Abdominal Differential Diagnosis & Screening Flashcards
Describe the sequence of an abdominal examination.
(1) inspection
(2) auscultation: all 4 quadrants for bowel sounds and then vascular areas (L/R renal and femoral arteries + aorta)
(3) percussion: all 4 quadrants, liver, and spleen
(4) palpation: light and deep, liver, spleen, L/R kidney, aorta, and bladder
What is percussion of the abdomen assessing for? (2)
(1) amount and distribution of gas
(2) sense of size of organ structures (i.e. liver and spleen)
What does palpating certain organs help with?
It will help elicit any tenderness, muscular resistance, and may help identify organs and masses
When inspecting the shape/contour of the abdomen, what are the various shapes/contours you could find? (4)
flat, round, protuberant, or distended
______ abdomens are often due to ascites with fluid accumulated at the sides with the flanks bulging.
protuberant
What regions are typical for developing hernias? (4)
epigastric, umbilical, inguinal, or femoral regions
If a mass is not located in a typical hernial region and is near a surgical incision, it would be referred to as a ____ ____.
incisional hernia
Hernias are usually painless and reproducible, only bulging with Valsalva maneuvers. If a hernia presents as painful, unreproducible, and with systemic symptoms (i.e. fever, nausea, vomiting, bloating, and redness at site) then it is considered _________.
strangulated
This is a medical emergency and should be referred to a general surgeon right away as the bowel or organ has lost its blood supply
If a patient has a bowel obstruction, you may see visible ______ across their abdomen.
peristalsis
It is normal to see a faint pulsation of the aorta, but an increased pulsation of the aorta is concerning for an ____ ______.
aortic aneurysm
When auscultating for bowel sounds, you should be paying attention to the frequency and character of the sounds. Normal would be ____ clicks and gurgles/minute.
5-34 clicks and gurgles/minute
Increased bowel sounds may indicate _____ or an early bowel obstruction.
diarrhea
Decreased bowel sounds may indicate ileus or ______.
peritonitis
When auscultating vasculature of the abdomen and you hear the sound of blood rushing through a narrowing artery, this is called a _____ and is suggestive of vascular ______ disease.
bruit
vascular occlusive disease
When auscultating the vasculature of the abdomen, you should listen to which arteries? (4 or 7 (with R/L)
aorta
R/L renal arteries
R/L iliac arteries
R/L femoral arteries
During percussion of the abdomen, a tympanic sound indicates ___, tympanic + distention indicates ________, and dullness indicates ____, _____, _____, ____ ____, ___ _____, ____ (dull flanks).
tympanic = gas
tympanic + distention = obstruction
dullness = fluid, feces, mass, enlarged organ, full bladder, ascites (dullness in flanks)
When identifying the borders of the liver, you should start percussing at the ______ for the lower border and the _____ _____ for the upper border until you move from tympanic sounds to ______.
lower border = below umbilicus
upper border = nipple line
dullness = liver
When percussing to identify liver boarders, you should be along the right _______ line.
midclavicular
A normal liver size is ____ cm and can be greater in men and taller people.
6-12 cm
An enlarged spleen results in the left upper quadrant’s tympanic sounds becoming ____.
dull
The spleen can be percussed in two ways.
(1) Start in the left lower anterior chest wall and percuss in the __________ direction. Enlargement would be indicated if dullness occurs.
(2) Percuss in the lowest interspcae in the left anterior wall and have patient _____ _____. Enlargement would be indicated if dullness occurs.
(1) posterolateral direction
(2) breath deeply
Light palpation of the abdomen is examining for what? (3)
tenderness, muscle resistance, or superficial mass
Deep palpation (one or two-handed) of the abdomen is examining for what? (2)
abdominal mass
organomegaly
The ____ kidney is not usually palpable.
left
Bilateral kidney enlargement is suggestive of _______ kidney disease.
polycystic kidney disease
Percussion of the bladder will sound ____ if it is distended above the symphysis pubis.
dull
What are some reasons a bladder would be distended? (4)
prostatic hyperplasia, a ureteral stricture, neurological conditions (MS, stroke), or it can be medication induced (narcotics, antipsychotic, or antihistamine classes of medications)
Suprapubic tenderness of the bladder is common if the individual has a _____ _____ ______.
urinary tract infection (UTI)
What are the risks for an abdominal aortic aneurysm? (4)
>65 years old, smoking, male, and 1st degree relative
What are the risks for an abdominal aortic aneurysm? (4)
>65 years old, smoking, male, and 1st degree relative
A normal sized aorta should be less than __ cm in width.
3 cm
Appendicitis can be tested for on an abdominal exam with what special tests? (4)
McBurney’s point, Rovsing’s sign, Psoas sign, Obturator sign
[Rovsing’s sign/McBurney’s point] is when you palpate the left and feel pain in the right when assessing for appendicitis.
Rovsing’s sign
[Psoas/Obturator] sign is when you place your hand just above the patient’s right knee and have them raise their leg against your resistance. If they feel pain in the right lower quadrant, this is concerning for appendicitis.
Psoas sign
[Psoas/Obturator] sign is when you flex the patient’s right thigh at the hip with knee bent and have them rotate their hip internally. If this causes pain in the right lower quadrant, this is concerning for appendicitis.
Obturator sign
______ sign is indicative of ______ __________ and is when the patient experiences right upper quadrant pain and halts their breathing because of pain as you palpate the liver while they take a deep breath.
Murphy’s sign
acute cholecystitis
Abdominal wall pain can be assessed with the _____ sign/test. This sign/test is done with the patient supine. You palpate a painful area on their abdomen and ask the patient to raise their head or legs off the table. If their pain increases or remains unchanged, then their pain is of myofascial source (+ sign/test). If their pain decreases, then their pain is of a deeper, visceral source (- sign/test).
Carnet’s sign/test
_______ is a surgical emergency. It is inflammation of the parietal peritoneum due to spillage of chemical or feces into abdomen.
peritonitis
Peritonitis would result in ______ tenderness, pain with coughing and percussion, and guarding and rigid abdomen.
rebound tenderness
Review slides 45-96 in “Abdominal Assessment and Differential Diagnosis” for specifics on common GI causes of abdominal pain.
Do it!
