Abdominal Exam Flashcards
There are essentially three different types of abdominal pain
Referred Pain
Parietal Pain
Visceral Pain
What is Referred pain?
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.
What is Parietal Pain?
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.
What is visceral pain?
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.
How do Kidney and Ureteral Pain differ?
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.
Vindicate Acronym
V – Vascular
I – Infectious
N – Neoplastic
D – Degenerative
I – Iatrogenic/intoxication
C – Congenital
A – Autoimmune
T – Traumatic
E – Endocrine/metabolic
increased peristaltic waves can strengthen the case of suspected _____
intestinal obstruction
ncreased pulsations can be seen with _____
aortic aneurysms
_____ is Subcutaneous edema with bruising in the fatty tissue around the umbilicus.
Cullen’s sign
Cullens sign can be a sign of
Acute pancreatitis
Hemorrhage from trauma
Bleeding from a ruptured ectopic pregnancy
Grey turners sign can be a sign of
Acute Pancreatitis
Blunt abdominal trauma
Ruptured ectopic pregnancy
Aortic rupture
Scleral Icterus (jaundice) can be present with
liver disease, hemolytic anemia, or other causes of high bilirubin levels.
We use auscultation to assess for
Bowel Sounds
Bruits
Friction Rubs
Auscultate the abdomen BEFORE palpation and percussion because ____
the maneuvers may alter the frequency and character of the bowel sounds.
Bowel sound frequencies
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.
Very high-pitched bowel sounds are often heard early in ______
intestinal obstruction.
Where to auscultate for bruits
Aorta, Renal Arteries, Iliac Arteries, and Femoral Arteries.
The tip of the spleen is palpable in only about _____% of healthy adults.
5
If you feel the aorta is enlarged, ____ is the next best step in evaluation.
ultrasound
The normal diameter of an abdominal aorta is _____
less than 3cms.
A protuberant abdomen that is tympanic throughout suggests ____.
bowel obstruction
Dullness in the flanks bilaterally may suggest ____ and warrant further workup
ascites
The normal vertical span of the liver is between ______ cm at the midclavicular line.
6 and 12
A sharp increase in RUQ pain with a sudden stop in inspiratory effort constitutes a Positive
Murphy Sign
A positive Murphy’s Sign is highly suggestive of an _____
Acute Cholecystitis
McBurney’s Point is located _____
2/3 the distance from the umbilicus to the Anterior Superior Iliac Spine in the Right Lower Quadrant.
Deep tenderness to palpation at this point (known as a Positive McBurney’s Sign), can be a sign of ______.
Acute Appendicitis
If you quickly withdraw your fingers after deep LLQ palpation and the patient experiences RLQ pain, this is called _____
“referred rebound tenderness.”; found with Rovsing’s sign
Rebound Tenderness is suggestive of _____, common with Acute Appendicitis.
Peritoneal Inflammation
______ is hyperactive sensitivity to non-noxious stimulation (pain when there shouldn’t be pain)
Cutaneous Hyperesthesia
Two types of Ascites
transudative (by far more common; usually due to liver disease, etc) or exudative (less common; due to cancer or acute inflammation, such as Pancreatitis).
This maneuver may cause internal organs to “bob” up and down in the fluid, suggestive of Abdominal Ascites
Ballottement
3 Exam techniques that all can indicate ascites
Fluid Wave
Shifting Dullness
Ballottment
Always try to stand on the patients ____ side when examining the abdomen
Right
