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Phase 1b - Clinical Practical Assessment (CPA) > Abdominal Examination > Flashcards

Abdominal Examination Flashcards

1
Q

What exposure is required for an abdominal examination?

A

Exposure from xiphisternum to the pubic symphysis

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2
Q

What position is required for an abdominal examination?

A

Supine position with the no upper body elevation

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3
Q

What lines divides the abdomen into 4 quadrants?

A
  • Transumbilical plane (Horizontal)
  • Median plane (Vertical)
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4
Q

The abdomen can be divided into 4 quadrants. Name them starting from the right superolateral point and going clockwise.

A
  • Right upper quadrant
  • Left upper quadrant
  • Left lower quadrant
  • Right lower quadrant
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5
Q

What lines divide the abdomen into 9 regions?

A
  • Left midclavicular line (Vertical)
  • Right midclavicular line (Vertical)
  • Subcostal plane (Horizontal)
  • Intertubercular plane (Horizontal)
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6
Q

The abdomen can be divided into 9 regions. Name them starting from the right superolateral point and going S - shaped.

A
  • Right hypochondrium
  • Epigastric
  • Left hypochondrium
  • Left lumbar
  • Umbilical
  • Right lumbar
  • Right inguinal
  • Pubic
  • Left inguinal
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7
Q

What are the 4 main areas of abdominal general inspection?

A
  • Shape & symmetry
  • Skin abnormalities
  • Surgical scars (indicating prior abdominal pathology)
  • Masses
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8
Q

What does swollen / distended abdomen suggest?

A

Ascites

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9
Q

What does abdominal asymmetry suggest?

A

Abdominal mass

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10
Q

What do enlarged veins on anterior umbilical wall suggest?

A

Portal hypertension

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11
Q

What does everted umbilicus suggest?

A

Umbilical hernia

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12
Q

What does sunken umbilicus suggest?

A

Obesity

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13
Q

In what order is the abdomen palpitated?

A
  • Light palpation (S shape)
  • Deep palpation (S shape)
  • Liver palpation (Red arrow)
  • Spleen palpation (Green arrow)
  • Bimanual palpation of the kidney, balloting of the kidneys
  • Palpation of the AA (Purple star)
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14
Q

How is light and deep palpitation performed?

A

S-shaped

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15
Q

How is liver palitation performed?

A

Right inferolaterally to right superiorlaterally (Red arrow)

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16
Q

How is spleen palitation performed?

A

Right inferolaterally to left superiorlaterally (Green arrow)

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17
Q

How is bimanual palpation of the kidney performed?

A

Balloting of the kidneys

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18
Q

How is palpitation of the abdominal aorta performed?

A

Firm pressure in umbilical region (Purple star)

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19
Q

What are the surface markings of the liver & the gallbladder?

A
  1. Right 5th rib at midclavicular line
  2. Lower end of sternum
  3. Left 5th intercostal space at midclavicular line
  4. Costal margin at right midaxillary line
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20
Q

What are the surface markings of the spleen?

A
  • Lateral border of erector spinae muscles
  • Midaxillary line
  • 9th intercostal space
  • 11th intercostal space
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21
Q

What are the surface markings of the kidneys & ureters?

A
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22
Q

What are the surface markings of the abdominal aorta (AA)?

A
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23
Q

In what order is the abdomen percussed?

A
  • Abdominal palpation (S shape)
  • Liver palpation (Red arrow)
  • Spleen palpation (Green arrow)
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24
Q

How is abdominal percussion performed?

