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PCM II > Abdominal Exam > Flashcards

Abdominal Exam Flashcards

1
Q

What is the order of an abdominal physical exam?

A
  1. Inspection
  2. Auscultation
  3. Percussion
  4. Palpation
    (you want to see first and touch last)
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2
Q

What is cullen’s sign?

A

Echymoses around umbiicus (hemoperitoneum, acute pancreatitis)

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3
Q

What is Grey Turner’s sign?

A

Echymoses of the flanks (hemoperitoneium, acute pancreatitis)

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4
Q

To auscultate the abdomen, would you use the diaphragm or bell of the stethoscope?

A

diaphragm.

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5
Q

How many clicks/gurgles is normal bowel sounds?

A

5-34

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6
Q

What is considered absent bowel sound and what are some examples that can cause it?

A

no sounds for >2 mins . long-lasting intestinal obsturction, intestinal perforation, mesenteric ischemia

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7
Q

What is considered decreased bowel sounds?

A

None for 1 minute. could be due to post-surgical ileus, peritonitits

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8
Q

What is high pitched bowel sounds indicate and what does it sound like?

A

Sounds like tinkling (raindrops on metals). suggests early intestinal obstruction

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9
Q

What does friction rub sound like and what is this sort of sound indicative of?

A

Grating Sounds with respiratory variation. Could be due to inflammation of the peritoneal surface of an organ
listen over liver and spleen

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10
Q

What is venous hum, and what does it sound like?

A

Soft humming noise. It’s increased collateral circulation between portal and systemic venous systems.

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11
Q

Where would one listen for venous hum?

A

Listen over epigastric and umbilical region.

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12
Q

During percussion, what is the predominant sound you’d hear over the abdomen?

A

Mainly tympany due to the gas int the GI tract. Scattered areas of dullness is normal form fluid and feces.

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13
Q

What causes visceral pain?

A

when hollow organs contract or are distended/stretched, ischemia also stimulates visceral pain fibers.

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14
Q

Where is visceral pain localized to?

A

Pain is difficult to localize but can be palpable in the midline at level of structure involved.

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15
Q

If a patient complains of pain in the RUQ, what visceral pain is that most indicative of?

A

Liver distention causing stretching of its capsule with alcoholic hepatitis

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16
Q

If a pt presents with pain due to acute appendicitis, where would you most likely palpate the visceral pain?

A

periumbilical region.

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17
Q

Which pain, visceral or parietal, is easier to localize?

A

Parietal is easier to localize

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18
Q

What is parietal pain?

A

inflammation in the parietal peritoneum.

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19
Q

Describe the difference between visceral and parietal pain.

A

Parietal pain is steady, aching pain usually more severe than visceral. Parietal pain is easy to localize. Parietal pain is aggravated by movement or coughing, patients want to lie still.

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20
Q

In which quadrant/region is parietal tenderness due to acute cholecystitis most likely localized to?

A

RUQ/epigastric

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21
Q

In which quadrant/region is parietal tenderness due to acute pancreatitis most likely localized to?

A

Epigastric

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22
Q

In which quadrant/region is parietal tenderness due to acute diverticulitis most likely localized to?

A

LLQ

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23
Q

This type of pain is felt at distant sites, which are innervated at approximately the same spinal levels as the disordered structure.

A

Referred pain

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24
Q

Where is duodenal and pancreatic pain classically referred to?

A

Back

25
Q

Pain from biliary tree is classically referred to where?

A

right shoulder

26
Q

To percuss the lower border of liver, how should you perform your percussion?

A

Start at RLQ (area of tympany) and percuss cephalad to an area of dullness

27
Q

To percuss the upper border of liver, how should you perform your percussion?

A

Start in RUQ (area of lung resonance) and percuss caudad toward liver dullness

28
Q

What is the normal vertical span of the liver?

A

6-12cm

29
Q

During percussion, a falsely increased vertical span of liver can be observed during what condition?

A

pleural effusion

30
Q

During percussion, a falsely decreased vertical span of the liver can be observed during what condition?

A

Free air under the diaphragm

31
Q

A doc places his left hand behind patient supporting the right 11th and 12th ribs and pushes left hand upward towards patient’s anteriior. Doc’s right hand is on patient’s right abdomen and presses cephalad gently and asks patient to take deep breaths. What is the doc trying to palpate?

