Abdominal Exam 1 - Arnce Flashcards
What’s the difference between Visceral Pain and Parietal (Somatic) Pain?
Visceral Pain
- Visceral Pain fibers
- NOT LOCALIZED
- Example: Periumbilical pain with early appendicitis
Parietal (Somatic) Pain
- Somatic pain fibers
- LOCALIZED
- Constant/more severe than visceral pain
- Example: RLQ parietal tenderness is a later finding in acute appendicitis
What is Referred Pain?
Originate in abdomen —> felt at distant site innervated at same spinal levels as disordered structure
Example: Duodenal and pancreatic pain —> classically to back.
Biliary tree —> right shoulder
For CC and HPI, which two subsets of OLDCAARTS are “most important?”
- Location
- Both initially and currently - Aggravating/Alleviating Factors
Which 3 Systems are considered part of a “Focused ROS” for an Abdominal Examination?
- Gastrointestinal (GI): nausea, vomiting, diarrhea, black stools, blood in stool, blood in vomit
- Genitourinary (GU): dysuria, polyuria, hematuria, flank or CVA pain
- Gynecological (GYN): vaginal bleeding, vaginal discharge, LMP, possibility of pregnancy
NOTE: Considered “Associated Symptoms” as well in OLDCAARTS.
What is the correct ABDOMINAL Physical Examination order?
- Inspection
- Auscultation
- Percussion
- Palpation
Note: Must drape your patient properly.
What are the 4 Inspection Landmarks for Abdominal Examination?
- Xiphoid process of the sternum
- Costal margins
- Umbilicus
- Anterior Superior Iliac Spine (ASIS)
What is found within each of the 4 quadrants?
- RUQ
- Liver, gallbladder, stomach, SB, LB - RLQ
- Appendix, Ovary, SB, LB - LLQ
- Sigmoid Colon, ovary, SB, LB - LUQ
- Spleen, stomach, SB, LB
Which structures are found within the epigastric area?
Pancreas, liver, gallbladder, stomach, SB, and LB
What range indicated “Normal” Bowel Sounds?
5-34 clicks or gurgles/minute
What are 3 indications for ABSENT bowel sounds?
- Long-lasting intestinal obstruction
- Intestinal perforation
- Mesenteric ischemia
NOTE: Absent is none for > 2 min.
What are 2 indications for DECREASED Bowel Sounds?
- Post-surgical ileus
- Peritonitis
NOTE: No bowel sounds for 1 min.
What are 2 indications for INCREASED Bowel Sounds?
- Diarrhea
- Early Bowel Obstruction
Which percussion sound predominates in the abdomen?
TYMPANY - high-pitched, air-filled - because of gas in the GI Tract
Scattered areas of dullness area normal - due to fluid/feces
What are the 4 main types of Percussion sounds?
Tympany - high pitched, air filled
Dullness - non-resonating, solid organs/masses
Resonance - hollow abdominal organs (lungs)
Hyper-resonance - air-filled hollow organ (pneumothorax)
When palpating the abdominal area, which part of the hand do you use? Where do you start palpating first?
Use the palmar aspect of your hand
Start farthest from the tender area
What are the 4 special tests for Appendicitis?
- McBurney’s Point Tenderness
- Rovsing’s Sign
- Psoas Sign
- Obturator Sign
What is McBurney’s Point Tenderness? What is a positive sign?
- Line from ASIS to Umbilicus
- Palpate 2 inches medial to ASIS on that line
Positive Test = Tenderness
NOTE: Best positive and negative predictor value of the 4 special tests for appendicitis
What is Rovsing’s Sign? What is a positive test?
- Palpate deeply in LLQ
Positive Test = Pain in RLQ
What is Psoas Sign? What is a positive test?
- Place hand above patient’s right knee and patient raises thigh against resistance
- Turn patient onto left side and extend right leg at hip
Positive Test = Increased abdominal pain
What is Obturator Sign? What is positive test?
- Flex patient’s right hip with knee bent
- Internally rotate hip
Positive Test = Right hypogastric pain
What is the special test for Biliary Colic (gallbladder/biliary pain)? What is a positive test?
Murphy’s Sign
- With RIGHT hand, palpate under patient’s RIGHT costal margin
- Ask patient to take deep breath in and palpate deeper
Positive Test = sharp increase in tenderness with sudden STOP in INSPIRATORY effort
What is the special test for kidney inflammation/distention? What is a positive test?
Lloyd’s Sign (Punch)
- Deep percussion in the area of the costovertebral angle
Positive Test = Pain in area of costovertebral angle with deep percussion
IMPLIES: Pyelonephritis or ureterolithiasis
What are the 3 signs of Peritoneal Inflammation?
- Guarding
- Rigidity
- Rebound Tenderness
What is Guarding?
- VOLUNTARY contraction of abdominal wall
- Abdominal musculature guards underlying inflamed organs from palpation pressure
