Abdominal Exam I Flashcards
Describe visceral pain.
Caused by stimulation of the visceral pain fibers!
• Secondary to distention, stretching or contracting of hollow organs, stretching the capsule of solid organs or organ ischemia
• Usually felt in the midline at the level of the structure involved
• Not localized
• Examples: periumbilical pain with early
appendicitis
Describe parietal (somatic) pain.
- Caused by stimulation of the somatic pain fibers
- Secondary to inflammation in the parietal peritoneum
- Usually constant and more severe than visceral pain
- localized
- Aggravated by movement or coughing
- Alleviated by remaining still
- Examples: RLQ parietal tenderness later finding in acute appendicitis
- LLQ parietal tenderness: later finding in acute diverticulitis
What is referred pain?
– Originates within the abdomen but is felt at
distant sites which are innervated at approximately the same spinal levels as the
disordered structure
What are two common examples of referred GI pain?
Duodenal and pancreatic pain - classically referred to back
Biliary tree
- referred to right shoulder
What parts of OLDCAARTS are particularly important when dealing with an abdominal complaint?
location as well as aggravating and alleviating factors
what meds are important to ask about when assessing a patient with an abdominal Cx?
• GI Prescriptions (H2 blockers, PPIs) • OTC meds (Tylenol, Aspirin/ibuprofen, antacids, laxatives) • Herbs • blood thinners • NSAIDS • Narcotics • Steroids
what are the steps of the PE for an abdominal exam?
- Inspection
- Auscultation
- Percussion
- Palpation
• **Must be done in this order
• **Must drape your patient
• Pearl: Do it the same way every time!
what are the landmarks of the abdomen?
Landmarks – Xiphoid process of sternum – Costal margins – Umbilicus – Anterior superior iliac spine
what contents are found in each of the 4 abdominal quadrants?
• Right upper quadrant (RUQ) – Liver, gallbladder, stomach, SB, LB • Right lower quadrant (RLQ) – Appendix, ovary, SB, LB • Left lower quadrant (LLQ) – Sigmoid colon, ovary, SB, LB • Left upper quadrant (LUQ) – Spleen, stomach, SB, LB
what is found in the epigastric area?
Epigastric Area
– Pancreas, Liver, gallbladder, stomach, SB, LB
***this is basically the contents of the RUQ with the addition of the pancreas
what are the parameters for normal bowel sounds?
5-34 clicks/gurgles per minute
what are the parameters for increased bowel sounds?
In what conditions could this occur?
Increased bowel sounds
• Diarrhea, early bowel obstruction
what are the parameters for decreased bowel sounds? In what conditions could this occur?
none for 1 minute; Post surgical ileus, peritonitis
what are the parameters for absent bowel sounds? In what conditions could this occur?
none for >2 minutes; Increased bowel sounds;
Long-lasting intestinal obstruction, intestinal perforation, mesenteric
ischemia
what sound predominates in the auscultation of the abdomen?
Tympany predominates
• because of gas in the GI tract, scattered areas
of dullness is normal from fluid and feces
– Abnormal= Large dull areas from a mass or enlarged
organ
– Protuberant abdomen typanitic throughout may
indicate an intestinal obstruction
how to perform a liver percussion
• Liver percussion:
– Right midclavicular line, start in RLQ (area
of tympany) and percuss cephalad to an area of dullness= lower border of liver
– Right midclavicular line, start in RUQ (area
of lung resonance) and percuss
caudad toward liver dullness = superior border of liver
what is the normal liver vertical span?
what is this increased with?
Normal liver vertical span= 6-12 cm
Vertical span increased with:
• Enlarged liver= cirrhosis, lymphoma, hepatitis, right-sided heart failure, amyloidosis, hemochromatosis
• Right pleural effusion (falsely increased
what is the vertical span of the liver decreased with?
cirrhosis
during what conditions will the liver feel irregular on the edges with nodules?
during what conditions will the liver feel hard/firm?
– Normal liver may be slightly tender, soft, smooth surface
- Irregular edge/ nodules= hepatocellular carcinoma
- Firmness/hardness= cirrhosis, hematochromatosis, amyloidosis, lymphoma
what conditions are associated with splenomegaly?
Splenomegaly= portal hypertension,
blood malignancies, HIV, splenic infarct, hematoma, mononucleosis
In approximately 5% of normal
adults, the tip of the spleen is
palpated
Describe the shifting dullness test.
Shifting dullness test • Percuss the borders of tympany and dullness with patient supine • Then have patient lay on side and percuss borders again • Normal= borders stay the same • Ascites/ positive test= dullness shifts to dependent side and tympany to top side
Describe the test for a fluid wave
• Test for a fluid wave • Ask the patient to rest his or her hands over chest • Have an assistant place the ulnar aspects of hands midline, then tap one flank sharply with finger tips • Normal= no impulse felt on the other flank • Ascites/positive test= impulse transmitted to the other flank
describe the four specialty tests for appendicitis and state the positive finding
•McBurney’s point Tenderness
• draw an imaginary line from ASIS to umbilicus, and palpate
2 inches medial to ASIS on that line
• Positive test= tenderness
- Rovsing’s sign
- palpate deeply in LLQ
- Positive test= pain felt in RLQ
• Psoas sign
• place hand above patient’s right knee and ask patient to raise thigh against resistance, then turn patient onto their left side and extend
right leg at the hip
• Positive test for either maneuver= increased abdominal pain
- Obturator sign
- flex patient’s right hip with knee bent, then internally rotate the hip
- Positive test= right hypogastric pain
Describe murphy’s sign and state the positive finding
Murphy’s sign
• with right hand, palpate deeply under the patient’s
right costal margin, ask the patient to take a deep
breath in, and palpate deeper
• Positive test= sharp increase in tenderness with sudden
stop in inspiratory effort
