abdominal exam lecture Flashcards
RUQ contents
liver, gallbladder
RLQ contents
appendix, cecum, ovary
LLQ contents
sigmoid colon, ovary
LUQ contents
spleen
the epigastric region is often used to describe location of
stomach, pancreas, and part of liver
inspection of abdomen, looking for what
surface: skin color, scars, rash, ecchymoses
contour of the abdomen
-contour of the abdomen (flat, round, scaphoid, bulges)
-peristalsis
-arterial pulsations
cullen’s sign
ecchymoses around umbilicus
- hemoperitoneium
- acute pancreatitis
grey turner’s sign
ecchymoses of the flanks
- hemoperitoneium
- acute pancreatitis
jaundice, ascites, caput medusae is indicative of
portal hypertension
auscultation of abdomen use
diaphragm
except when listening for bruits, then use bell
normal bowel sounds
clicks/gurgles
5-34
if you have absent bowel sounds this can be indicative of what
none for >2
intestinal obstruction, intestinal perforation, mesenteric ischemia
decreased bowel sounds
post-surgical ileus, peritonitis
increased bowel sounds
diarrhea, early bowel obstruction
high pitched bowel sounds
early intestinal obstruction
bruits
vascular obstruction
renal a, iliac a, femoral a
friction rub sound
what is it
what does it indicate
where to listen
grating sounds with respiratory variation
- inflammation of peritoneal surface of organ
- listen over liver and spleen
venous hum
what is it, what does it mean, where to listen
soft humming noise
- increased collateral circulation btwn portal and systemic venous systems
- listen over epigastric and umnilical regions
percussion for what
size of liver and spleen
assess for tympany and dullness
tympany
dullness
resonance
hyper-resonance
tymp: high pitched, air filled
dullness: non resonating, solid organs or mases
- rosonance: hollow abdominal organs
- hyper res: air filled hollow organ (pneumothorax)
palpation
gently palpate then deeply palpate all 4 regions
what does periumbilical visceral pain indicate
acute appendicitis
pain from SI, or proximal colon
visceral pain
difficult to localize
can be palpable in the midline at level of structure involved
epigastric pain could be from
stomach, duod, pancreas
suprapubic or sacral pain from
rectum
hypogastric pain from
colon, bladder, uterus
parietal pain
more severe than visceral pain and easier to localize
RUQ/epigastric parietal tenderness
acute cholecystitis
epigastric parietal tenderness
actue pancreatitis
RLQ parietal tenderness
later finding in acute appenicitis
LLQ parietal tenderness
actue diverticulitis
referred pain: duod and pancrease
referred to back
biliary tree referred pain
to right shoulder
is spleen normally palpable
no, unless enlarged
normal liver vertical span
where to check
6-12 cm, checking at midclavicular line on right
vertical span decreased by
cirrhosis, free air under diaphragm
irregular edge/nodules on liver palpation may be
hepatocellular carcinoma
firmness/hardness of palpated liver may be
cirrhosis, hematochromatosis, amyloidosid, lymphoma
what can cause splenomegaly
portal hypertension, blood malignancies, HIV, splenic infact, mono
test for ascites
shifting dullness test
- percuss borders of tympany and dullness w/ patient supine
- have patient lay on side and percuss borders again
- normal = borders stay same
- ascites/postive test if dullness shifts to dependent side and tympany to top side
another test for ascites
test for a fluid wave
assistant places ulnar aspects of hands midline, tap one flank sharply with finger tips
normal = no impulse other flnk
-acites/postive test = impulse transmitted to other flank
(+) mcBurney’s point
appendicites
rovsings sign
palpate deeply in LLQ and if pain felt RLQ then positive for appendicitis
psoas sign
dr places hand on thigh of pt and have them try to flex at hip, if abdominal pain then appendicits possible
obturator sign
flex patients right hip with knee bent, internally rotate hip
-if right hypogastric pain then irritation of obturator muscle from inflamed appendix
murphy’s sign test for
cholecystitis
signs of peritoneal inflammation
guarding
rigidity
rebound tenderness
test for pyelonephritis or renal stone
lloyds punch
test for abdominal wall mass vs intraabdominal mass
ask patient to raise head and shoulders when lying supine
-palpate for mass again
-abdominal wall mass remains palp
intraabdominal mass, no longer palp
test for ventral hernia
when lying supine, ask patient to raise head and hsoulders off table
-positive test = bulge of hernia will usually appear
depth of light vs mod vs deep palp
light = 1 cm mod = 2-3 cm deep = more than 3 cm
what is courvoisier’s sign
enlarged, non tender gallbladder 2ndary to pancreatic disease or cancer
what rib level are you at on pts back when feeling for liver?
spleen?
liver = 11 and 12 on right side spleen = 12 on left side
aorta palpation location and width
above umbilicus slightly left of midline
2-3 cm
pulsation in anterior-inferior direction
sympathetic levels of esophagus
T2-T8
symp levels stomach
T5-T9
symp levels of liver
T6-T9
symp levels of GB
T6-T9
symp levels of SI
T9-T11
symp levels colon
T10-T12
symp levels of pancres
T5-T11
symp levels of appendix
T12
parasymp, vagus nerve
esophagus through transverse colon
parasymp S2-S4
descending colon, sigmoid, rectum
heel stirke
pt supine, doc strikes patient’s heel
-pain upon striking could indicate appendicitis
percussion of spleen, span from what ribs
6 to 10
documentation of normal abdominal exam
Abd S/NT/ND/BS+ x 4, no R/G/R, HSM or CVAT
abdomen is soft, nontender, nondistended, bowel sounds heard in all 4 quadrants, no rebound, guarding, rigidity, hepatosplenomegaly, or costovertebral angle tenderness
