abdominal exam Flashcards
ladder pattern+visible peristaltic waves+hyperactive bowel sounds
intestinal obstruction!
cupid’s bow
acute pancreatitis
central dimple at umbilicus
auenbrugger’s sign
large pericardial effusion
-localized bulge in epigastric area
sister mary joseph’s nodule
palpable lymph node
intrabdominal metastasis
cullen’s sign and grey turners sign
periumbilical ecchymosis/bilateral discoloration assoc. w/ acute hemorrhagic pancreatitis
venous pattern: obstructed SVC
vv are engorged on upper abdominal wall and when you milk them you get downward flow
venous pattern: obstructed IVC
vv are engorged in lateral abdominal wall and when you milk them you get upward flow
caput medusae
cirrhotics and portal HTN (umbilical v reopened)
venous pattern obstructed portal system
periumbilical v: rostral drain up (to internal mammary) and lower drain down (inferior mammary)
percussion: central dullness + lateral resonance
pregnancy
central tympany/resonance and lateral dullness
ascites/fluid
murmurs/bruits in epigastrum
pregnancy, normal thin women, d/t celiac tripod
murmurs/bruits in RUQ
hepatoma, cirrhosis, metastatic liver disease, AV malformation, tricuspid regurg
murmurs/bruits in LUQ
pancreatic ca or vascular anomaly of spleen
murmurs/bruits in both upper quadrants +/- epigastrium
renovascular disease
cruveilhier-baumgarten murmur/sign
- continuous venous hum/murmur
- due to reopening of umbilical v d/t portal HTN
hepatic friction rub
hepatoma
hepatic bruits
arterial (in systole), if assoc/ w/ a rub=neoplasia
hepatic venous hums
systolic and diastolic
indicate portal venous hypertension
percussion of spleen
- nixon’s technique: percuss whole spleen with patient in R lateral decubitus (best specificity)–dullness>8cm=bad
- catell’s technique: percuss lowest left ICS while patient breathes in and out (best sensitivity)–dullness in 8th ICS=bad
- percussion of traube’s semilunar space: dullness can indicate splenomegaly
splenic rubs
splenic infarct
splenic murmur
massive splenomegaly or pancreatic carcinoma
costophrenic tenderness
pyelonephritis or renal infarct
tender flank and costovertebral region
renal colic
renovascular disease
can have anterior systolic murmur, posterior systolic murmur, anterior continuous bruit
right supraclavicular node
drains R lung, R breast, and contralateral *Left lung base!
left supraclavicular node
drains L lung, L breast
Trossier: L node (stomach, intestine, liver, kidney, pancreas, testicles, endometrium)
Virchow: L node draining stomach (gastric carcinoma)
gallbladder disease 4 Fs
fat, fertile, female, forty
murphy’s sign
-painful reflex arrest in inspiration, triggered by palpation of edge of inflamed gallbladder
Courvoisier’s law
painless jaundice + enlarged, palpable, non-tender gallbladder
-cancer of biliary tract or pancreatic head
Boa’s sign
area of hypersensitivity over R. costophrenic angle (and R. shoulder)
big clues to ascites
recent wt gain or hx of liver disease
PE tests for ascites
- bulging lfanks
- flank dullness
- shifting dullness
- fluid wave (only specific test)
- ballottement sign
* *only good if 500-1000cc of fluid (if less than US is gold standard, can detect 100cc fluid)
tests to rule-in ascites
fluid wave and hx of ankle edema
tests to r/o ascites
absence of shifting dullness, esp in abscence of ankle edema/abd girth
transudate ascitic fluid
cirrhosis, CHF, nephritic syndrome
exudative ascitic fluid
ruptured viscus with peritonitis, tumors
causes of distension w/o ascites
aerophagia, malabsorption, chronic pancreatic insufficiency, bowel obstruction
induced guarding/carnett’s sign
touch chin to chest (activate abdominal mm) if tender (+ sign), lesion in abdominal wall if not tender (-sign), lesion is intra-abdominal
modified induced guarding/abdominal wall tenderness
differentiate abdominal wall mischief from intra-abdominal
-don’t do in kids or elderly, pts with diffuse abdominal pain and rigidity, patients with intra-abdominal abscess
rebound tenderness (blumberg sign)
don’t need to do if already have guarding/rigidity
-indicates localized peritonitis
referred rebound tenderness
palpable quadrant contralateral to patient’s pain
+ if it elicits pain in original site
variants: cough test, jar test, valsalva
closed eye sign
if have true intraabdominal pathology, will keep eyes open and monitor exam
PE signs of liver disease
- spider teleangiectasias (nevi): abnormally inc. ratio estradiol:testosterone, pregancy, malnutrition
- palmar erythema (hepatic inability to inactivate vasodilators)
- asterixis (hepatic encephelopathy)
- palpable spleen (portal HTN)
- fetor hepaticus (severe parenchymal disease)
- dilated abdominal vv
- clubbing
- . orthodeoxia/platypnea b/c created shunts
tests for appendicitis
none are sensitive
- MucBurney’s (focal tenderness/rigidity 2 inch medial of R ASIS)
- Rovsings (pain in R. iliac fossa d/t pressure over LLQ)
- Obturator: pain if flex and rotate hip
- reverse psoas: retrocecal processes
- rectal tenderness: perforation
PE findings: absent bowel sounds and tympany
late stage of bowel obstruction (paralytic ileus)
PE findings: hyperactive high pitched bowel sounds and tympany and visible hyperperistalsis
early stage obstruction
PE findings: vascular bruit
dissecting arterial aneurysm
PE findings: distension, absent sounds, absent liver dullness
free intraperitoneal air due to perforated viscus
