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PCM II Exam 1 > Abdominal Exam > Flashcards

Abdominal Exam Flashcards

1
Q

Steps of abdominal exam

A
  1. Inspection
  2. Auscultation
  3. Percussion
  4. Palpation
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2
Q

What are aspects of your inspection exam of the abdomen?

A

Skin color/characteristics
Contour/symmetry
Surface motion
Pulsations

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3
Q

What types of skin changes/characteristics are you looking for on your inspection exam of abdomen

A 
Jaundice
Grey turner sign
Cullen sign
Scars/striae
Dilated veins
Rashes and lesions
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4
Q

What aspects of contour/symmetry are you looking for on inspection of abdomen

A

Abdominal distension

Hernias/masses

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5
Q

What are you looking at with surface motion of inspection of abdomen

A

Peristalsis

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6
Q

Flank ecchymosis secondary to hemorrhage

A

Grey Turner Sign

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7
Q

Ecchymosis around the umbilicus (periumbilical) secondary to hemorrhage

A

Cullen sign

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8
Q

Auscultation of abdomen

A

Bowel sounds: Note the frequency and character of bowel sounds with diaphragm of stethoscope. Listen in all 4 quadrants

Vascular sounds: abdominal aorta, iliac, renal, and femoral aa. — listen for bruits with bell of stethoscope

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9
Q

Normal bowel sounds

A

5-34 clicks or gurgles per minute

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10
Q

Abnormal bowel sounds

A

High pitched, decreased/absent

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11
Q

Percussion of abdomen assesses for ____ and _____

A

Tympany; dullness

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12
Q

Describe tympany found on abdominal percussion

A

Found within majority of abdomen, caused by air filled viscera

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13
Q

Describe dullness found on abdominal percussion

A

Flat sound without echoes, heard over solid organs. The liver and spleen, fluid in peritoneum, or feces give dull note

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14
Q

Expected liver span

A

6-12 cm at midclavicular line on right

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15
Q

Expected spleen span

A

From ribs 6-10 at midaxillary line on left

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16
Q

Levels of palpation

A

Light = up to 1 cm depth in all 4 quadrants

Moderate = 2-3 cm depth in all 4 quadrants

Deep = more than 3 cm in all 4 quadrants

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17
Q

Pain upon removal of pressure

A

Rebound tenderness

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18
Q

What does rebound tenderness indicate

A

Peritoneal inflammation

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19
Q

Voluntary tightening of abdominal mm secondary to pain

A

Guarding

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20
Q

Abdomen is hard, involuntary reflex contraction of abdominal wall

A

Rigidity

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21
Q

What is significance of McBurney’s point

A

Rebound tenderness or pain 1/3 of distance between ASIS and umbilicus — indicates possible appendicitis/peritoneal irritation

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22
Q

What is Rosving’s sign

A

Pain in RLQ during left-sided pressure — indicates possible appendicitis (referred rebound tenderness)

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23
Q

Iliopsoas muscle test

A

Have pt flex their hip against resistance.

+ test = Increased abdominal pain

Indicates irritation of the psoas muscle from inflammation of the appendix

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24
Q

Obturator m. Test

A

Flex pt’s right thigh at hip, with the knee bent, and rotate the leg internally at the hip.

+ test = right hypogastric pain

Indicates irritation of the obturator muscle from inflammation of the appendix

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25
Q

Heel strike

A

With patient supine, strike patient’s heel

+ test = abdominal pain

Indicates possible appendicitis or peritonitis

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26
Q

Liver palpation

A

Left hand behind patient’s back, supporting right 11th and 12th ribs, and lightly press anterior

Right hand just below costal margin in midclavicular line with fingers pointing cephalad or in oblique position. Gently press in and up with fingertips, try to palpate liver edge during patient’s inhalation

[also alternate hooking technique]

27
Q

Murphy’s sign

A

Palpate deeply under right costal margin during inspiration

+ test = pain and/or sudden stop in inspiratory effort

Indicates acute cholecystitis or cholelithiasis

28
Q

Courvoisier’s sign

A

Enlarged nontender gallbladder

Indicates pancreatic disease/cancer

29
Q

T/F: the normal spleen should be palpable

A

False, should not be palpable

30
Q

Lloyd punch

A

Gently tap area of the back overlying the kidney (CVAs)

+ test = pain

Indicates infection around kidney (perinephric abscess), pyelonephritis, or renal stone

31
Q

Expected width of aorta

A

2-3 cm with pulsation in anterior-inferior direction

[unexpected would be greater than 3 cm in width with prominent lateral pulsation]

32
Q

2 major structures in RUQ

A

Liver

Gallbladder

33
Q

3 major structures in RLQ

A

Appendix
Cecum
Ovary

34
Q

2 major structures in LLQ

A

Sigmoid colon

Ovary

35
Q

Major structure in LUQ

A

Spleen

36
Q

Of the 9 regions of the abdomen, what are the columns on each side from top to bottom?

