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P4T1 > Abdominal exam > Flashcards

Abdominal exam Flashcards

1
Q

physical exam- order

A

IAPP

  • inspection
  • auscultate
  • percussion
  • palpation
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2
Q

9 regions of abdomen

A
  • right and left hypochondriac
  • epigastric
  • right and left lumbar
  • umbilical
  • right and left iliac
  • hypogastric
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3
Q

cullen’s sign

A

-ecchymoses around umbilicus (hemoperitoneum, acute pancreatitis)

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4
Q

grey turner’s sign

A

-ecchymoses of flanks (hemoperitoneum, acute pancreatitis)

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5
Q

hypertension- inspection

A
  • jaundice
  • caput medusae
  • ascites
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6
Q

normal bowel sounds / min

A

-5/34 gurgles/min

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7
Q

absent bowel sounds

A

none for > 2 min

-long-lasting intestinal obstruction, intestinal perforation, mesenteric ischemia

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8
Q

decreased bowel sounds

A

none for 1 min

-post-surgical ileus, peritonitis

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9
Q

increased bowel sounds

A

-diarrhea, early bowel obstruction

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10
Q

high pitched bowel sounds- suggest what?

A

early intestinal obstruction

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11
Q

bruits- suggest what?

A 
vascular obstruction
(over renal, iliac, femoral a's)
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12
Q

friction rub- listen where? suggests what?

A
  • listen over liver and spleen

- infl. of peritoneal surface of an organ

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13
Q

venous hum- listen where? suggests what?

A
  • listen over epigastric and umbilical regions

- increased collateral circulation between portal and systemic venous systems

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14
Q

percussion- assess for?

A
  • tympany (air-filled)

- dullness (solid organs/masses)

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15
Q

abnormal percussion

A
  • large dull areas- from enlarged organ or mass

- large tympanic areas- intestinal obstruction

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16
Q

visceral pain- when?

A
  • when hollow organs contract or are stretched
  • ischemia
  • diff. to localize
  • palpable at midline at level of structure involved
17
Q

parietal pain- when?

A
  • infl. in parietal peritoneum

- easy to localize

18
Q

parietal pain- in RUQ, epigastric, RLQ, LLQ

A
  • RUQ/epigatric- acute cholecystitis
  • epigastric- acute pancreatitis
  • RLQ- later finding in acute pancreatitis
  • LLQ- acute diverticulitis
19
Q

referred pain- duodenal and pancreatic pain

A

referred to back

20
Q

referred pain- biliary tree

A

right shoulder

21
Q

organ assessment

A

liver and spleen

22
Q

liver percussion- normal vertical span?

A
  • 6-12 cm
  • right midclavicular ilne- start in RLQ and percuss cephalad
  • right midclavicular line- start in RUQ and percuss caudad
23
Q

liver- vertical span increased with

A

> 12 cm

  • enlarged liver- cirrhosis, lymphoma, hepatitis, right-sided heart failure
  • right pleural effusion (falsely increased)
24
Q

liver- vertical span decreased with

A

-shrunken liver- cirrhosis

25
Q

irregular edge/nodules- liver

A

-hepatocellular carcinoma

26
Q

firmness/hardness- liver

A

-cirrhosis, hematochromatosis, amyloidosis, lymphoma

27
Q

spleen percusion- normal? splenomegaly?

A
  • start at cardiac border of left anterior axillary line- percuss laterally (ribs 6-10)
  • normal- tympany laterally in midaxillary line
  • splenomegaly- dullness at midaxillary line
28
Q

splenomegaly- due to?

A

-portal hypertension, blood malignancies, HIV, splenic infarct, hematoma, infectious mononucleosis

29
Q

tests for ascites

A
  • shifting dullness test- percuss borders of tympany and dullness with pt supine. have pt lay on side and percuss borders again. positive test if dullness shifts to dependent side and tympany to top side
  • test for a fluid wave- assistant places ulnar aspects of hands midline, tap 1 flank sharply with finger tips. positive test when impulse transmitted to other flank
30
Q

tests of appendicitis

A
  • mcburney’s point (ASIS to umbilicus)
  • rovsing’s sign (palpate deeply in LLQ- + if pain felt in RLQ)
  • psoas sign (have pt raise thigh against resistance- + if increased abdominal pain)
  • obturator sign (flex pts right hip with knee bent, then internally rotate the hip- + if right hypogastric pain)
31
Q

tests for cholecysitis

A

-murphy’s sign (palpate under pt’s right costal margin with right hand, ask pt to take a deep breath in and palpate deeper- + if sharp increase in tenderness with sudden stop in inspiratory effort)

32
Q

sign for enlarged non-tender gallbladder

A

courvoiser’s sign

33
Q

signs of peritoneal infl.

A
  • guarding
  • rigidity (stiff, board-like m’s)
  • rebound tenderness (more tenderness when letting of of pressing on abdomen)
34
Q

test for pyelonephritis

A

-lloyd’s punch/kidney punch/CVA tenderness (test with fist percussion- place ball of one hand on costovertebral angle and strike with ulnar aspect of other hand- + if tenderness)

35
Q

test for abdominal wall mass vs. intraabdominal mass

A

ask pt to raise head and shoulders when lying supine

  • palpate for mass again
  • abdominal mass- remains palpable
  • intraabdominal mass- no longer palpable
36
Q

tests for ventral hernia

A

-when lyine supine, ask pt to raise both head and shoulders off the table- + if bulge of hernia appears

P4T1 (7 decks)

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