Abdominal Exam 1 Flashcards
Visceral Pain?
example?
Not localized –> goes to midline instead cause by distention, stretching or contracting of hollow organs, or organ ischemia. early appendicitis in periumbilical (nondescriptive), but late is localized.. it’s peritonitis
Parietal (somatic)
secondary to inflammation in the parietal peritoneum localized pain usually constant and more severe than visceral pain
`Referred Pain? examples of pancreatic pain?
originates in the abdomen but felt elsewhere.
pancreatic/duodenal pain –> back pain biliary tree –> right shoulder
What’s in the Right Upper Quadrant?
Liver, Gallbladder, Stomach, SI, LI
What’s in the Right Lower Quadrant?
Appendix, ovary, SI, LI
What’s in the Left Lower Quadrant?
Sigmoid Colon, Ovary, SI, LI
What’s in the Left Upper Quadrant
Spleen, Stomach, SB, LB
What’s in the epigastric area?
Pancreas, Liver, Gallbladder, Stomach, SI, LI
This is Striae (stress marks) –> history of having gastric surgery and losing weight.
Cullen’s Sign (echymosis around the belly button)
Normal bowel sounds, how many clicks/gurgles
5-34
How do you listen for abdominal bowel sounds? what about bruits?
Diaphragm
Bell
Absent bowel sounds is what?
Examples?
no sounds for more than 2 minutes
long lasting intestinal obstruction, mesenteric ischemia, intestinal perforation
Decreased bowel sound examples? What’s the difference between this and absent?
Increased bowel sounds examples?
Post surgical Ileus, peritonitis
Diarrhea, EARLY bowel obstruction
What sounds would suggest early intestinal obstruction?
What do bruits in abdominal auscultation suggest?
Friction rub?
Venous Hum?
High pitched
vascular sounds–> vascular obstruction
grating sounds –> inflammation of peritoneal surface of an organ
soft humming –> increased collateral circulation between portal/systemic system
Percussion assesses what?
what are the 4 types of sounds? what 2 are found in the abdominal?
which predominates
assessing for air or fluid
Percuss in all 4 quadrants
**tympany –> high pitch.. air filled
***Dull –> solid organs or masses
Resonance –> hollow abdominal organs (like the lungs)
hyperresonance –> air filled hollow organ (like a pneumothorax)
tympany
How do we palpate the abdominal organs?
You gently palpate all 4 quadrants using the palmar aspect of your hand with fingers together
then do the same thing deeply again.
What are you not going to feel during palpation, and if you do it’s not a good sign
spleen –> splenomegaly
Liver increased span is associated with what?
decreased?
cirrhosis, heart failure, lymphoma, etc.
also cirrhosis (shrunken liver this time)
Splenomegaly indicates what?
portal hypertension, blood malignancies, HIV, hematoma, Mono
Ascites?
what test do you do for this and how does it work?
Fluid in the peritoneal cavity
“Shifting Dullness Test” –> percuss the borders of tympany and dullness with the patient and then have them lay on their side.
normal = borders stay the same
ascites/positive test = dullness shifts to dependent side and tympany to top side
(fluid and solid follow gravity so tympany shifts)!!
Also test for fluid wave –> can feel the wave on either side.
McBurney’s Point?
Rovsing’s?
Psoas sign?
Obturator Sign?
all for appendicitis
McBurney’s –> line ASIS to umbilicus. –> 2 inches medial to ASIS on that line –> tenderness there = appendicitis
Rovsings –> palpate deeply in LLQ and you’ll get pain in the RLQ
Psoas –> ask pt to raise knee against resistance and then turn pt on their left side and extend right leg at the hip.. positive test is increased abdominal pain.
Obturator sign –> flex pt right hip with knee bent, internally rotate the hip –> right hypogastric pain = positive test
Murphy’s sign?
Hands in right upper quadrant and push down and have them take a deep breath.
they’ll either stop breathing in or it’ll hurt a lot.
gallbladder pain!
Pyelonephritis or ureterolithiasis.. what test do you do and where is it at?
at the costovertebral angle area –> Lloyd’s punch