A

Liver

32
Q

Palpating a slightly tender, soft, smooth surface of the liver indicates _

A

Normal liver

33
Q

A doc starts his percussion from the cardiac border of left anterior axillary line, and moves laterally. What is he trying to percuss?

A

Spleen

34
Q

Doc starts his percussion from the cardiac border of the left anterior axillary line and moves laterally. He notices tympany is prominent laterally in midaxillary line. This is indicative of _

A

a normal spleen and splenomegaly is not likely. Splenomegaly is percussed as dullness at midaxillary line.

35
Q

A doc’s left hand grasps posterior aspect of LUQ and right hand below left costal margin and presses posteriorly and asks patient to take deep breaths. What is he trying to palpate?

A

Spleen

36
Q

WHat are two tests you can perform to check for ascites ?

A
  1. Shifting dullness test

2. Test for a fluid wave

37
Q

What is a positive test for shifting dullness test?

A

dullness shifts to dependent side and tympany to top side when percussing the borders in supine vs lateral recumbent.

38
Q

What is a positive test for test for fluid wave?

A

Impulses is transmited to the other flank when tapped from one side.

39
Q

What are some tests you can do to test for appendicitis?

A
  1. McBurney’s point
  2. Rovsing’s sign
  3. Psoas sign
  4. Obturator sign
  5. Heel strike
40
Q

What is positive for McBurney’s point?

A

Tenderness at McBurney’s point (2 inches medial to ASIS in an imaginary line from ASIS to umbilicus)

41
Q

What is positive test for Rovsing’s sign?

A

Pain felt in the RLQ during deep palpation

42
Q

How do you perform a Psoas test?

A

Place hand above patient’s right knee and ask patient to raise thigh against resistance.

43
Q

What is a positive test for Psoas test?

A

Increased abdominal pain

44
Q

How do you test for obturator sign?

A

Flex patient’s right hip with knee bent, then internally rotate the hip.

45
Q

What is a positive test for obturator sign?

A

Right hypogastric pain

46
Q

What is Murphy’s sign?

A

It’s a test for cholecystitis. With right hand, palpate deeply under the patient’s right costal margin, ask pt to take a deep breath in and palpate deep.

47
Q

What is a positive test for Murphy’s sign?

A

Sharp increase in tenderness with sudden stop in inspiratory effort

48
Q

What are some common causes of peritonitis?

A

appendicitis, cholescystitis, diverticulitis, pancreatitis, perforation of bowel or other organ

49
Q

What are some observable signs of peritoneal inflammation

A
  • Guarding
  • Rigidity
  • Rebound tenderness
50
Q

Is guarding a voluntary or involuntary action?

A

Voluntary contraction of the abdominal wall.

51
Q

Is rigidity voluntary or involuntary?

A

Involuntary reflex contraction of the abdominal wall.

52
Q

What is Lyod’s punch?

A

It’s a kidney punch to test for pyelonephritis (CVA tenderness).

53
Q

How do you perform a Lyod’s punch?

A

Pressure from fingertips may be enough to elicit tenderness. If not then test with fist percussion. Place ball of one hand on costovertebral angle and strike with ulnar aspect of other hand

54
Q

How do you test for abdominal wall mass vs. intraabdominal mass?

A

Ask pt to raise head and shoulders when lying supine or to strain down then palpate for the mass again.
Abdominal wall mass = remains palpable
Intraabdominal mass = no longer palpable, because obscured by muscular contraction

55
Q

How do you test for a ventral hernia?

A

When lying supine, ask patient to raise both head and shoulders off the table. A positive test = bulge of hernia will usually appear

56
Q

What is courvoisier’s sign?

A

Enlarged non-tender gallbladder secondary to pancreatic disease or cancer

57
Q

where would you palpate for the abdominal aorta?

A

Above the umbilicus, just slightly to the left of midline

58
Q

How would you document normal abdominal exam?

A

Abdomen is soft, nontender, nondistended, bowel sounds heard in all 4 quadrants, no rebound, guarding, rigidity, hepatosplenomegaly or costovertebral angle tenderness.
Abbreviation: Abd S/NT/ND/BS+ x 4, no R/G/R, HSM or CVAT

59
Q

what is the expected spleen span upon percussion/palpation?

A

Ribs 6-10 at the mid-axillary line on the left.

PCM II (11 decks)

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