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physical diagnosis > abdominal exam > Flashcards

abdominal exam Flashcards

1
Q

ladder pattern+visible peristaltic waves+hyperactive bowel sounds

A

intestinal obstruction!

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2
Q

cupid’s bow

A

acute pancreatitis

central dimple at umbilicus

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3
Q

auenbrugger’s sign

A

large pericardial effusion

-localized bulge in epigastric area

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4
Q

sister mary joseph’s nodule

A

palpable lymph node

intrabdominal metastasis

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5
Q

cullen’s sign and grey turners sign

A

periumbilical ecchymosis/bilateral discoloration assoc. w/ acute hemorrhagic pancreatitis

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6
Q

venous pattern: obstructed SVC

A

vv are engorged on upper abdominal wall and when you milk them you get downward flow

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7
Q

venous pattern: obstructed IVC

A

vv are engorged in lateral abdominal wall and when you milk them you get upward flow

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8
Q

caput medusae

A

cirrhotics and portal HTN (umbilical v reopened)

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9
Q

venous pattern obstructed portal system

A

periumbilical v: rostral drain up (to internal mammary) and lower drain down (inferior mammary)

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10
Q

percussion: central dullness + lateral resonance

A

pregnancy

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11
Q

central tympany/resonance and lateral dullness

A

ascites/fluid

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12
Q

murmurs/bruits in epigastrum

A

pregnancy, normal thin women, d/t celiac tripod

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13
Q

murmurs/bruits in RUQ

A

hepatoma, cirrhosis, metastatic liver disease, AV malformation, tricuspid regurg

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14
Q

murmurs/bruits in LUQ

A

pancreatic ca or vascular anomaly of spleen

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15
Q

murmurs/bruits in both upper quadrants +/- epigastrium

A

renovascular disease

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16
Q

cruveilhier-baumgarten murmur/sign

A
  • continuous venous hum/murmur

- due to reopening of umbilical v d/t portal HTN

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17
Q

hepatic friction rub

A

hepatoma

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18
Q

hepatic bruits

A

arterial (in systole), if assoc/ w/ a rub=neoplasia

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19
Q

hepatic venous hums

A

systolic and diastolic

indicate portal venous hypertension

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20
Q

percussion of spleen

A
  • 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
21
Q

splenic rubs

A

splenic infarct

22
Q

splenic murmur

A

massive splenomegaly or pancreatic carcinoma

23
Q

costophrenic tenderness

A

pyelonephritis or renal infarct

24
Q

tender flank and costovertebral region

A

renal colic

25
Q

renovascular disease

A

can have anterior systolic murmur, posterior systolic murmur, anterior continuous bruit

26
Q

right supraclavicular node

A

drains R lung, R breast, and contralateral *Left lung base!

27
Q

left supraclavicular node

A

drains L lung, L breast
Trossier: L node (stomach, intestine, liver, kidney, pancreas, testicles, endometrium)
Virchow: L node draining stomach (gastric carcinoma)

28
Q

gallbladder disease 4 Fs

A

fat, fertile, female, forty

29
Q

murphy’s sign

A

-painful reflex arrest in inspiration, triggered by palpation of edge of inflamed gallbladder

30
Q

Courvoisier’s law

A

painless jaundice + enlarged, palpable, non-tender gallbladder
-cancer of biliary tract or pancreatic head

31
Q

Boa’s sign

A

area of hypersensitivity over R. costophrenic angle (and R. shoulder)

32
Q

big clues to ascites

A

recent wt gain or hx of liver disease

33
Q

PE tests for ascites

A
  1. bulging lfanks
  2. flank dullness
  3. shifting dullness
  4. fluid wave (only specific test)
  5. ballottement sign
    * *only good if 500-1000cc of fluid (if less than US is gold standard, can detect 100cc fluid)
34
Q

tests to rule-in ascites

A

fluid wave and hx of ankle edema

35
Q

tests to r/o ascites

A

absence of shifting dullness, esp in abscence of ankle edema/abd girth

36
Q

transudate ascitic fluid

A

cirrhosis, CHF, nephritic syndrome

37
Q

exudative ascitic fluid

A

ruptured viscus with peritonitis, tumors

38
Q

causes of distension w/o ascites

A

aerophagia, malabsorption, chronic pancreatic insufficiency, bowel obstruction

39
Q

induced guarding/carnett’s sign

A 
touch chin to chest (activate abdominal mm)
if tender (+ sign), lesion in abdominal wall
if not tender (-sign), lesion is intra-abdominal
40
Q

modified induced guarding/abdominal wall tenderness

A

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

41
Q

rebound tenderness (blumberg sign)

A

don’t need to do if already have guarding/rigidity

-indicates localized peritonitis

42
Q

referred rebound tenderness

A

palpable quadrant contralateral to patient’s pain
+ if it elicits pain in original site
variants: cough test, jar test, valsalva

43
Q

closed eye sign

A

if have true intraabdominal pathology, will keep eyes open and monitor exam

44
Q

PE signs of liver disease

A
  1. spider teleangiectasias (nevi): abnormally inc. ratio estradiol:testosterone, pregancy, malnutrition
  2. palmar erythema (hepatic inability to inactivate vasodilators)
  3. asterixis (hepatic encephelopathy)
  4. palpable spleen (portal HTN)
  5. fetor hepaticus (severe parenchymal disease)
  6. dilated abdominal vv
  7. clubbing
  8. . orthodeoxia/platypnea b/c created shunts
45
Q

tests for appendicitis

A

none are sensitive

  1. MucBurney’s (focal tenderness/rigidity 2 inch medial of R ASIS)
  2. Rovsings (pain in R. iliac fossa d/t pressure over LLQ)
  3. Obturator: pain if flex and rotate hip
  4. reverse psoas: retrocecal processes
  5. rectal tenderness: perforation
46
Q

PE findings: absent bowel sounds and tympany

A

late stage of bowel obstruction (paralytic ileus)

47
Q

PE findings: hyperactive high pitched bowel sounds and tympany and visible hyperperistalsis

A

early stage obstruction

48
Q

PE findings: vascular bruit

A

dissecting arterial aneurysm

49
Q

PE findings: distension, absent sounds, absent liver dullness

A

free intraperitoneal air due to perforated viscus

physical diagnosis (7 decks)

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