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Physical Diagnosis > Abdominal Exam > Flashcards

Abdominal Exam Flashcards

1
Q

What are the 4 abdominal quadrants?

A
  1. RUQ
  2. LUQ
  3. RLQ
  4. LLQ
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2
Q

What are the nine abdominal sections?

A
  1. R Epigastric
  2. Middle Epigastric
  3. L Epigastric
  4. R Umbilical
  5. Middle Umbilical
  6. L umbilical
  7. R hypogastric
  8. Middle Hypogastric
  9. L hypogastric
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3
Q

what condition is asst. with abdominal fullness or early satiety?

A

Gastroparesis asst. with diabetes

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4
Q

Define Heartburn

A

a burning sensation in the epigastric area radiating into the throat; often associated with regurgitation

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5
Q

Define excessive gas or flatus

A

needing to belch or pass gas by the rectum; patients often state they feel bloated

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6
Q

Define anorexia

A

lack of an appetite

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7
Q

Define regurgitation

A

the reflux of food and stomach acid back into the mouth; brine-like taste

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8
Q

Define the physiology of retching

A

spasmodic movement of the chest and diaphragm like vomiting, but no stomach contents are passed

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9
Q

What additional questions need to be asked about a vomiting pt?

A
  1. AMount of vomit

2. Type of vomit: food, green- or yellow-colored bile, mucus, blood, coffee ground emesis (often old blood)

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10
Q

Define hematemesis

A

Blood or coffee ground emesis

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11
Q

Describe Visceral pain etiology

A

when hollow organs (stomach, colon) forcefully contract or become distended. Solid organs (liver, spleen) can also generate this type of pain when they swell against their capsules.

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12
Q

What are the descriptors for visceral pain?

A

Visceral pain is usually gnawing, cramping, or aching and is often difficult to localize (hepatitis)

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13
Q

Describe the etiology of parietal pain

A

when there is inflammation from the hollow or solid organs that affect the parietal peritoneum

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14
Q

What are the descriptors for parietal pain?

A

Parietal pain is more severe than visceral and is usually easily localized (appendicitis)

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15
Q

Describe the etiology of referred pain

A

originates at different sites but shares innervation from the same spinal level

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16
Q

Where is referred pain from the gallbladder felt?

A

Shoulder

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17
Q

Where is referred pain from pancreatitis felt?

A

back

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18
Q

Where is pain from the biliary tree and liver felt?

A

RUQ or epigastric

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19
Q

Where is pain from the rectum felt?

A

Suprapubic or sacral region

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20
Q

Where is pain from the colon, bladder or uterus felt?

A

Hypogastric region. Colon pain may be diffuse

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21
Q

Where is pain from the SI, appendix, or proximal colon felt?

A

Perilumbar region

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22
Q

Where is pain from the stomach, duodenum, or pancreas felt?

A

epigastric region

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23
Q

What questions need to be asked about BMs?

A
  1. Frequency
  2. Consistency (diarrhea vs. constipation)
  3. Any pain
  4. Any blood (hematochezia, usually hemorrhoids) or black, tarry stool (melena: usually GI bleed)
  5. color
  6. Look for any associated signs such as jaundice or icteric sclerae
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24
Q

What does melena indicate?

A

GI bleed

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25
Q

What does hematochezia indicate?

A

Hemorrhoids

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26
Q

What do white or grey stools indicate?

A

white or gray stools can indicate liver or gallbladder disease

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27
Q

What questions need to be asked about the GU tract?

A
  1. frequency and urgency
  2. dysuria (burning at the urethra or aching in the suprapubic area of the bladder)
  3. color and smell of the urine; red urine usually means hematuria
  4. Ask about difficulty starting to urinate (especially in men) or the leakage of urine (incontinence, especially in women)
  5. Ask about back pain at the costovertebral angle (kidney) and in the lower back in men
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28
Q

Where is prostate pain referred to?

A

lower back

29
Q

What is painless hematuria until proven otherwise?

A

Bladder cancer

30
Q

What are you looking for when inspecting abdominal skin?

A

scars, striae (stretch marks), vein pattern, hair distribution, rashes, or lesions

31
Q

What are you looking for when inspecting the umbilicus?

A

observe contour and location and any signs of an umbilical hernia

32
Q

What are you looking for when inspecting the contour of the abdomen?

A

flat, rounded, protuberant, or scaphoid, symmetry

33
Q

What are you looking for when inspecting the movements of the abdomen?

A

Inspect for signs of peristalsis (rhythmic movement of the intestine that can be seen in thin people) and pulsations (within blood vessels such as the aorta)

34
Q

What order is used when assessing the abdomen?

A

Inspection
Ascultation
percussion
palpation

35
Q

What side of the stethoscope is used to hear bowel sounds?

A

diaphragm

36
Q

How long must one listen for bowel sounds until they are considered absent?

A

2 mins

37
Q

Where must one listen for abdominal bruits?

A
  1. Aorta (midline)
  2. Renal arteries ( above umbilicus off midline)
  3. Bifurcation of common iliac arteries (below umbilicus off midline)
  4. Hepatic
38
Q

What does a hepatic bruit indicate?

A

suggests heptocellular carcinoma or alcoholic hepatitis

39
Q

What does a hepatic venous hum indicate?

A

suggest portal hypertension

40
Q

What is the normal sound when percussing over the abdomen?

