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History & Physical Exam > Abdominal Exam > Flashcards

Abdominal Exam Flashcards

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0
Q

Inspection

A
  • General appearance
  • Vital signs
  • Scleral icterus
  • Skin tugor
  • Venous pattern - caput medusae
  • Skin characteristics
  • Contour ( protuberant, flat, scaphoid)
  • Symmetry
  • Surface motion
  • Musculature
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1
Q

Patient position for an abdominal exam

A
  • Comfortable

- Supine, with knees slightly flexed and neck in a neutral position

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2
Q

Skin signs:

A

-abnormal color
-jaundice, cyanosis
-bruises, erythema
-periumbilical discoloration
(Cullen’s sign- acute pancreatitis)
-Flank discoloration
(Grey Turner sign- ac. pancreatitis)
-Striae- purple stretch marks- cushings
-Scars
(Draw- location, size, condition)
Ask about & consider adhesions

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3
Q

Look for these bulges with Pts head lifted:

A
  • Hernias: umbilical, incisional,
    epigastric
  • Diastasis recti ( 2 recti from split)
  • Lipomas (benign fat tumor)
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4
Q

Diaphragm:

A

^ pressure engages it
^ pitch can be heard
- bowel sounds in all 4 quads
- friction rub over liver and spleen

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5
Q

Bell:

A 
Low pressure
Decreased pitch can be hers 
-> Venous hums
    - Epigastrium
    - Umbilicus
-> Bruits
    - Aorta
    - Renals
    - Iliacs
    - Femorals
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6
Q

High pitch tinkling bs :

A

= obstruction

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7
Q

If ten situ of abdomen remains after advising the pt to relax on palpating:

A

Involuntary board like hardness=

Peritoneal irritation

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8
Q

Peritoneal irritation

A

Primary
- cirrhosis -> ascites

Secondary

  • pancreatitis -> pancreatic enzymes
  • gall bladder-> bile
  • stomach perf. -> acid
  • tubal preg. rupture -> blood
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9
Q

Peritoneal inflammation Sx:

A
  • localized pain

- rebound tenderness

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10
Q

Liver border by costal margin > 2-3cm:

A

Hepatomegly
Or
Displacement from lung dz

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11
Q

Avg liver span

A

6-12 cms

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12
Q

Liver movement with inspiration

A

Descend

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13
Q

Murphy’s sign:

A

Gallbladder inflammation

- PT take a deep breath in and observe for cessation of inspiration as the pressure you apply continues

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14
Q

Don’t forget to palpate the: and measure it:

A

Aorta - should be 50yo

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15
Q

Check for palpable ____.

A

Bladder

16
Q

Summery of abdominal exam:

A

-Inspection
-general
-abdomen
-Auscultation
-bowl sounds
-vasculature ( venous hums, Bruits,
friction rub)
-Percussion
-general
-liver
-spleen
-Palpation
-general
-liver
-spleen
-CVA tenderness
Pelvic/ Rectal

17
Q

Ascities Tests

A 
Fluid wave ( tap)
Shifting dullness ( percussion /      
                             decubital position)
18
Q

Ballance’s sign:

A

Rare hematuria from splenic rupture causing :
Left- dull flank from Coag. Blood
Right- shifting dullness from liquid blood

19
Q

Courvoisier’s sign:

A

Jaundice with palpable gallbladder

  • if non tender more likely to be pancreatic mass
20
Q

Fothergill’s sign

A

Rectus sheath hemotoma

  • superficial abdominal mass
  • does not cross midline
  • stays the same while lifting head***
21
Q

Carnett’s sign:

A

Cavity mass non-palpable + deminished

22
Q

Dance sign:

A

Seen with intusseption -

Empty RLQ but sausage mass RUQ

23
Q

Charcot’s Triad:

A
  • jaundice
  • fever
  • RUQ pain
25
Q

Boas’ sign:

A

Hyperaesthesias below the right scapula

( help diff from musculoskeletal pain)

26
Q

Appendicitis tests:

A
  • Iliopsoas sign
  • Obturator sign
  • Markle sign
  • Rovsing’s sign
  • Aaron’s sign over McBurney’s point
27
Q

Rovsing’s sign

A
  • sign of appendicitis

- RLQ pain when LLQ palpated

28
Q

Markle sign

A

Heel jar

29
Q

Aaron’s sign

A

Appendicitis sign

Pain in Epigastrium when holding palpation over McBurney’s point

30
Q

Iliospoas sign

A

Appendicitis sign
Attempt hip flexion with exonerated resistance
(+) pain in RLQ

31
Q

Obturator sign

A

Same as psoas appendicitis
- internal and external hip rotation with knee at 90*
(+) suprapubic area pain

32
Q

Cholecystitis signs

A
  • Murphy’s sign

- Boas’ sign

33
Q

Peritoneal irritation:

A
  • Rebound tenderness (Blumberg sign)

- Invol. Guarding

34
Q

Castell’s sign

A

Splenic percussion sign

35
Q

Reynold’s Pentad:

A

** medical emergency**

Charcot’s triad

  • jaundice
  • fever
  • RUQ pain

Plus/

  • HYPOtension
  • mental status changes

History & Physical Exam (2 decks)

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