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PCMII Exam 1 > Abdominal Exam > Flashcards

Abdominal Exam Flashcards

1
Q
  • Types of abdominal pain
A
  • Visceral
    • From stim of visceral pain fibers
    • Secondary to distension, stretching or contracting of hollow organs, stretching capsule of organs or organ ischemia
    • NOT LOCALIZED
  • Parietal
    • From stim of somatic pain fibers
    • Secondary to inflammation in parietal peritoneum
    • Localized
  • Referred
    • Originates within abdomen but felt at distant sites which are innervated at approximately same spinal levels as disordered structure
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2
Q
  • Focused ROS is based on _
  • General ROS is performed _
A
  • CC
  • All the time
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3
Q
  • When asking about past surgical history, what surgical procedures should you be asking about?
A
  • Abdominal
    • Cholecystectomy
    • Appendectomy
  • Gynecologic
    • Hysterectomy
    • BTL
    • C Section
    • Ovarian Cyst
    • Etc
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4
Q
  • What type of GI prescriptions may a patient be taking?
A
  • H2 Blockers
  • PPI
  • Dicyclomine
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5
Q
  • What steps do you perform an abdominal exam?
  • What else must you always do
A
  1. Inspection
  2. Ascultation
  3. Percussion
  4. Palpation

Drape the patient

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6
Q
  • What are the landmarks of the abdomen to look for during inspection?
A
  • Xiphoid process of sternum
  • Costal margin
  • Umbilicus
  • ASIS
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7
Q
  • What organs are located in which abdominal quadrants?
A
  • RUQ
    • Liver
    • Gallbladder
    • Stomach
    • SB
    • LB
  • RLQ
    • Appendix
    • Ovary
    • SB
    • LB
  • LUQ
    • Spleen
    • Stomach
    • SB
    • LB
  • LLQ
    • Sigmoid colon
    • Ovary
    • SB
    • LB
  • Epigastric area
    • Pancreas
    • Liver
    • Gallbladder
    • Stomach
    • LB
    • SB
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8
Q
  • Ascultation
    • Use bell to listen for _
    • What is the normal amount of bowel sounds/min
A
  • Bruits
  • 5-34 clicks/gurgles per min
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9
Q
  • Absent bowel sounds
A
  • No bowel sounds for > 2 min
  • Causes:
    • Long lasting intestinal obstruction
    • Intestinal perforation
    • Mesenteric ischemia
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10
Q
  • Decreased bowel sounds
A
  • None heard for 1 min
  • Causes:
    • Post surgical ileus
    • Peritonitis
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11
Q
  • Hyperactive bowel sounds causes
A
  • Diarrhea
  • Early bowel obstruction
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12
Q
  • What are high pitched bowel sounds indicative of (raindrops on metal)
A
  • Early intestinal obstruction
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13
Q
  • What are bruits heard in the abdominal aorta or other abdominal arteries suggestive of?
A
  • Vascular obstruction
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14
Q
  • What is a friction rub?
  • What is it indicative of?
A
  • Abnormal grating spunds with respiratory . variation
  • Inflammation of peritoneal surface of an organ (usually over liver or spleen)
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15
Q
  • Where should you listen for venous hum?
  • What is this abnormal sound indicative of?
A
  • Epigastric and umbilical regions
  • Increased collateral circulation between portal and systemic venous systems
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16
Q
  • _ sound predominates when percussing the 4 quadrants of the GI tract. Why?
A
  • Tympany
  • Gas in Gi tract, scattered areas of dullness is normal for fluid and feces

Abnormal-large dull areas from mass or enlarged organ

Protuberant abdomen that is tympanic throughout may indicate intestinal obstruction

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17
Q
  • Tympany
A
  • High pitched, air filled
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18
Q
  • Dullness
A
  • Non-resonating, solid organs or masses
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19
Q
  • Resonance
A
  • Hollow abdominal organs (lungs)
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20
Q
  • Hyper-resonance
A
  • Air filled hollow organ (ie: pneumothorax)
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21
Q
  • Palpation
A
  • Helpful for discerning abdominal tenderness. resistance, superficial organs and masses
  • Use palmar aspect of hand with fingers together
  • Gently then deeply palpate all 4 quads
  • ALWAYS START FURTHEST FROM TENDER AREA
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22
Q
  • What two organs need additional assessment
A
  • Liver
  • Spleen
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23
Q
  • How do you assess liver size and shape
A
  • Percussion and palpation
  • Percussion
    • Right midclavicular line, start in RLQ and percuss cephalad to an area of dullness (lower border of liver)
    • Right midclavicular line, start in RUQ, percuss caudad towards liver dullness (superior border of liver)
  • Normal liver span (6-12 cm)
  • Vertical span increased with
    • Cirrhosis
    • Lymphoma
    • Hepatitis
    • Right sided heart failure
    • Amyloidosis
    • Hemochromatosis
  • Vertical span decreased with
    • Cirrhosis
24
Q
  • Liver palpation
A
  • Left hand behind patient supporting ribs 11-12
  • Push left hand up
  • Right hand on abdomen-press cephalad
  • Ask patient to breathe deeply
  • Feel liver edge as it comes down to meet right hand