A

S-shaped

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25
How is liver percussion performed?
Right inferolaterally to right superolaterally (Red arrow)
26
How is spleen percussion performed?
Right inferolaterally to left superolaterally (Green arrow)
27
How is percussion of shifting dullness performed?
28
What is the clinical significance of abdominal hyperresonance?
Air in the abdomen
29
What is the clinical significance of abdominal hyporesonance?
Fluid
30
What is the clinical significance of shifting abdominal hyporesonance?
Tests for **ascites**
31
How is auscultation of the abdomen performed?
* Only listen in 2 regions * Listen for 30s
32
What is the clinical significance of abdominal auscultation?
* Bowel sounds must **not be present for 3-4 minutes** in order to conclude that they are missing * Indicate **constipation**
33
What does abdominal pain on movement generally indicate?
**Musculoskeletal** pain
34
What does abdominal colicky pain generally indicate?
Indicates **obstruction**
35
What does abdominal constant pain generally indicate?
Indicates **inflammation**
36
What does colicky pain on the right hypochondriac region indicate?
* Cholelithiasis * Choledocholithiasis
37
What is cholelithiasis? Where does it radiate?
* Cholelithiasis is the **presence of one or more calculi** (gallstones) in the **gallbladder** * Radiates through to the **back** & the **right**
38
What is choledocholithiasis? Where does it radiate?
* Choledocholithiasis is the presence of **at least one gallstone** in the **common bile duct** * Radiates through to the **back** & the **right**
39
What does colicky pain on right lumbar region & right iliac region indicate?
**Urinary tract calculi**
40
What is urinary tract calculi? Where does it radiate?
* Urinary tract calculi are **hard masses** that form in the **urinary tract** and may cause pain, bleeding, or an infection or block of the flow of urine * Radiates to the **loin** & to the **groin**
41
What does colicky pain on umbilical region indicate?
Small Bowel Obstruction / Large Bowel Obstruction (SBO/LBO)
42
Where does Small Bowel Obstruction / Large Bowel Obstruction (SBO/LBO) radiate?
Does **not** normally **radiate**
43
What does constant pain on the right hypochondriac region indicate?
* Cholecystitis * Hepatitis * Cholangitis
44
What is cholecystitis? Where does it radiate?
* Cholecystitis is a **redness** **&** **swelling** (inflammation) of the **gallbladder** * Radiates through to the **back** & the **right**
45
What is hepatitis? Where does it radiate?
* Hepatitis means **inflammation** of the **liver** * Does **not** normally **radiate**
46
What is cholangitis? Where does it radiate?
* Cholangitis is an **inflammation** of the **bile duct system** * Radiates through to the **back** & the **right**
47
What does constant pain on the right lumbar region indicate?
Nephritis
48
What is nephritis? Where does it radiate?
* Nephritis is a condition in which the **nephrons**, the functional units of the kidneys, become **inflammed** * Radiates to the **loin** & to the **groin**
49
What does constant pain on the right iliac region indicate?
Appendicitis
50
What is appendicitis? Where does it radiate?
* Appendicitis is an **inflammation** of the **appendix** * Does **not** normally **radiate**
51
What does constant pain on the epigastric region indicate?
* Pancreatitis * Gastritis * Chron’s disease
52
What is pancreatitis? Where does it radiate?
* Pancreatitis is **inflammation** of the **pancreas** * Radiates straight **through** to the **back**
53
What is gastritis? Where does it radate?
* Gastritis is **inflammation** of the **lining** of the **stomach** * Radiates straight **through** to the **back**
54
What is Chron’s disease? Where does it radiate?
* Chron’s disease is a type of inflammatory bowel disease **(IBD)** * Does **not** normally **radiate**
55
What does constant pain on the hypogastric region indicate?
Cystitis
56
What is cystitis? Where does it radiate?
* Cystitis is the **inflammation** of the **bladder** * Does **not** normally **radiate**
57
What does constant pain on the left iliac region indicate?
* Diverticulitis * Ulcerative Colitis (UC)
58
What is diverticulitis? Where does it radiate?
* Diverticulitis is the **infection or inflammation** of **pouches** that can form in your **intestines** * Does **not** normally **radiate**
59
What is Ulcerative Colitis (UC)? Where does it radiate?
* Ulcerative Colitis (UC) is an **inflammatory bowel disease (IBD)** that causes **inflammation** and **ulcers** (sores) in your **digestive tract** * Does **not** normally **radiate**
60
How does one differentiate between MRI and CT scans?
Bones on CT scans appears white, while in the MRI appears black
61
How does one differentiate between small and large bowel obstruction on X Ray?
* Remember the 3,6,9 rule of the AXR * Small bowel diameter \<3cm * Colon \<6cm * Caecum \<9cm
62
What are the key presentations of acute appendicitis (6)?
* Tenderness at McBurney’s point * Rovsing sign * Psoas Sign * Obturator sign * Blumberg's sign * Triad of anorexia, nausea and vomiting
63
What are the key presentations of unruptured abdominal aortic aneurysm (3)?
* Often **asymptomatic** * **Bruits** (abnormal sound generated by turbulent flow of blood in an artery due to either an area of partial obstruction or a localized high rate of blood flow through an unobstructed artery) on **auscultation** * **Pulsatile & laterally expansile pulse**
64
What are the key presentations of ruptured abdominal aortic aneurysm (2)?
* Signs of **shock** (tachycardia, hypotension, loss of consciousness) * May see **Cullen’s or Grey Turner’s sign**
65
What are the key presentations of bowel obstruction (6)? What are the distinct presentations of SBO (2)? What are the distinct presentations of LBO (2)?
* Abdominal distention * Bloating * Nausea * Vomiting * Constipation * Colicky abdominal pain * **SBO:** * Bilious vomiting early sign * Abdominal distention less prevalent * **LBO:** * Faeculent vomiting late sign * Abdominal distention has high prevalence
66
What are the key presentations of peritonitis (7)?
* Diffuse abdominal pain * Tenderness * Guarding * Rigidity * Rebound tenderness * Patient lying still * Systemic symptoms: fever, tachycardia, nausea and vomiting

Phase 1b - Clinical Practical Assessment (CPA) (5 decks)

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