Abdominal Exam Flashcards
Visceral pain
caused by stimulation of visceral pain fibers, secondary to distention or stretching or contracting of organs, not localized
Parietal pain
caused by stimulation of somatic pain fibers, secondary to inflammation in the parietal peritoneum, localized
Referred Pain
pain felt at distant sites which are innervated at approx. same spinal levels
What is the order of an abdominal exam?
inspection, auscultation, percussion, palpation
What are some key landmarks of the abdomen?
xiphoid process, costal margins, umbilicus, anterior superior iliac line
Auscultating abdomen
listen for bowel motility and bruits, 5-34 clicks per minute
What might high pitched bowel sounds suggest?
intestinal obstruction
What might a friction rub sound indicate?
Grating sounds with respiratory variation, inflammation of peritoneal surface of an organ
What might a venous hum indicate?
soft humming noise, increased collateral circulation between portal and systemic venous systems
What is the best way to palpate an abdomen?
Light to deep, clockwise fashion
Liver Assessment
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
Spleen Assessment
Normally not palpable, can be percussed laterally from cardiac border, if tympany in midaxillary line, splenomegaly not likely
What is associated with splenomegaly?
Mono, hematoma, blood malignancies, portal hypertension
Shifting dullness test
if dullness shifts when pt lays on side, positive test indicative of ascites
McBurney’s point Tenderness
palpate 2 inches medial to ASIS between umbilicus
Rovsing’s sign
palpate LLQ, positive if pain felt in RLQ
Psoas Sign
have pt flex hip against resistance
Obturator Sign
flex patient’s hip then internally rotate
Murphy’s Sign
palpate deeply under patient’s right costal margin, test gall bladder/biliary colic
Lloyd’s punch
pain to deep percussion in area of costovertebral angle, implies kidney patho
Voluntary guarding
patient consciously protects the abdomen when it is palpated
Involuntary guarding
unconscious contraction of abdominal wall when musculature when abdomen is palpated
Rigidity
Involuntary reflex contraction of abdominal wall
Rebound tenderness
occurs when you push down and let go quickly
Rome Criteria - Constipation
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
Bristol Stool Scale
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
What are some important things to note in history when doing an abdominal PE?
normal pattern of defecation, frequency, perceived hardness, straining, time spent on toilet, what has tried to help, changes in diet or water or exercise
What are some important lifestyle modifications for constipation?
increase fiber, increase water, use the bathroom right away, increase exercise
What is norovirus?
viral gastroenteritis, starts with uncontrolled vomiting 12-48 hours after exposure, usually more vomiting than diarrhea
What is rotavirus?
viral gastroenteritis, can be immunized
Salmonella gastroenteritis
eating something contaminated, onset 12-36 hrs
C. difficile gastroenteritis
most common hospital acquired, exposure to abx
E. coli gastroenteritis
food, water, person to person, starts within 5 days but lasts 2 weeks
Giardia gastroenteritis
causes diarrhea, bloating, abdominal cramping, transmits person to person and animals to humans
Irritable Bowel Syndrome
altered bowel habits, abdominal pain and bloating, alternating constipation and diarrhea, defecation improves abdominal pain but doesn’t relieve it
What are some osteopathic treatment options for patients with gastroenteritis and constipation?
mesenteric release (help constipation), ganglion inhibition (help diarrhea)
What are some classical presentations of acute appendicitis?
Gastroenteritis, RLQ pain
What are some classical presentations of acute cholecystitis?
RUQ, shoulder pain, often female, older, obese, family and fertility
What is a cullen sign?
ecchymosis around umbilicus
What is a grey turner sign?
flank ecchymosis secondary to hemorrhage
What is the heel strike test?
strike heel, indicates possible appendicitis or peritonitis
Courvoisier’s Sign
englarged gallbladder, indicates pancreatic disease
