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ECOS 2 Pre-Midterm > Abdominal Complaint 1 > Flashcards

Abdominal Complaint 1 Flashcards

1
Q

What are the types of abdominal pain?

A

Parietal pain
Visceral pain
Referred pain

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2
Q

Visceral pain

A

Stimulation of visceral pain fibers

  • Secondary to distention or stretching of organs
    • NOT LOCALIZED
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3
Q

Parietal pain

A

Stimulation of somatic pain fibers

  • Secondary to inflammation in the parietal peritoneum
    • LOCALIZED
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4
Q

Referred pain

A

Originates within the abdomen but is felt at distant sites which are innervated at same spinal levels as the disordered structure

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5
Q

Important information to get from the HPI?

A

Location

Aggravating and Alleviating factors

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6
Q

Important information to get from medications?

A

Blood thinners
NSAIDS
Narcotics, steroids

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7
Q

What is the order of the physical exam for an abdominal complaint?

A
  1. Inspection
  2. Auscultation
  3. Percussion
  4. Palpation
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8
Q

What must you do to start the physical exam for an abdominal complaint?

A

Drape your patient

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9
Q

What is the importance of ausciltation?

A

Bowel sounds - bowel motility information

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10
Q

What do you use to listen (ausiltation) to bowel sounds?

A

Diaphragm of stethoscope (bigger side)

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11
Q

What are the normal bowel sounds?

A

5-34 clicks/gurgles per minute

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12
Q

Absent bowel sounds are none for how long?

A

At least 2 minutes

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13
Q

Decreased bowel sounds are none for how long?

A

1 minute

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14
Q

Increased bowel sounds can indicate?

A

Diarrhea, early bowel obstruction

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15
Q

High pitched bowel sounds can suggest?

A

Early intestinal obstruction

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16
Q

What does percussion allow you to assess for?

A

Fluid and solid-filled masses
Amount of gas in the abdomen
Sizing of liver and spleen

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17
Q

Tympany of percussion

A

High-pitched = air filled

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18
Q

Dullness of percussion

A

Non-resonating = solid organs or masses or feces

19
Q

Resonance of percussion

A

Hollow abdominal organs (lungs)

20
Q

Hyper-resonance of percussion

A

Air-filled hollow organ = pneumothorax

21
Q

Most common percusssion?

A

Tympany because of gas in GI tract

- Scattered dullness is normal from fluid and feces

22
Q

Gently palpate in all 4 quadrants and then _____ in all 4 quadrants

A

Deeply palpate

23
Q

When palpating, always start where?

A

AWAY from area of reported tenderness

24
Q

Is the spleen normally palpable?

A

NO, unless enlarged

25
Q

How can you tell if the liver is enlarged when palpating?

A

Vertical span is increased

26
Q

Where do you palpate for the liver?

A

Right midclavicular line

27
Q

What is the best test for testing for Ascites?

A

Test for a fluid wave

28
Q

Describe the way to test for a fluid wave for Ascites

A
  • 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
29
Q

Normal response for test for a fluid wave for Ascites?

A

NO impulse felt on other flank

30
Q

ABnormal response for test for a fluid wave for Ascites?

A

(+) = impulse transmitted to the other flank

31
Q

What are the special tests for appendicitis?

A

McBurney’s Point Tenderness
Rovsing’s Sign
Psoas sign
Obturator sign

32
Q

Best test for appendicitis?

A

McBurney’s Point Tenderness

33
Q

Describe McBurney’s point tenderness

A

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)

34
Q

(+) McBurney’s point tenderness test?

A

Tenderness = indicates appendicitis

35
Q

Describe the Rovsing’s sign

A

Palpate deep in LLQ

(+) = pain in RLQ - indicates appendicitis

36
Q

Psoas sign

A

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

37
Q

Obturator sign

A

Flex patient’s right hip with knee bent, then internally rotate hip
(+) = right hypogastric pain - indicates appendicitis

38
Q

Special test for biliary colic

A

Murphy’s sign

39
Q

Describe Murphy’s sign

A

With right hand, palpate deeply under patient’s right costal margin
- ask patient to take a deep breath in and palpate deeper

40
Q

(+) murphy’s sign

A

Sharp increase in tenderness with sudden stop in inspiration when deeply palpating below right costal margin = biliary colic

41
Q

Special test for kidney inflammation/distention

A

Lloyd’s sign (punch)

42
Q

Describe (+) Lloyd’s sign

A

Pain to deep percussion in the area of the costovertebral angle

43
Q

What are the peritoneal signs of an acute abdomen?

A

Guarding
Rigidity - abdominal muscles are stiff
Rebound tenderness - more tenderness when letting go than when pushing in during palpating

ECOS 2 Pre-Midterm (14 decks)

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