Abdominal Pain

Question 1

Visceral pain

Answer 1

• caused by stimulation of the visceral pain fibers
• secondary to distension, stretching or contraction of hollow organs
• usually felt in the midline at the level of the structure involved
• not localized
• ex) periumbilical pain with early appendicitis

Question 2

Parietal (somatic) pain

Answer 2

• caused by stimultation of the somatic pain fibers
• secondary inflammation in the parietal peritoneum
• usually constant and more severe than visceral pain
• localized
• aggravated by movement or coughing
• alleviated by remaining still
• ex) RLQ or LLQ parietal tenderness in acute appendicitis

Question 3

Referred pain

Answer 3

• originates within the abdomen but is felt at distant sites which are innervated at approximately the same spinal levels as the disordered structure
• duodena and pancreatic pain classically referred to back
• biliary tree referred to right shoulder

Question 4

Physical Exam Order

Answer 4

1) Inspection
2) Auscultation
3) Percussion
4) Palpation
Must be done in this order
Must drape patient

Question 5

Right Upper Quadrant

Answer 5

liver, gallbladder, stomach

Question 6

Right Lower Quadrant

Answer 6

appendix, ovary

Question 7

Left Lower Quadrant

Answer 7

colon, ovary

Question 8

Left Upper Quadrant

Answer 8

stomach, spleen

Question 9

Epigastric area

Answer 9

pancreas, liver, gallbladder, stomach

Question 10

Auscultation

Answer 10

• provides important info about bowel motility
• use diaphragm of stethoscope for bowel sounds
• use bell to listen for bruits
• normal bowel sounds: 5-34 clicks/gurgles per minute

Question 11

Absent bowel sounds

Answer 11

none for >2 minutes; can be long lasting intestinal destruction, intestinal perforation, mesenteric ischemia

Question 12

Decreased bowel sounds

Answer 12

none for 1 minute

post surgical ileus, peritonitis

Question 13

Increased bowel sounds

Answer 13

diarrhea, early bowel obstruction

Question 14

High pitched bowel sounds

Answer 14

sounds like tinkling raindrops on metal

suggests early intestinal obstruction

Question 15

Bruits

Answer 15

vascular sounds resembling a heart murmur, over the aorta or other abdomen arteries (renal, iliac, femoral)

Question 16

Friction rub

Answer 16

grating sounds with respiratory variation
inflammation of the peritoneal surface of an organ
listen over liver and spleen

Question 17

Venous hum

Answer 17

soft humming noice
increased collateral circulation between portal and systemic venous systems
listen over epigastric and umbilical regions

Question 18

Percussion

Answer 18

• allows you to assess for fluid and solid-filled masses, the amount of gas in the abdomen, and sizing of the liver and spleen
• percuss in all 4 quads
• assess for tympany and dullness

Question 19

Tympany

Answer 19

high pitched, air filled

Question 20

Dullness

Answer 20

non-resonating, solid organs or masses

Question 21

Resonance

Answer 21

hollow abdominal organs (lungs)

Question 22

Hyper-resonance

Answer 22

air filled hollow organ (pneumothorax)

Question 23

Which sound predominates?

Answer 23

tympany; gas in the GI tract, scattered areas of dullness is normal from fluid and feces
abnormal = large dull area from a mass or enlarged organ

Question 24

Palpation

Answer 24

• helpful for discerning abdominal tenderness, resistance, superficial organs and masses
• use palmar aspect of hand with fingers together
• gently palpate all 4 quads, then deeply palpate
• always start away from tender area

Question 25

Liver Assessment

Answer 25

• mostly covered by rib cage, assessment is difficult

- assess shape and size by percussion and palpation

Question 26

Spleen Assessment

Answer 26

• normally not palpable, unless enlarged
• when spleen enlarges, it expands anteriorly, downward, and medially
• percussion and palpation help assess splenomegaly