abdominal exam Flashcards
organs in right upper quadrant
- liver and gallbladder
- Pylorus
- duodenum
- head of pancreas
- right adrenal gland
- portion of right kidney
- hepatic flexure of colon
- portions of ascending and transverse colon
Organs in Left upper quadrant
Left lobe liver Spleen Stomach Body Pancreas Left adrenal gland & part of left kidney Splenic flexure Part of transverse & descending colon
Organs of Right Lower quadrant
Lower pole of right kidney Cecum & appendix Bladder (if distended) Ovary & salpinx Uterus (if enlarged) Right spermatic cord Right ureter Portion of ascending colon
Organs of Left Lower quadrant
Lower pole Left kidney Sigmoid colon Bladder (if distended) Ovary & salpinx Uterus (if enlarged) Left spermatic cord Left ureter Portion of descending colon
Define Grey-turners sign
- Bruising of the Flanks
- caused by Pancreatitis, abdominal trauma, ruptured AAA, ruptured ectopic pregnancy
- Has a low specificity and disappointing sensitivity
Define Cullen’s sign
- Periumbilical ecchymosis
- suggests (hemoperitoneum
- Caused by Pancreatitis, ruptured ectopic pregnancy
- same low specificity and disappointing sensitivity as Grey turner
What is a localized bulge in the abdominal wall suggests
HERNIA
Patients with Peritonitis
- have increased pain with sudden movements of the abdomen
Linea Nigra
a line of pigmentation that often develops during pregnancy
Caput Medusa
- dilated tortuous, superficial veins radiating upwards from the umbilicus
Loud prolonged gurgles
borborygmi: normal sounds
- stomach growling
Increased sounds
gastroenteritis, early obstruction or hunger
High pitched tinkling
- intestinal fluid and air under pressure
- early obstruction
Decreased sounds
Peritonitis and paralytic ileus
Abscent sounds
must listen for a full five minutes
- associated with pain and rigidity, surgical emergency
sign of interstinal obstruction
a protuberant abdomen that is diffusely tympanitic
The liver, spleen, kidney and aorta are palpable?
Liver - normal liver edge may be palpable
Kidney - normal kidney is not palpable
Spleen - if palpable it is considered enlarged
Aorta - may be palpable
Define Peritonitis
- inflammation of peritoneum
- typically made worse by patient movement, abdominal wall percussion, and with palpation
Define tenderness
discomfort elicited by palpation
Define Guarding
- VOLUNTARY contraction of the abdominal musculature due to tenderness, fear, the examiners cold hands, or patients anxiety
Define Rebound
- abdominal tenderness that is WORSE when palpating fingers are quickly removed from the place of palpable tenderness
Define Rigidity
- INVOLUNTARY contraction of the abdominal musculature in response to peritoneal inflammation
(involuntary guarding)
Define McBurney’s point
- 1/3 the distance along the imaginary line drawn from the anterior superior iliac spine to the umbilicus
- represents the approximate position of the appendix in a non-pregnant adult
Define Murphy’s sign
- brief inspiratory arrest secondary to patient discomfort when the examiner presses their fingers inward in the RUQ mid-clavicular line
- associated with ACUTE CHOLECYSTITIS
Describe Pancreatitis
- sudden LUQ, epigastric, or umbilical pain
- may refer to left shoulder
- associated: vomiting, fever, shock
PHYSICAL EXAM = Epigastric tenderness, Positive Grey turner and Cullen signs
Describe Cholecytitis
- Severe, unrelenting RUQ or epigastric pain
- refers to right subscapular area
- associated symptoms: anorexia, vomiting, fever, possible jaundice
PHYSICAL EXAM = RUQ tenderness, POSITIVE MURPHY SIGN
describe DIVERTICULITIS
- LLQ pain or localized to diseased area
- Associated: fever, anorexia, diarrhea
PHYSICAL EXAM: LLQ pain on palpation, borborygmus
Describe pelvic inflammatory disease
- Lower quadrant pain in sexually active females
- Assocaited: nausea, vomiting, cervical discharge, dyspareunia
PHYSICAL EXAM: adnexal and cervical tenderness
Appendicitis
- initially presents with periumbilical or epigastric pain that localizes to RLQ
- associated: fever, nausea, vomiting, anorexia
PHYSICAL EXAM: Guarding, Positive obturator, iliopsoas, rovsing, markle, McBurney’s sign
Omphalitis
- infection of umbilical area that may stay localized or extend into umbilical wall, fascia, and peritoneum and portal vessels
- treatment = antistaphylococcal antibiotics
what are the ways to keep a baby calm during palpation
Eating, sucking on pacifier, allow to stay on parents lap
technique to palpation of a baby
flex infants legs at the hips and knees and wait for expiration to accomplish deep palpation
- Most common mass palpable in newborn is ENLARGED KIDNEY
Describe auscultation and percussion in pediatric exam
- different liver spans with differnent ages
- infants = 1-3cm below costal margin
- Hepatomegaly is when the liver is below this level and may be a sign of: congestive heart failure, infection, liver failure
Toddler inspection
- standing toddler has a lumbar lordosis which may give sense of abdominal distension
- lay patient down to be certain
umbilical cord
jelly consistency for a few days
- dries up and falls off by 14 days of age
Blumberg sign
fixed dullness to percussion in left flank and dullness in right flank diasppears with position change
- INDICATES PERITONEAL IRRITATION OR APPENDICITIS
Dance sign
absence of bowl sounds in RLQ
- INDICATES INTUSSUSCEPTION
Kehr sign
Abdominal pain radiating to left shoulder
- INDICATES SPLEEN RUPTURE, RENAL CALCULI, OR ECTOPIC PREGNANCY
MARKLE SIGN
hitting heels causing jarring of the body will cause pain
- INDICATES PERITONEAL IRRITATION OR APPENDICITIS
MURPHY SIGN
ABRUPT CESSATION OF INHALATION WITH PALPATION OF GALLBLADDER
- INDICATES CHOLECYSTITIS
Romber-howship sign
Pain medial aspec thigh to knee
- INDICATES STRANGULATED OBTURATOR HERNIA
ROVSING SIGN
RLQ pain worsed by palpation of LLQ
- INDICATES PERITONEAL IRRITATION OR APPENDICITIES
