Abdominal Pain Flashcards
Visceral pain
- 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
Parietal (somatic) pain
- 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
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
- duodena and pancreatic pain classically referred to back
- biliary tree referred to right shoulder
Physical Exam Order
1) Inspection
2) Auscultation
3) Percussion
4) Palpation
Must be done in this order
Must drape patient
Right Upper Quadrant
liver, gallbladder, stomach
Right Lower Quadrant
appendix, ovary
Left Lower Quadrant
colon, ovary
Left Upper Quadrant
stomach, spleen
Epigastric area
pancreas, liver, gallbladder, stomach
Auscultation
- 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
Absent bowel sounds
none for >2 minutes; can be long lasting intestinal destruction, intestinal perforation, mesenteric ischemia
Decreased bowel sounds
none for 1 minute
post surgical ileus, peritonitis
Increased bowel sounds
diarrhea, early bowel obstruction
High pitched bowel sounds
sounds like tinkling raindrops on metal
suggests early intestinal obstruction
Bruits
vascular sounds resembling a heart murmur, over the aorta or other abdomen arteries (renal, iliac, femoral)
Friction rub
grating sounds with respiratory variation
inflammation of the peritoneal surface of an organ
listen over liver and spleen
Venous hum
soft humming noice
increased collateral circulation between portal and systemic venous systems
listen over epigastric and umbilical regions
Percussion
- 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
Tympany
high pitched, air filled
Dullness
non-resonating, solid organs or masses
Resonance
hollow abdominal organs (lungs)
Hyper-resonance
air filled hollow organ (pneumothorax)
Which sound predominates?
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
Palpation
- 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
Liver Assessment
- mostly covered by rib cage, assessment is difficult
- assess shape and size by percussion and palpation
Spleen Assessment
- normally not palpable, unless enlarged
- when spleen enlarges, it expands anteriorly, downward, and medially
- percussion and palpation help assess splenomegaly
