Abdominal Exam 1

Question 1

Three types of abdominal pain

Answer 1

Visceral pain

Parietal pain

Referred pain

Question 2

Charateristics of visceral pain

Answer 2

• Caused by stimulation of visceral pain fibers
• Secondary to distension, stretching, or contraction of hollow organs, stretching of capsule of solid organs or organ ischemia
• Not localized-usually felt at he organ midline level

**Paraumbilical pain with appendicitis

Question 3

Characteristics of Parietal (Somatic) Pain

Answer 3

• Caused by stimulation of the somatic pain fibers
• Secondary to in flammation in the parietal peritoneum
• LOCALIZED - usually constant & more severe
• Aggravated by movement or coughing

Alleviated by remaining still

** RLQ parietal tenderness –> acute peddicitis

Question 4

Describe referred pain

Answer 4

• Originates w/in the abdomen but is felt at distant sites which ate innervated at approx the same spinal levels as the disordered structure

**Ex: duodenal and pancreatic pain are classically referred to the back

Question 5

In lecture, what were described at the “standout” questions for abdominal pain HPI?

Answer 5

• Location
• Aggravating/Alleviating factors

Question 6

What are the three focused ROS areas for abdominal pain?

Answer 6

GI, GU, GYN

Question 7

Flags in PMH

Answer 7

General: HTN, DM, CAD, CHF, COPD

Complaint specific: Hep, GERD/PUD, GB, IBD, Cancer, chronic pain, constip.

Question 8

Flags in SurgHx

Answer 8

Cholecystectomy

Appy

Hysterectomy

C-Sect

Ovarian Cysts/PCOS

Question 9

Medications associated with abdominal pain

Answer 9

Emphasized in lecture : Blood thinners, NSAIDS, Narcotics, Steroids

Others: GI Rx (H2 blockers, PPI), Tylenol, NSAIDS, Antacids, Laxitives)

Herbals

Question 10

Social History Flags specific to Abd pain

Answer 10

“Bigg three” –> Smoking, Alcohol, Drugs

Additional: stress, travel, well water, undercooked meat

Question 11

Order of Physical exam

Answer 11

1, Inspection

2. Auscultation
3. Percussion
4. Palpation

**Palpation last so not to disrupt bowel sounds before auscultation

Question 12

Contents of the RUQ

Answer 12

Right kidney, right lobe of the liver, gallbladder and bile ducts, head of the pancreas, stomach, small bowel, large bowel (hepatic flexure and portions of ascending and transverse)

Question 13

Contents of LUQ

Answer 13

Left kidney, spleen, left lobe of the liver, stomach, duodenum, body and tail of the pancreas, pancreatic duct, large bowel ( splenic flexure and portions of transverse and descending)

Question 14

Contents of the LRQ

Answer 14

Distal ileum, appendix, cecum and first part of ascending colon, uterus, right ovary, right half of bladder and anus

Question 15

Contents of the LLQ

Answer 15

Small intestine, large intestine (portion of the descending colon, sigmoid and rectum), left half of the urinary bladder and anus, left ovary and uterus

Question 16

Contents of the epigastric area

Answer 16

Pancreas, liver, gallbladder, stomach, small bowel, large bowel

Question 17

Important considerations for abdominal inspection

Answer 17

Surface: color, scars, striae, dilated veins, rash, eccymoses

Contour: flat, round, scaphoid, bulges, obese, protuberant

Question 18

Classifications of bowel sounds

Answer 18

Normal bowel sounds: 5-34 clicks/gurgles per minute

Absent: none for >2 minutes (long term obstruction, intestinal perf, mesenteric ischemia)

Decreased: none for 1 minute (post-surg ileus, peritonitis)

Increased: >35 per minute (diarrhea, early bowel obstruction)

Question 19

Auscultation characterizations for bowel sounds

Answer 19

• High pitched: “tinkling” (rain on a metal roof; suggests early intestinal obstruction)
• Bruits: vascular sounds resembling a heart murmur over the aorta, iliacs, or renal arteries; suggests vascular obstruction
• Friction rub: grating sounds with respiratory variation; suggestive of inflammation of the peritoneal surface of an organ (listen over liver and spleen)
• Venous hum: soft humming noise; indicative of increased collateral circulation btw portal & systemic venous systems (listen over epigastric & umbilical regions)