A

tympany (hollow sounds)

41
Q

What does dullness to percussion indicate?

A

a large stool or a mass

42
Q

How does one percuss out the liver?

A
  1. Lower border: start below umbilicus (tympanic) and percuss upward in right MCL or MSL until liver dullness
  2. Upper border: start from lung resonance in MCL or MSL and percuss downward to liver dullness
    Measure span:
43
Q

What are the normal ranges for liver span?

A

males 8-12 cm,

females 6-10 cm

44
Q

How do you determine shifting dullness?

A

Determine the border of tympany and dullness by percussion in supine position, beginning at the umbilicus and moving laterally (mark the spot with a pen). Repeat percussion in the same direction with the patient rolled to that same side.

45
Q

What are the normal results of shifting dullness?

A

Margin does not move

46
Q

What are the results of shifting dullness when ascites is present?

A

In the presence of ascites, the tympany-dullness margin will move “upward” (toward the umbilicus) as the ascitic fluid pools in the dependent side of the peritoneal cavity.

47
Q

What does a fluid wave indicate?

A

Ascites

48
Q

How is a fluid wave determined?

A
  1. Ask the patient to place the ulnar side of his/her hand in the midline of the abdomen (this prevents a false positive due to the patient’s fat and flatus)
  2. Tap on lateral side of abdomen and assess the transmission of a wave to contralateral side using the other hand – if the fluid thrill can be palpated by this hand, the abdominal distension is likely due to ascites
49
Q

When performing light palpation, how do you assess voluntary guarding?

A

Tell the patient to breathe out deeply

Tell the patient to breathe through the mouth with the jaw dropped open

50
Q

How do you differentiate between voluntary and involuntary guarding?

A
  1. patient consciously flinches when you touch him

2. muscles spasm when you touch the patient, but he cannot control the reaction

51
Q

What are you looking for when performing light palpation?

A

superficial organs or masses

52
Q

What is rebound tenderness indicative of?

A

inflammatory disorder: peritonitis, appendicitis

53
Q

Define rebound tenderness

A

Rebound tenderness occurs if pain increases when the examiner decreases the pressure against the abdomen

54
Q

How is the liver palpated?

A
  1. Using the left hand to support the back at the level of the 11th and 12th rib, the right hand presses on the abdomen inferior to the border of the liver and continues to palpate superiorly until the liver border is palpated.
  2. Ask the patient to take a deep breath. This can illicit pain in liver or gallbladder disease and also makes it easier to find the inferior border of the liver (the diaphragm lowering during deep inspiration forces the liver downward).
55
Q

When is the spleen palpable?

A

Splenomegaly

56
Q

What is costovertebral angle tenderness indicative of?

A

pyelonephritis until proven otherwise

57
Q

what is protuberant abdomen with bulging flanks is suspicious for?

A

Ascites

58
Q

What conditions can cause ascites

A

cancer

59
Q

What special tests are used for appendicitis assessment?

A
  1. Check for involuntary guarding and rebound tenderness in the right lower quadrant
  2. Perform a rectal examination in both sexes and a pelvic examination in women
  3. Check for Rovsing’s sign
  4. Check for Psoas sign
  5. Check for the Obturator sign
60
Q

What is Rovsing’s sign and what is it used for?

A
  1. rebound tenderness in the left lower quadrant

2. Appendicitis assessment

61
Q

What is the Psoas sign and what is it used for?

A
  1. the patient flexes his thigh against the examiner’s hand; pain indicates a positive sign
  2. Appendicitis
62
Q

What is the obturator sign and what is it used for?

A
  1. flex the patient’s thigh and rotate the leg internally at the hip; pain indicates a positive sign
  2. Appendicitis
63
Q

What is the Carnett’s sign and what is it used for?

A
  1. Abdominal pain/tenderness exascerbated when pt lifts feet above bed without bending knees
  2. Positive: Source of pain is abdominal wall (strain/sprain/hernia) bc stretching of wall worsens any lesion within
  3. Negative: source of pain is inside abdominal cavity bc stabilizing abdominal wall protects the organs within
64
Q

What is the Kehr’s sign and what is it used for?

A
  1. left shoulder pain exacerbated by elevating foot of bed: referred pain, diaphragmatic involvement
  2. Splenic rupture
65
Q

What is the Grey-Turner’s sign and what is it used for?

A
  1. Blue discooration of the flank area caused by retoperitoneal hemorrhage
  2. Acute hemorrhagic pancreatitis, ruptured abdominal aneurysm, strangulated bowel
66
Q

What is the Cullen’s sign and what is it used for?

A
  1. Blue discooration of the periumbilical area caused by retoperitoneal hemorrhage tracking around to anterior abdominal wall
  2. Acute hemorrhagic pancreatitis, ectopic pregnancy
67
Q

What is the Courvoisier’s sign and what is it used for?

A
  1. Painless, palpable distended gallbladder

2. Pancreatic cancer

68
Q

What is the Murphy’s sign and what is it used for?

A
  1. Hand contact with gallbladder elicits pain, arrest of deep inspiration on RUQ pain
  2. Cholecystitis
69
Q

What is the McBurney’s sign and what is it used for?

A
  1. Tenderness at McBUrney’s point (1/3 along the line extending from ASIS to umbilicus)
  2. Appendicitis

Physical Diagnosis (9 decks)

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