”
Not expected to feel kidneys as the kidneys require very deep palpation
What 2 big conditions would cause the kidney’s to be enlarged?
- Polycystic kidney disease
- Wilm’s tumor - very important to rule out when doing a wellness child visit because this is the most common reason for an enlarged kidney
The specific test for the kidneys what test? This is also known as looking for ________________________ tenderness
- Lloyd’s test
- Costovertebral angle
this is a percussive test NOT a palpation test
This can be very painful if patient has issue with kidneys such as kidney stones or kidney infection
What 2 other organs can you palpate?
- Bladder - unlikely to feel
- Aorta
At what age would you palpate the aorta and what is considered the normal width?
- > 50 years old
- < 3 cm - over 3 cm = enlarged
Guarding and Rigidity when assessing for peritonitis both involve ________ of the abdominal muscles
- Contraction
What 2 reasons is the presence of Rigidity far more concerning than Guarding when assessing for peritonitis?
- Rigidity is involuntary
- It is a response to peritonitis
Guarding can just be due to patient being scared about it hurting when y
Assessing for peritonitis =
1. Guarding vs Rigidity
2. Rebound Tenderness
3. Percussive Tenderness
The key to rebound tenderness when testing for peritonitis is when the patient says it hurts more when you…
Pull away! This is a response to an irritated peritoneum
Assessing for peritonitis =
1. Guarding vs Rigidity
2. Rebound Tenderness
3. Percussive Tenderness
Percussive tenderness is when the patient describes pain when you…
Percuss over a certain area - This is a response to an irritated peritoneum
What are the 4 peritoneal signs?
- Rovsing’s sign
- Obturator sign
- Psoas sign
- Heel-jar test
The fluid-wave test is specific to test for what?
Ascites - fluid collection in the abdomen
The shifting dullness test is specific to test for what? What would you see if it is a positive test?
- Ascites
- Dullness line shifts from when they are supine to when they are on their side
What are the 3 primary causes of ascites?
- Heart failure
- Liver cirrhosis
- Cancer
cirrhosis and cancer are both due to blocking of hepatic portal vein
When is a Murphy’s sign positive? What does a positive Murphy’s sign indicate?
- When the patient stops inspiration because of the pain
- Acute Cholecystitis
McBurney’s Point is testing for what? Where on the abdomen is the test done?
- Appendicitis
- 1/3 from ASIS to umbilicus