Normal-slightly tender, soft, smooth surface

Irregular edge/nodules=hepatocellular carcinoma

Firmness/hardness=cirrhosis, hemochromatosis, amyloidosis, lymphoma

25
Q
  • Spleen percussion
A
  • Start from border of cardiac border of left anterior axillary line, percuss laterally
  • If tympany is prominent laterally in midaxillary line, splenomegaly is not likely
  • Dullness at midaxillary line-splenomegaly
26
Q
  • Spleen palpation
A
  • With left hand, reach over patient and grasp posterior LUQ
  • Right hand below left costal margin, press posteriorl toward spleen
  • Ask patient to take deep breath in
  • Feel edge of spleen as it comes down to meet your hand
  • 5% normal patients-spleen is palpated
27
Q
  • Splenomegaly can be caused by?
A
  • Portal HTN
  • Blood Malignancies
  • HIV
  • Splenic infarct
  • Hematoma
  • Mononucleosis
28
Q
  • How do you test for ascities
29
Q
  • How do you test for appendicitis
30
Q
  • How do you test for biliary colic
31
Q
  • How do you test for kidney inflammation/distension
32
Q
  • Signs of peritoneal inflammation/acute abdomen
A
  • Guarding
    • Voluntary contraction of abdominal wall
    • When palpating abdomen, abdominal musculature guards underlying inflamed organs and becomes tense and contractred
  • Rigidity
    • Involuntary reflex contraction of abdominal wall
    • Will see stiff, board like muscle contractions on inspection
    • May not see abdomen move with respirations
    • Can also be felt during palpation
  • Rebound tenderness
    • Occurs when you pish down deep into abdomen and let go quickly
33
Q
  • Process for developing and working thru DDX
A
  • Develop broad Dx
    • Based on CC, Sex, age, race
  • Narrow Dx
    • HPI, History, PE
  • Develop working Dx
    • Most common/likely diagnosis and life threats
  • Pursue working Dx
    • Therapeutic innerventions
    • Confirmatory/Exclusionary diagnostic testing
  • Assessment and plan (final primary and secondary diagnosis)
    • Treatment
    • Disposition
    • Communication/Documentation
34
Q
  • What pneumonic can be used when helping develop a differential diagnosis?
A
  • VINDICATE
  • V=Vascular
  • I=Infections/Inflammatory
  • N=Neoplasm
  • D=Drugs/Degenerative
  • I=Iatrogenic/Idiopathic
  • C=Congenital
  • A=Autoimmune/Allergic/Anatomic
  • T=Trauma
  • E=Endocrine/Environment

