Abdominal Exam Flashcards
Borborygmi
Increased hyperactive bowel sounds
low pitch rumbling
hyper-peristalsis
Auscultation- where?
Listen before palpation
All 4 quadrants- RLQ d/t cecum best
W/bell L. and R. & midline (between xiphoid and umbilicus) for aortic and renal bruits as well as over femoral a.
Percussion- where?
All 4 quadrants and to determine size of the liver
Percussion- What should you hear?
Tympany
Dull over the liver- resonant over the lungs
Liver- normal size?
less then 10cm
Ascites- signs
Fluid Wave or shifting dullness w/ percussion
Rovsing’s Sign
Referred Rebound Tenderness: press in the LLQ and release- is positive if there is pain in the RLQ
Palpation of the liver-
L. hand under 11th and 12 rib, R. hand in RUQ. Instruct pt to breath deeply as you press gently inward and upward with the right hand
Palpation of the liver- hooking technique
While standing at the head- with both hands hook your fingers under the r. costal margin. Instruct pt to breath deeply while gently pulling inward and upward to palpate the liver
Palpation of the spleen
Same as live but in the LUQ
Spleen should not be palpable under normal conditions
Normal Aorta Size
2.5-3cm
Palpation of the kidney’s
Sandwich method
Should not be palpable under normal conditions
Percussion of the Kidneys
Check for CVA tenderness- AKA Lloyds sign
Positions for a rectal examination
Standing
Modified Lithotomy (on back, legs spread)
Sims’ position (on side)
Positive Fecal Occult Blood Test?
evaluate for colorectal cancer- colonoscopy = best choice.
Condyloma acuminata (type of anal wart) is indicative of what?
HPV
Condyloma lata (anal wart) is indicative of what?
Syphilis
Appendicits- etiology
Obstruction of the appendicular lumen
Appendicitis - typical hx
pain starts around the belly button and migrates to RLQ
+ N/V
Anorexia
Fever
Appendicitis Physical Exam Signs
RLQ pain and rebound tenderness
decreased or absent bowel sounds
+ Rovsing, Psoas, and Obturator sign
Psoas Sign
Pain when pt turned on L side with r. leg extended
Obturator Sign
Right Leg in a figure 4 position, press on r. knee while holding onto l. iliac crest
Appendicitis work up: Bloodwork?
CBC w/ diff: Moderate leukocytosis with a left shift (elevated neutrophils)
BMP: evalute electrolytes and renal function especially if vomiting
Appendicitis work up: Imaging?
CT scan is your best bet. X-ray not helpful. US can show an enlarged and thickened appendix
Appendicitis: Urine?
Pregnancy test imperative. Will help r/o GU condition.
Cholecystitis: Etiology
Obstruction of the cystic duct usually by a gallstone, sometimes neoplasm
Cholecystitis: Hx findings
RUQ postprandial (after eating) pain- biliary colic pain Pain that radiates to R. shoulder \+ N/V Anorexia Obesity Fever Female. Fat, Fertile, Fair, Flatulent
Acute Cholecystitis: PE findings?
RUQ pain and RUQ rebound tenderness
decreased or absent bowel sounds
abdominal distension
+ Murphy’s Sign (RUQ pain and sudden arrest of inspiration during palpation of the liver and bladder)
Diagnostic triad: RUQ pain, fever, leukocytosis
Cholecystitis bloodwork?
CBC: leukocytosis w/ left shift
Serum Bilirubin: can be mildly elevated
AST/ALT: can be elevated
Cholecystitis: Imaging?
US: detect stones, thinking of the wall and dilated bile duct and fluid
HIDA Scan: radionucleotide biliary scan
CT Scan
