Abdominal Complaint 1 Flashcards
What are the types of abdominal pain?
Parietal pain
Visceral pain
Referred pain
Visceral pain
Stimulation of visceral pain fibers
- Secondary to distention or stretching of organs
- NOT LOCALIZED
Parietal pain
Stimulation of somatic pain fibers
- Secondary to inflammation in the parietal peritoneum
- LOCALIZED
Referred pain
Originates within the abdomen but is felt at distant sites which are innervated at same spinal levels as the disordered structure
Important information to get from the HPI?
Location
Aggravating and Alleviating factors
Important information to get from medications?
Blood thinners
NSAIDS
Narcotics, steroids
What is the order of the physical exam for an abdominal complaint?
- Inspection
- Auscultation
- Percussion
- Palpation
What must you do to start the physical exam for an abdominal complaint?
Drape your patient
What is the importance of ausciltation?
Bowel sounds - bowel motility information
What do you use to listen (ausiltation) to bowel sounds?
Diaphragm of stethoscope (bigger side)
What are the normal bowel sounds?
5-34 clicks/gurgles per minute
Absent bowel sounds are none for how long?
At least 2 minutes
Decreased bowel sounds are none for how long?
1 minute
Increased bowel sounds can indicate?
Diarrhea, early bowel obstruction
High pitched bowel sounds can suggest?
Early intestinal obstruction
What does percussion allow you to assess for?
Fluid and solid-filled masses
Amount of gas in the abdomen
Sizing of liver and spleen
Tympany of percussion
High-pitched = air filled
Dullness of percussion
Non-resonating = solid organs or masses or feces
Resonance of percussion
Hollow abdominal organs (lungs)
Hyper-resonance of percussion
Air-filled hollow organ = pneumothorax
Most common percusssion?
Tympany because of gas in GI tract
- Scattered dullness is normal from fluid and feces
Gently palpate in all 4 quadrants and then _____ in all 4 quadrants
Deeply palpate
When palpating, always start where?
AWAY from area of reported tenderness
Is the spleen normally palpable?
NO, unless enlarged
How can you tell if the liver is enlarged when palpating?
Vertical span is increased
Where do you palpate for the liver?
Right midclavicular line
What is the best test for testing for Ascites?
Test for a fluid wave
Describe the way to test for a fluid wave for Ascites
- Patient rests hands over chest
- Have assistant place ulnar aspects of hands midline
- Place your hands on flanks and tap one flank sharply with finger tips
Normal response for test for a fluid wave for Ascites?
NO impulse felt on other flank
ABnormal response for test for a fluid wave for Ascites?
(+) = impulse transmitted to the other flank
What are the special tests for appendicitis?
McBurney’s Point Tenderness
Rovsing’s Sign
Psoas sign
Obturator sign
Best test for appendicitis?
McBurney’s Point Tenderness
Describe McBurney’s point tenderness
Draw imaginary line from ASIS to umbilicus and palpate 2 inches medial to ASIS on that line (1/3 of way to umbilicus on that line)
(+) McBurney’s point tenderness test?
Tenderness = indicates appendicitis
Describe the Rovsing’s sign
Palpate deep in LLQ
(+) = pain in RLQ - indicates appendicitis
Psoas sign
Have patient raise right thigh against resistance, then turn patient on left side and extend right leg at hip
(+) = increased abdominal pain for either maneuver - indicates appendicitis
Obturator sign
Flex patient’s right hip with knee bent, then internally rotate hip
(+) = right hypogastric pain - indicates appendicitis
Special test for biliary colic
Murphy’s sign
Describe Murphy’s sign
With right hand, palpate deeply under patient’s right costal margin
- ask patient to take a deep breath in and palpate deeper
(+) murphy’s sign
Sharp increase in tenderness with sudden stop in inspiration when deeply palpating below right costal margin = biliary colic
Special test for kidney inflammation/distention
Lloyd’s sign (punch)
Describe (+) Lloyd’s sign
Pain to deep percussion in the area of the costovertebral angle
What are the peritoneal signs of an acute abdomen?
Guarding
Rigidity - abdominal muscles are stiff
Rebound tenderness - more tenderness when letting go than when pushing in during palpating
