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PCM II > Abdominal Exam I > Flashcards

Abdominal Exam I Flashcards

1
Q

Describe visceral pain.

A

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

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2
Q

Describe parietal (somatic) pain.

A
  • 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
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3
Q

What is referred pain?

A

– Originates within the abdomen but is felt at
distant sites which are innervated at approximately the same spinal levels as the
disordered structure

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4
Q

What are two common examples of referred GI pain?

A

Duodenal and pancreatic pain - classically referred to back
Biliary tree
- referred to right shoulder

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5
Q

What parts of OLDCAARTS are particularly important when dealing with an abdominal complaint?

A

location as well as aggravating and alleviating factors

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6
Q

what meds are important to ask about when assessing a patient with an abdominal Cx?

A 
• GI Prescriptions (H2 blockers, PPIs)
• OTC meds (Tylenol, Aspirin/ibuprofen,
antacids, laxatives)
• Herbs
• blood thinners
• NSAIDS
• Narcotics
• Steroids
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7
Q

what are the steps of the PE for an abdominal exam?

A
  1. Inspection
  2. Auscultation
  3. Percussion
  4. Palpation
    • **Must be done in this order
    • **Must drape your patient
    • Pearl: Do it the same way every time!
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8
Q

what are the landmarks of the abdomen?

A 
Landmarks
– Xiphoid process of sternum
– Costal margins
– Umbilicus
– Anterior superior iliac spine
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9
Q

what contents are found in each of the 4 abdominal quadrants?

A 
• 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
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10
Q

what is found in the epigastric area?

A

Epigastric Area
– Pancreas, Liver, gallbladder, stomach, SB, LB

***this is basically the contents of the RUQ with the addition of the pancreas

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11
Q

what are the parameters for normal bowel sounds?

A

5-34 clicks/gurgles per minute

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12
Q

what are the parameters for increased bowel sounds?

In what conditions could this occur?

A

Increased bowel sounds

• Diarrhea, early bowel obstruction

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13
Q

what are the parameters for decreased bowel sounds? In what conditions could this occur?

A

none for 1 minute; Post surgical ileus, peritonitis

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14
Q

what are the parameters for absent bowel sounds? In what conditions could this occur?

A

none for >2 minutes; Increased bowel sounds;
Long-lasting intestinal obstruction, intestinal perforation, mesenteric
ischemia

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15
Q

what sound predominates in the auscultation of the abdomen?

A

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

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16
Q

how to perform a liver percussion

A

• 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

17
Q

what is the normal liver vertical span?

what is this increased with?

A

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

18
Q

what is the vertical span of the liver decreased with?

A

cirrhosis

19
Q

during what conditions will the liver feel irregular on the edges with nodules?

during what conditions will the liver feel hard/firm?

A

– Normal liver may be slightly tender, soft, smooth surface

  • Irregular edge/ nodules= hepatocellular carcinoma
  • Firmness/hardness= cirrhosis, hematochromatosis, amyloidosis, lymphoma
20
Q

what conditions are associated with splenomegaly?

A

Splenomegaly= portal hypertension,
blood malignancies, HIV, splenic infarct, hematoma, mononucleosis

In approximately 5% of normal
adults, the tip of the spleen is
palpated

21
Q

Describe the shifting dullness test.

A 
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
22
Q

Describe the test for a fluid wave

A 
• 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
23
Q

describe the four specialty tests for appendicitis and state the positive finding

A

•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
24
Q

Describe murphy’s sign and state the positive finding

A

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

25
Q

Describe lloyd’s sign and state the positive finding

A

• Lloyd’s sign (punch)
• Pain to deep percussion in the area of the costovertebral
angle
• Positive test= pain in the area of the CVA with deep
percussion
• Implies kidney pathology
• Pyelonephritis or ureterolithiasis

26
Q

Describe guarding

A

a sign of peritoneal inflammation!!!
• Guarding
• Voluntary contraction of the abdominal wall
• When palpating the abdomen, the abdominal musculature
“guards” the underlying inflamed organs from the pressure of
palpation, and become tense and contracted

27
Q

describe abdominal rigidity

A

a sign of peritoneal inflammation!!!
• Rigidity
• Involuntary reflex contraction of the abdominal wall
• Will seen stiff, board-like muscle contraction on inspection, also
may not see the abdomen move will respirations- can also be felt
during palpation.

28
Q

describe rebound tenderness

A

a sign of peritoneal inflammation!!!
• Rebound tenderness
• Occurs when you Push down deep into the abdomen and then let
go quickly
• Positive= more tenderness when letting go than pushing in

29
Q

what do high pitched bowel sounds sound like?

A

High pitched bowel sounds- sounds like tinkling (raindrops on metal),
• Suggests early intestinal obstruction

30
Q

what is the difference between a friction rub and a venous hum?

A

– Friction rub
- grating sounds with respiratory variation
• Inflammation of the peritoneal surface of an organ
• Listen over liver and spleen

– Venous hum- soft humming noise
• Increased collateral circulation between portal and systemic venous
systems
• Listen over epigastric and umbilical regions

PCM II (5 decks)

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