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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
Heel strike
With patient supine, strike patient’s heel + test = abdominal pain Indicates possible appendicitis or peritonitis
26
Liver palpation
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
Murphy’s sign
Palpate deeply under right costal margin during inspiration + test = pain and/or sudden stop in inspiratory effort Indicates acute cholecystitis or cholelithiasis
28
Courvoisier’s sign
Enlarged nontender gallbladder Indicates pancreatic disease/cancer
29
T/F: the normal spleen should be palpable
False, should not be palpable
30
Lloyd punch
Gently tap area of the back overlying the kidney (CVAs) + test = pain Indicates infection around kidney (perinephric abscess), pyelonephritis, or renal stone
31
Expected width of aorta
2-3 cm with pulsation in anterior-inferior direction [unexpected would be greater than 3 cm in width with prominent lateral pulsation]
32
2 major structures in RUQ
Liver | Gallbladder
33
3 major structures in RLQ
Appendix Cecum Ovary
34
2 major structures in LLQ
Sigmoid colon | Ovary
35
Major structure in LUQ
Spleen
36
Of the 9 regions of the abdomen, what are the columns on each side from top to bottom?
Right/Left Hypochondriac region Right/Left Lumbar region Right/Left Iliac region
37
In the 9 regions of the abdomen, what is the center column from top to bottom?
Epigastric region Umbilical region Hypogastric region
38
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 ____
Hemoperitoneum; flanks
39
Signs of liver failure on abdominal exam
``` Jaundice Ascites Caput medusae (portal HTN) Hepatomegaly Fluid wave on percussion ```
40
What might cause absence of bowel sounds
Long lasting intestinal obstruction Intestinal perforation Mesenteric ischemia
41
What might cause decreased bowel sounds? (None for 1 min)
Post-surgical ileus Peritonitis
42
What might cause increased bowel sounds?
Diarrhea Early bowel obstruction
43
What might cause high pitched bowel sounds
Early intestinal obstruction
44
What might cause bruits heard in abdominal exam?
Vascular obstruction
45
What might cause friction rub on abdomen auscultation
Inflammation of peritoneal surface of an organ (liver or spleen)
46
What might cause venous hum on auscultation of abdomen
Increased collateral circulation between portal and systemic venous systems (heard over epigastric and umbilical region)
47
Protruberant abdomen tympanitic throughout may indicate what
Intestinal obstruction
48
During palpation of a tender abdomen, what is an important consideration?
Warm hands and palpate tender area LAST
49
Difference between parietal and visceral abdominal pain
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
Examples of visceral pain
Liver distention against its capsule with alcoholic hepatitis (RUQ) Periumbilical visceral pain = acute appendicitis
51
Examples of parietal pain
Acute cholecystitis (RUQ/epigastric) Acute pancreatitis (epigastric) Late appendicitis (RLQ) Acute diverticulitis (LLQ)
52
Examples of conditions causing referred abd. pain
Duodenal and pancreatic pain classically referred to back Biliary tree referred to right shoulder — diaphragm irritation
53
What increases vertical span of liver
Enlargement d/t cirrhosis, lymphoma, hepatitis, right-heart failure, amyloidosis, hemachromatosis Right pleural effusion (falsely increased)
54
What decreases the vertical span of the liver
Shrunken liver = cirrhosis Free air under diaphragm/perforated hollow viscus
55
The liver span is _____ in the midsternal line and _____ cm in the midclavicular line
4-8 cm; 6-12
56
Irregular edge or nodules on liver exam may indicate what
Hepatocellular carcinoma
57
Firmness/hardness on liver exam may indicate what
Cirrhosis, hemachromatosis, amyloidosis, lymphoma
58
Dullness at the midaxillary line on spleen percussion would indicate what
Splenomegaly
59
Splenomegaly may be present in what conditions
``` Portal HTN Blood malignancies HIV Splenic infarct Hematoma Mono ```
60
Tests for ascites
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
4 tests for appendicitis
McBurney’s point Rosving’s sign Psoas sign Obturator sign
62
Test for cholecystitis
Murphy’s sign
63
Testing for ventral hernia
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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