Abdominal Exam

Question 1

There are essentially three different types of abdominal pain

Answer 1

Referred Pain
Parietal Pain
Visceral Pain

Question 2

What is Referred pain?

Answer 2

Pain felt in more distant sites that have similar innervation.
Referred pain is usually well localized and often develops as the initial pain becomes more severe.
Example: Biliary tree pain felt in right shoulder.

Question 3

What is Parietal Pain?

Answer 3

Parietal Pain-
Originates from inflammation of the parietal peritoneum and is localized to that inflamed spot.
Steady, aching, and severe, which is typically aggravated by movement or coughing.

Question 4

What is visceral pain?

Answer 4

When hollow organs contract forcefully or are distended.
When solid organs like the liver distend and stretch their capsule.
Difficult to localize.
Can be gnawing, burning, cramping, or aching.

Question 5

How do Kidney and Ureteral Pain differ?

Answer 5

Kidney Pain is often reported as flank pain, which may radiate anteriorly toward the umbilicus.
Ureteral Pain is much different and is severe, colicky, and often radiates around and down into the groin.

Question 6

Vindicate Acronym

Answer 6

V – Vascular
I – Infectious
N – Neoplastic
D – Degenerative
I – Iatrogenic/intoxication
C – Congenital
A – Autoimmune
T – Traumatic
E – Endocrine/metabolic

Question 7

increased peristaltic waves can strengthen the case of suspected _____

Answer 7

intestinal obstruction

Question 8

ncreased pulsations can be seen with _____

Answer 8

aortic aneurysms

Question 9

_____ is Subcutaneous edema with bruising in the fatty tissue around the umbilicus.

Answer 9

Cullen’s sign

Question 10

Cullens sign can be a sign of

Answer 10

Acute pancreatitis
Hemorrhage from trauma
Bleeding from a ruptured ectopic pregnancy

Question 11

Grey turners sign can be a sign of

Answer 11

Acute Pancreatitis
Blunt abdominal trauma
Ruptured ectopic pregnancy
Aortic rupture

Question 12

Scleral Icterus (jaundice) can be present with

Answer 12

liver disease, hemolytic anemia, or other causes of high bilirubin levels.

Question 13

We use auscultation to assess for

Answer 13

Bowel Sounds
Bruits
Friction Rubs

Question 14

Auscultate the abdomen BEFORE palpation and percussion because ____

Answer 14

the maneuvers may alter the frequency and character of the bowel sounds.

Question 15

Bowel sound frequencies

Answer 15

Hyperactive bowel sounds can occur with diarrhea and right after eating.
Hypoactive bowel sounds occur with slowing of the digestive tract.
Absence of bowel sounds could indicated Paralytic Ileus.

Question 16

Very high-pitched bowel sounds are often heard early in ______

Answer 16

intestinal obstruction.

Question 17

Where to auscultate for bruits

Answer 17

Aorta, Renal Arteries, Iliac Arteries, and Femoral Arteries.

Question 18

The tip of the spleen is palpable in only about _____% of healthy adults.

Answer 18

5

Question 19

If you feel the aorta is enlarged, ____ is the next best step in evaluation.

Answer 19

ultrasound

Question 20

The normal diameter of an abdominal aorta is _____

Answer 20

less than 3cms.

Question 21

A protuberant abdomen that is tympanic throughout suggests ____.

Answer 21

bowel obstruction

Question 22

Dullness in the flanks bilaterally may suggest ____ and warrant further workup

Answer 22

ascites

Question 23

The normal vertical span of the liver is between ______ cm at the midclavicular line.

Answer 23

6 and 12

Question 24

A sharp increase in RUQ pain with a sudden stop in inspiratory effort constitutes a Positive

Answer 24

Murphy Sign

Question 25

A positive Murphy’s Sign is highly suggestive of an _____

Answer 25

Acute Cholecystitis

Question 26

McBurney’s Point is located _____

Answer 26

2/3 the distance from the umbilicus to the Anterior Superior Iliac Spine in the Right Lower Quadrant.

Question 27

Deep tenderness to palpation at this point (known as a Positive McBurney’s Sign), can be a sign of ______.

Answer 27

Acute Appendicitis

Question 28

If you quickly withdraw your fingers after deep LLQ palpation and the patient experiences RLQ pain, this is called _____

Answer 28

“referred rebound tenderness.”; found with Rovsing’s sign

Question 29

Rebound Tenderness is suggestive of _____, common with Acute Appendicitis.

Answer 29

Peritoneal Inflammation

Question 30

______ is hyperactive sensitivity to non-noxious stimulation (pain when there shouldn’t be pain)

Answer 30

Cutaneous Hyperesthesia

Question 31

Two types of Ascites

Answer 31

transudative (by far more common; usually due to liver disease, etc) or exudative (less common; due to cancer or acute inflammation, such as Pancreatitis).

Question 32

This maneuver may cause internal organs to “bob” up and down in the fluid, suggestive of Abdominal Ascites

Answer 32

Ballottement

Question 33

3 Exam techniques that all can indicate ascites

Answer 33

Fluid Wave
Shifting Dullness
Ballottment

Question 34

Always try to stand on the patients ____ side when examining the abdomen

Answer 34

Right