Anatomic location of pain

Sex of patient

35
Q
  • Normal findings on an abdominal exam
A
  • Flat
  • Nondistended
  • Normoactive bowel sounds throughout
  • Tympanic throughout
  • Soft
  • No masses
  • Nontender
  • No hepatomegaly/splenomegaly/hepatosplenomegaly/organomegaly
  • EX; Abd-Soft, NT/ND, BS+ x4, no HSM
36
Q
  • Abnormal findings on abdominal exam
A
  • Distended
  • Round
  • Obese
  • Scaphoid
  • Hyperactive/hypoactive/diminished bowel sounds
  • TTP (tenderness to palpation)
  • Rebound
  • Guarding
    Rigid
  • Palpable mass (would describe area located and size of mass)
  • Special tests positive or negative
37
Q
  • GERD
    • Typical Sx
    • Atypical Sx
A
  • Typical
    • Heartburn-retrosternal sensation of burning or discomfort that usually occurs after eating, when lying supine, or bending over
    • Regurgitation-return of gastric and/or esophageal contents into pharynx
    • Dysphagia-30% GERD-sensation that food is stuck in retrosternal area
  • Atypical
    • Coughing/Wheezing
    • Hoarsness, sore throat
    • Otitis media
    • Noncardiac chest pain
    • Enamel erosion or other dental manifestation
38
Q
  • GERD Differential Dx
A
  • Achalasia
  • Acute/Chronic Gastritis
  • Chronic Gastritis
  • Coronary disease
  • Esophageal cancer
  • Esophageal spasm
  • Esophagitis
  • Cholelithiasis
  • H.Pylori infection
  • Hiatal hernia
  • Intestinal malrotation
  • IBS
  • PUD
39
Q
  • GERD Lifestyle modification
A
  • Losing weight
  • Avoiding known triggers
  • Avoiding large meals
  • Avoid lying down until 3 hrs after meal
  • Elevating head of the bed by 8 inches
40
Q
  • GERD medication therapies
A
  • Antacids
  • H2 receptor antagonists-famotidine,cimetidine, ranitidine, nizatadine
  • PPis-omeprazole, lansoprazole, rabeprazole, esomeprazole
41
Q
  • Constipation
A
  • Most common digestive complaint in US
  • SYMPTOM NOT DISEASE
  • Tools used to categorize
    • ROME III
    • Bristol Stool Scale
42
Q
  • ROME III Criteria for Constipation
A
  • Must have at least 2 over preceding 3 months
    • Fewer than 3 Bms/week
    • Straining
    • Lumpy or hard stools
    • Sensation of incomplete defecation
    • Manual maneuvering req to defecate
43
Q
  • Bristol Stool Scale
A
  • 1-2: usually patients presenting with constipation
  • 3-4: normal
  • 7-Diarrhea (all liquid)
44
Q
  • What might constipation look like on an abdominal exam?
A
  • Distension or masses (colonic stools or tumor)
  • Abdominal wall hernias may interfere with generation of intraabdominal pressure req for initiation of defectation
45
Q
  • Pelvic exam for females (presenting with constipation)
A
  • Palpate posterior vaginal wall at rest and while straining
  • Checks for internal prolapse or rectocele
46
Q
  • What may be some exam findings for constipation on an anorectal exam
A
  • Perianal excoriation
  • Skin tags/Hemorrhoids
  • ANal fissure
  • Prolapse during straining
  • Anorectal masses
  • Tone of internal anal sphincter
  • Presence of gross blood or occult bleeding
  • Presence of fecal impaction
47
Q
  • Positioning for performing a rectal exam
48
Q
  • Skin tags v external hemorrhoids
49
Q
  • Nonspecific term, primary manifestation is diarrhea, but nausea vomiting and abdominal pain can accompany
  • What most people consider the stomach flu
A
  • Gastroenteritis
50
Q

Etiology of Gastroenteritis

A
  • Infectious agents are usual cause
  • Viral (50-70%)
    • Norovirus or rotavirus
  • Bacterial (15-20%)
    • Salmonella
    • C Diff
    • E COli
  • Parasitic (10-15%)
    • Giardia
  • Food-borne toxigenic
  • Drug-associated
    • Antibiotics
    • Laxatives
    • Colchicin
    • Quinidine
    • Sorbitol
    • PPis
51
Q
  • Most common viral causes of gastroenteritis
52
Q
  • Most common causes of bacterial gastroenteritis
53
Q
  • Most common cause of parasitic gastroenteritis
54
Q
  • IBS: Functional GI Disorder
    • Manifestations
    • Common
A
  • Manifestations:
    • Altered bowel habits
    • Abdominal pain, bloating, distension
  • Common
    • Postprandial urgency
    • Alternating between constipation and diarrhea, with one dominating per individual patient
    • Intractability to laxatives
    • Defecation improves abdominal pain but does not relieve it
55
Q
  • Associated symptoms with diarrhea
A
  • Nausea
  • Vomiting
  • Abdominal Cramping
  • Abdominal Bloating
  • Fever
56
Q
  • Questions to ask patient presenting with diarrhea
A
  • Stools
    • Frequency
    • Amount
    • Color
    • Consistency
  • Historical clues
    • Travel
    • Changes in meds
    • Recent hiking/camping

Large volumes of stool-enteric infection

Small stools-colonic infection

Blood-can indicate colonic ulceration

White/bulky-small bowel pathology (ie: malabsorption)

Copious rice water diarrhea=hallmark for cholera

PCMII Exam 1 (7 decks)

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