Abdominal Differential Diagnosis & Screening

Question 1

Describe the sequence of an abdominal examination.

Answer 1

(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

Question 2

What is percussion of the abdomen assessing for? (2)

Answer 2

(1) amount and distribution of gas
(2) sense of size of organ structures (i.e. liver and spleen)

Question 3

What does palpating certain organs help with?

Answer 3

It will help elicit any tenderness, muscular resistance, and may help identify organs and masses

Question 4

When inspecting the shape/contour of the abdomen, what are the various shapes/contours you could find? (4)

Answer 4

flat, round, protuberant, or distended

Question 5

______ abdomens are often due to ascites with fluid accumulated at the sides with the flanks bulging.

Answer 5

protuberant

Question 6

What regions are typical for developing hernias? (4)

Answer 6

epigastric, umbilical, inguinal, or femoral regions

Question 7

If a mass is not located in a typical hernial region and is near a surgical incision, it would be referred to as a ____ ____.

Answer 7

incisional hernia

Question 8

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 _________.

Answer 8

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

Question 9

If a patient has a bowel obstruction, you may see visible ______ across their abdomen.

Answer 9

peristalsis

Question 10

It is normal to see a faint pulsation of the aorta, but an increased pulsation of the aorta is concerning for an ____ ______.

Answer 10

aortic aneurysm

Question 11

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.

Answer 11

5-34 clicks and gurgles/minute

Question 12

Increased bowel sounds may indicate _____ or an early bowel obstruction.

Answer 12

diarrhea

Question 13

Decreased bowel sounds may indicate ileus or ______.

Answer 13

peritonitis

Question 14

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.

Answer 14

bruit

vascular occlusive disease

Question 15

When auscultating the vasculature of the abdomen, you should listen to which arteries? (4 or 7 (with R/L)

Answer 15

aorta

R/L renal arteries

R/L iliac arteries

R/L femoral arteries

Question 16

During percussion of the abdomen, a tympanic sound indicates ___, tympanic + distention indicates ________, and dullness indicates ____, _____, _____, ____ ____, ___ _____, ____ (dull flanks).

Answer 16

tympanic = gas

tympanic + distention = obstruction

dullness = fluid, feces, mass, enlarged organ, full bladder, ascites (dullness in flanks)

Question 17

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 ______.

Answer 17

lower border = below umbilicus

upper border = nipple line

dullness = liver

Question 18

When percussing to identify liver boarders, you should be along the right _______ line.

Answer 18

midclavicular

Question 19

A normal liver size is ____ cm and can be greater in men and taller people.

Answer 19

6-12 cm

Question 20

An enlarged spleen results in the left upper quadrant’s tympanic sounds becoming ____.

Answer 20

dull

Question 21

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.

Answer 21

(1) posterolateral direction
(2) breath deeply

Question 22

Light palpation of the abdomen is examining for what? (3)

Answer 22

tenderness, muscle resistance, or superficial mass

Question 23

Deep palpation (one or two-handed) of the abdomen is examining for what? (2)

Answer 23

abdominal mass

organomegaly

Question 24

The ____ kidney is not usually palpable.

Answer 24

left

Question 25

Bilateral kidney enlargement is suggestive of _______ kidney disease.

Answer 25

polycystic kidney disease

Question 26

Percussion of the bladder will sound ____ if it is distended above the symphysis pubis.

Answer 26

dull

Question 27

What are some reasons a bladder would be distended? (4)

Answer 27

prostatic hyperplasia, a ureteral stricture, neurological conditions (MS, stroke), or it can be medication induced (narcotics, antipsychotic, or antihistamine classes of medications)

Question 28

Suprapubic tenderness of the bladder is common if the individual has a _____ _____ ______.

Answer 28

urinary tract infection (UTI)

Question 29

What are the risks for an abdominal aortic aneurysm? (4)

Answer 29

>65 years old, smoking, male, and 1st degree relative

Question 29

What are the risks for an abdominal aortic aneurysm? (4)

Answer 29

>65 years old, smoking, male, and 1st degree relative

Question 30

A normal sized aorta should be less than __ cm in width.

Answer 30

3 cm

Question 31

Appendicitis can be tested for on an abdominal exam with what special tests? (4)

Answer 31

McBurney’s point, Rovsing’s sign, Psoas sign, Obturator sign

Question 32

[Rovsing’s sign/McBurney’s point] is when you palpate the left and feel pain in the right when assessing for appendicitis.

Answer 32

Rovsing’s sign

Question 33

[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.

Answer 33

Psoas sign

Question 34

[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.

Answer 34

Obturator sign

Question 35

______ 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.

Answer 35

Murphy’s sign

acute cholecystitis

Question 36

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).

Answer 36

Carnet’s sign/test

Question 37

_______ is a surgical emergency. It is inflammation of the parietal peritoneum due to spillage of chemical or feces into abdomen.

Answer 37

peritonitis

Question 38

Peritonitis would result in ______ tenderness, pain with coughing and percussion, and guarding and rigid abdomen.

Answer 38

rebound tenderness

Question 39

Review slides 45-96 in “Abdominal Assessment and Differential Diagnosis” for specifics on common GI causes of abdominal pain.

Answer 39

Do it!