Abdominal Exam

Question 1

Visceral pain

Answer 1

caused by stimulation of visceral pain fibers, secondary to distention or stretching or contracting of organs, not localized

Question 2

Parietal pain

Answer 2

caused by stimulation of somatic pain fibers, secondary to inflammation in the parietal peritoneum, localized

Question 3

Referred Pain

Answer 3

pain felt at distant sites which are innervated at approx. same spinal levels

Question 4

What is the order of an abdominal exam?

Answer 4

inspection, auscultation, percussion, palpation

Question 5

What are some key landmarks of the abdomen?

Answer 5

xiphoid process, costal margins, umbilicus, anterior superior iliac line

Question 6

Auscultating abdomen

Answer 6

listen for bowel motility and bruits, 5-34 clicks per minute

Question 7

What might high pitched bowel sounds suggest?

Answer 7

intestinal obstruction

Question 8

What might a friction rub sound indicate?

Answer 8

Grating sounds with respiratory variation, inflammation of peritoneal surface of an organ

Question 9

What might a venous hum indicate?

Answer 9

soft humming noise, increased collateral circulation between portal and systemic venous systems

Question 10

What is the best way to palpate an abdomen?

Answer 10

Light to deep, clockwise fashion

Question 11

Liver Assessment

Answer 11

mostly covered by rib cage, assess shape and size by percussion and palpation, palpate with hand behind ribs and push left hand upward and right hand on patient’s abdomen, feel for hardness, firmness, nodules

Question 12

Spleen Assessment

Answer 12

Normally not palpable, can be percussed laterally from cardiac border, if tympany in midaxillary line, splenomegaly not likely

Question 13

What is associated with splenomegaly?

Answer 13

Mono, hematoma, blood malignancies, portal hypertension

Question 14

Shifting dullness test

Answer 14

if dullness shifts when pt lays on side, positive test indicative of ascites

Question 15

McBurney’s point Tenderness

Answer 15

palpate 2 inches medial to ASIS between umbilicus

Question 16

Rovsing’s sign

Answer 16

palpate LLQ, positive if pain felt in RLQ

Question 17

Psoas Sign

Answer 17

have pt flex hip against resistance

Question 18

Obturator Sign

Answer 18

flex patient’s hip then internally rotate

Question 19

Murphy’s Sign

Answer 19

palpate deeply under patient’s right costal margin, test gall bladder/biliary colic

Question 20

Lloyd’s punch

Answer 20

pain to deep percussion in area of costovertebral angle, implies kidney patho

Question 21

Voluntary guarding

Answer 21

patient consciously protects the abdomen when it is palpated

Question 22

Involuntary guarding

Answer 22

unconscious contraction of abdominal wall when musculature when abdomen is palpated

Question 23

Rigidity

Answer 23

Involuntary reflex contraction of abdominal wall

Question 24

Rebound tenderness

Answer 24

occurs when you push down and let go quickly

Question 25

Rome Criteria - Constipation

Answer 25

must have 2 of the following over 3 months; fewer than 3 bowel mvmts/wk, straining, lumpy or hard stools, sensation of incomplete defecation, manual maneuvering required to defecate

Question 26

Bristol Stool Scale

Answer 26

``` 1 - separate hard lumps 2 - sausage shaped, lumpy 3 - sausage-shaped, but with cracks 4 - snake, soft 5 - soft blobs with clear edges 6 - fluffy pieces, ragged edges 7 - watery, no solid pieces ```

Question 27

What are some important things to note in history when doing an abdominal PE?

Answer 27

normal pattern of defecation, frequency, perceived hardness, straining, time spent on toilet, what has tried to help, changes in diet or water or exercise

Question 28

What are some important lifestyle modifications for constipation?

Answer 28

increase fiber, increase water, use the bathroom right away, increase exercise

Question 29

What is norovirus?

Answer 29

viral gastroenteritis, starts with uncontrolled vomiting 12-48 hours after exposure, usually more vomiting than diarrhea

Question 30

What is rotavirus?

Answer 30

viral gastroenteritis, can be immunized

Question 31

Salmonella gastroenteritis

Answer 31

eating something contaminated, onset 12-36 hrs

Question 32

C. difficile gastroenteritis

Answer 32

most common hospital acquired, exposure to abx

Question 33

E. coli gastroenteritis

Answer 33

food, water, person to person, starts within 5 days but lasts 2 weeks

Question 34

Giardia gastroenteritis

Answer 34

causes diarrhea, bloating, abdominal cramping, transmits person to person and animals to humans

Question 35

Irritable Bowel Syndrome

Answer 35

altered bowel habits, abdominal pain and bloating, alternating constipation and diarrhea, defecation improves abdominal pain but doesn't relieve it

Question 36

What are some osteopathic treatment options for patients with gastroenteritis and constipation?

Answer 36

mesenteric release (help constipation), ganglion inhibition (help diarrhea)

Question 37

What are some classical presentations of acute appendicitis?

Answer 37

Gastroenteritis, RLQ pain

Question 38

What are some classical presentations of acute cholecystitis?

Answer 38

RUQ, shoulder pain, often female, older, obese, family and fertility

Question 39

What is a cullen sign?

Answer 39

ecchymosis around umbilicus

Question 40

What is a grey turner sign?

Answer 40

flank ecchymosis secondary to hemorrhage

Question 41

What is the heel strike test?

Answer 41

strike heel, indicates possible appendicitis or peritonitis

Question 42

Courvoisier's Sign

Answer 42

englarged gallbladder, indicates pancreatic disease