Abdominal Exam 1

Question 1

Visceral Pain

Answer 1

secondary to distention, stretching or contracting of hollow organ,
**Not localized

Question 2

Parietal(Somatic) Pain

Answer 2

secondary to inflammation in the parietal peritoneum
usually constant and more severe than visceral pain
***localized
aggravated by movement or coughing
alleviated by remaining still

Question 3

Referred Pain

Answer 3

originated within the abdomen is felt at distant sites that are innervated at approximately the same spinal levels as disordered structure

Question 4

General ROS

Answer 4

fever, chills, chest pain, shortness of breath, cough

Question 5

Focused ROS

Answer 5

GI: nausea, vomiting, diarrhea, black stools, blood in the stool, blood in the vomit
GU: dysuria, polyuria, hematuria, flank or CVA pain
GYN: vaginal bleeding, vaginal discharge, LMP, possible pregnancy

Question 6

Past Surgical History

Answer 6

General
Complaint Specific
–abdominal (cholescystectomy, appendectomy)
–gynecologic (hysterectomy, BTL, C-Section, Ovarian cyst)

Question 7

Medications

Answer 7

GI prescriptions
OTC meds
-blood thinners
-NSAIDS
-Narcotics
-Steroids

Question 8

Important GI Social History

Answer 8

Smoking, Alcohol, Drugs, Stress, Travel

Question 9

GI Physical Exam

Answer 9

1. Inspection
2. Auscultation
3. Percussion
4. Palpation
   - -drape your patient

Question 10

RUQ

Answer 10

liver, gallbladder, stomach, SB, LB

Question 11

RLQ

Answer 11

Appendix, ovary, SB, LB

Question 12

LLQ

Answer 12

sigmoid colon, ovary, SB, LB

Question 13

LUQ

Answer 13

spleen, stomach, SB, LB

Question 14

Epigastric Area

Answer 14

pancreas, liver, gallbladder, stomach, SB, LB

Question 15

Auscultation

Answer 15

gives information about bowel motility
–bell used to listen to bruits

• absent bowel sounds
• decreased bowel sounds
• increased bowel sounds

Question 16

Absent Bowel Sounds

Answer 16

none for more than 2 minutes

d/t long lasting intestinal obstruction, intestinal perforation, mesenteric ischemia

Question 17

Decreased bowel sounds

Answer 17

none for 1 minute

d/t post surgical ileus and peritonitis

Question 18

Increased Bowel sounds

Answer 18

diarrhea, early bowel obstruction

Question 19

High Pitched Bowel Sounds

Answer 19

sounds like tinkling

suggests early intestinal obstruction

Question 20

Bruits

Answer 20

vascular sounds resembling a hear murmur

-vascular obstruction

Question 21

Friction Rub

Answer 21

grating sounds with respiratory variation
inflammation of the peritoneal surface of an organ
listen over liver and spleen

Question 22

Venous Hum

Answer 22

increased collateral circulation between portal and systemic venous system
—epigastric and umbilical regions

Question 23

Percussion

Answer 23

Tympany predominates

protuberant abdomen tympanitic throughout may indicate an obstruction

Question 24

Palpation

Answer 24

gently palpate in all 4 quadrants
then deeply palpate in all 4 quadrants
**always start away from the tender area

Question 25

splenomegaly

Answer 25

when spleen enlarges, it expands anteriorly, downward and medially --assess with percussion and palpation dullness at midaxillary line --portal hypertension, blood malignancies, HIV, splenic infarct, hematoma, mononucleosis

Question 26

Liver Percussion

Answer 26

start in RLQ and RUQ in mid clavicular line and palpate toward the dullness to hit the border of the liver

Question 27

Normal liver span

Answer 27

6-12 cm

Question 28

Liver Span

Answer 28

enlarged: cirrhosis, lymphoma, right sided heart failure, hemachromatosis decreased: cirrhosis

Question 29

Irregular edge/nodules of liver

Answer 29

hepatocelluar carcinoma

Question 30

Firmness/hardness

Answer 30

cirrhosis, hemachromatosis, amyloidosis, lymphoma

Question 31

Shifting Dullness Test

Answer 31

percuss the borders of tympany and have the patients lay on side and percuss the borders again normal: borders stay the same positive test: ascites--dullness shifts to the dependent side and tympany to the topside

Question 32

Test for fluid wave

Answer 32

have patient rest hands over chest ulnar aspects of hands midline and tap sharply on finger tips normal: no impulse felt on the other flank positive test: ascites--impulse transmitted to the other flank

Question 33

McBurneys Point of Tenderness

Answer 33

draw an imaginary line from ASIS to umbilicus and palpate 2 inches medial positive test: tenderness *Appendicitis

Question 34

Rovsing's Sign

Answer 34

palpate deeply in LLQ quickly remove positive test: pain felt in RLQ *Appendicitis

Question 35

Psoas Sign

Answer 35

place hand above patients right knee and ask patient to raise thigh agains resistance positive test: increased abdominal pain *appendicitis

Question 36

Obturator Sign

Answer 36

flex patient right hip with knee bent then internally rotate the hip positive test: right hypogastric pain * appendicitis

Question 37

Murphy's Sign

Answer 37

Test for biliary colic -with right hand, palpate deeply under right costal margin and ask patient to take a deep breath in and palpate deeper + test: sharp increase in tenderness with sudden stop in inspiratory effort

Question 38

Lloyd's Punch

Answer 38

pain to deep percussion in CVA + test: pain implies kidney pathology (pylonephritis, ureterolithiasis)

Question 39

Signs of Acute Abdomen

Answer 39

Guarding Rigidity Rebound tenderness

Question 40

Guarding

Answer 40

Voluntary contraction of the abdominal wall | when palpating the abdomen

Question 41

DDX

Answer 41

cholelithiasis, cholecystitis, pancreatitis, gastritis, PUD, UTI, hepatitis,