A

Right/Left Hypochondriac region

Right/Left Lumbar region

Right/Left Iliac region

37
Q

In the 9 regions of the abdomen, what is the center column from top to bottom?

A

Epigastric region

Umbilical region

Hypogastric region

38
Q

Cullen’s sign consists of ecchymosis around the umbilicus, also known as ____; this is the same as Grey-Turner’s sign, but that is ecchymosis of the ____

A

Hemoperitoneum; flanks

39
Q

Signs of liver failure on abdominal exam

A 
Jaundice
Ascites
Caput medusae (portal HTN)
Hepatomegaly
Fluid wave on percussion
40
Q

What might cause absence of bowel sounds

A

Long lasting intestinal obstruction

Intestinal perforation

Mesenteric ischemia

41
Q

What might cause decreased bowel sounds? (None for 1 min)

A

Post-surgical ileus

Peritonitis

42
Q

What might cause increased bowel sounds?

A

Diarrhea

Early bowel obstruction

43
Q

What might cause high pitched bowel sounds

A

Early intestinal obstruction

44
Q

What might cause bruits heard in abdominal exam?

A

Vascular obstruction

45
Q

What might cause friction rub on abdomen auscultation

A

Inflammation of peritoneal surface of an organ (liver or spleen)

46
Q

What might cause venous hum on auscultation of abdomen

A

Increased collateral circulation between portal and systemic venous systems (heard over epigastric and umbilical region)

47
Q

Protruberant abdomen tympanitic throughout may indicate what

A

Intestinal obstruction

48
Q

During palpation of a tender abdomen, what is an important consideration?

A

Warm hands and palpate tender area LAST

49
Q

Difference between parietal and visceral abdominal pain

A

Parietal occurs d/t inflammation in parietal peritoneum, more easily localized, steady, and aggravated by movement or coughing, pt wants to lie still

Visceral abdominal pain occurs when organs contract or are distended, or from ischemia causing stim of visceral pain fibers, usually difficult to localize and palpated at midline of structure involved

50
Q

Examples of visceral pain

A

Liver distention against its capsule with alcoholic hepatitis (RUQ)

Periumbilical visceral pain = acute appendicitis

51
Q

Examples of parietal pain

A

Acute cholecystitis (RUQ/epigastric)

Acute pancreatitis (epigastric)

Late appendicitis (RLQ)

Acute diverticulitis (LLQ)

52
Q

Examples of conditions causing referred abd. pain

A

Duodenal and pancreatic pain classically referred to back

Biliary tree referred to right shoulder — diaphragm irritation

53
Q

What increases vertical span of liver

A

Enlargement d/t cirrhosis, lymphoma, hepatitis, right-heart failure, amyloidosis, hemachromatosis

Right pleural effusion (falsely increased)

54
Q

What decreases the vertical span of the liver

A

Shrunken liver = cirrhosis

Free air under diaphragm/perforated hollow viscus

55
Q

The liver span is _____ in the midsternal line and _____ cm in the midclavicular line

A

4-8 cm; 6-12

56
Q

Irregular edge or nodules on liver exam may indicate what

A

Hepatocellular carcinoma

57
Q

Firmness/hardness on liver exam may indicate what

A

Cirrhosis, hemachromatosis, amyloidosis, lymphoma

58
Q

Dullness at the midaxillary line on spleen percussion would indicate what

A

Splenomegaly

59
Q

Splenomegaly may be present in what conditions

A 
Portal HTN
Blood malignancies
HIV
Splenic infarct
Hematoma
Mono
60
Q

Tests for ascites

A

Shifting dullness test — percuss borders of tympany and dullness with pt supine vs. lateral recumbent; if borders change, positive test

Test for fluid wave — postive test if impulse transmitted to other flank

61
Q

4 tests for appendicitis

A

McBurney’s point

Rosving’s sign

Psoas sign

Obturator sign

62
Q

Test for cholecystitis

A

Murphy’s sign

63
Q

Testing for ventral hernia

A

When lying supine, have pt raise head and shoulders off table, positive test is bulge of hernia

PCM II Exam 1 (5 decks)

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