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Physical Diagnosis Exam 2 (Lauren) > Abdominal Exam > Flashcards

Abdominal Exam Flashcards

1
Q

What is the order for abdominal exam?

A

Inspection

Auscultation

Percussion

Palpation

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2
Q

What is it important to have your pt do when they lay back for the abdominal exam?

A

Bend knees

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3
Q

What is diastasis recti?

A

Separation of the rectus abdominis muscles

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4
Q

How do you check for diastasis recti?

A

Ask patient to lift their head off the table

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5
Q

What do dilated veins on abdomen suggest?

A

Portal hypertension due to cirrhosis

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6
Q

When do you see increased peristaltic waves

A

Intestinal obstruction

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7
Q

What can cause ecchymosis on abdomen

A

Hemorrhage in abdomen

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8
Q

What can cause high-pitched tinkling bowel sounds

A

Early Intestinal obstruction

Everything proximal to obstructing will be dilated

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9
Q

What percussion sound will predominate in abdomen/

A

Tympany due to gas in GI tract

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10
Q

What does this suggest:

Distended abdomen that is tympanic throughout

A

Intestinal obstruction

Paralytic ileus

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11
Q

Protuberant abdomen with bulging flanks and dullness suggests:

A

Ascites

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12
Q

Where should the vertical span of the liver be measured?

A

Mid clavicular line

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13
Q

What is the normal liver size at MCL?

A

6-12 cm

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14
Q

What direction does the spleen expand in?

A

Anteriorly, downward, and medially

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15
Q

What are two types of muscular resistance?

A

Guarding

Rigidity

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16
Q

What do peritoneal signs suggest?

A

Intrapertoneal infection, ruptured viscus, etc

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17
Q

What is guarding/tensing?

A

Voluntary contraction of abdominal muscles with palpation

(May diminish when pt is distracetd_

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18
Q

What is rigidity/stiffness?

A

Involuntary reflex contraction of abdominal muscles with palpation

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19
Q

Where do liver and gallbladder pain refer to?

A

R shoulder

20
Q

Where does appendix pain refer to?

A

Periumbilicus area

21
Q

What exam findings would you expect for acute cholesyctitis?

A

RUQ pain

+Murphy’s sign

22
Q

What exam findings would you expect with acute pancreatitis?

A

Epigastric pain that may radiate to the back

23
Q

What exam findings would you expect wirth acute appendicitis?

A

Pain begins at umbilicus

Migrates to RLQ*

+Psoas, Obturator, Rovsing’s signs

24
Q

What exam findings would suggest acute diverticulitis?

A

LLQ pain

25
Q

What exam findings would you expect with acute pyelonephritis?

A

+costovertebral angle tenderness

26
Q

What must pt do when you palpate their liver?

A

Take a deep breath

27
Q

What must pt do for you to palpate the spleen?

A

Take a deep breath

28
Q

What can cause splenomegaly?

A

Congestive diseases (portal HTN, heart failure, etc)

Hematologist malignancies

Mononucleosis

Bacterial/parasitic infections

29
Q

What can cause kidney enlargement?

A

Hydronephrosis

Cysts/tumors

Polycystic Kidney Disease

30
Q

What are abnormal findings with liver palpation?

A

Firmness

Bluntness/rounding of edge

Surface irregularities

31
Q

What are the three peritoneal signs?

A

Guarding

Rigidity

Rebound tenderness

32
Q

WWhat does a positive rebound tenderness in RLQ suggest?

A

Appendicitis

33
Q

What is the Rovsing’s sign?

Normal

A

Press gently and deeply in LLQ and look for pain in RLQ

34
Q

What is the variation of Rovsing’s sign aka referred rebound tenderness?

A

Press gently and deeply in LLQ and QUICKLY withdraw fingers, looking for pain in RLQ

35
Q

What are the 2 wats to do psoas sign?

A
  1. Resisted straight leg raise

2. While lying on L side, extend pt’s R leg @ hip

36
Q

What is a positive psoas sign?

A

RLQ pain suggests inflamed appendix

37
Q

What is obturator sign?

A

With pt supine, flex R leg at hip, bend the knee, and then rotate leg internally @ hip

38
Q

What is a positive obturator sign?

A

RLQ pain may indicate inflamed appendix

39
Q

What is the shifting dullness technique?

A

Supine: find border of tympany and dullness

THen roll on side and see if it moved

40
Q

What does a positive shifting dullness test suggests/.

A

Ascites

41
Q

What is the fluid wave technique?

A

Stabilize mid-abdomen and tap one side and see if a fluid wave hits your hand on the other side

42
Q

How is Murphy’s sign tested?

A

With your fingers under the right ribs, ask patient to take a deep breath and look for a SUDDEN stop in inspiratory effort

43
Q

What does a positive Murphy’s sign suggest?

A

Acute cholecystitis

44
Q

Psoas, Obturator, and Rovsing’s are helpful in the assessment of peritoneal irritation, which can be associated with:

A

Appendiceal inflammation

45
Q

Shifting dullness and fluid wave are helpful in the assesssment of:

A

Ascites

46
Q

Sudden pain the RUQ during inspiration constitutes a positive:

A

Murphy’s sign

47
Q

Ventral hernias can be identified by asking the pt to:

A

Raise head and shoulders off the table

Physical Diagnosis Exam 2 (Lauren) (3 decks)

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