Abdominal Pain Flashcards
Visceral vs Parietal (Somatic) Pain
Visceral -visceral pain fibers -secondary to distention, stretching or contracting hollow organs, stretching capsule of solid organs -not localized Parietal -somatic pain fibers -secondary to inflammation in parietal peritoneum -localized
Referred Pain
origin in abdomen but felt at distant sites where innervated at same spinal levels
- duodenal and pancreatic pain-referred to back
- biliary tree-referred to right shoulder
ROS To Ask
General ROS
-fever, chills, CP, SOA, cough
Focused ROS
-GI: nauesa, vomitting, diarrhea, blood in stool
-GU: dysuria, polyuria, flank pain
-GYN: vaginal bleeding, discharge, LMP, poss pregnancy
Order for Abdominal Pain
- Inspection
- Auscultation
- Percussion
- Palpation
Quadrants
- RUQ
- RLQ
- LUQ
- LLQ
- Epigastric Area
- RUQ: liver, gallbadder
- RLQ: Appendix, ovary
- LUQ: Stomach
- LLQ: colon
- Epigastric Area: pancreas
Auscultation
-bell for bruits
-Normal Bowel Sounds: 5-34 clicks per min
Absent: long lasting intestinal obstruction, perforation
Decreased: post surgical lieus, peritonitis
Increased: diarrhea, early bowel obstruction
-High pitched bowel sounds: early intestinal obstruction
-Frictional Rub: grating sounds with resp variation
-Venous Hum: collateral circulation between portal and systemic venous systems
Percussion
tympany (high pitched air filled) predominates
Organ Assessment Liver
Liver hard to assess-palpate from RLQ to dullness then RUQ caudal to dullness
-Normal liver vertical span 6-12 cm
Enlarged-cirrhosis, lymphoma, hepatitis, R sided HF
Decreased: shrunken liver cirrhosis
-Irregular edge: hepatocellular carcinoma
-Firmness/hardness: cirrhosis, hematochromatosis, lymphoma
Organ Assessment Spleen
- percuss from border of cardiac border of left ant axillary line and percuss laterally
- dullness at midaxillary line= splenomegaly (portal hypertension, blood malignancies, hematoma, mononucelosis)
- usually not palpated
Special Test Shifting Dullness (Ascites)
percuss borders of tympany and dullness with pt supine then on side
- normal: borders stay same
- Ascites= dullness shifts to dependent side and tympany to top side
Special Test Fluid Wave (Ascites)
-place ulnar pt of hands midline and tap one flank with finger
Normal: no impulse felt on other flank
Ascites: impulse transmitted to other flank
Special Test for Appendicitis
- McBurney’s Pt Tenderness
- Rovsings sign
- Psoas Sign
- Obturator Sign
- McBurney’s Pt Tenderness: 1/3 bw ASIS and umbilicus and tender spot
- Rovsings sign: pain in RLQ when palpate LLQ
- Psoas Sign: place hand on right knee and ask pt to raise thigh against resistance and then turn pt on left side and extend right leg at hip–> positive if increased abdominal pain
- Obturator Sign: flex pt right hip with knee bent, IR hip so pos test–> right hypogastric pain
Special Test ofr Biliary Colic
-Murphys Sign
- Murphys Sign: with right hand, palpate under right costal margin, ask pt to take deep breath in and palpate deeper
- pos test–> sharp increase in tenderness with sudden stop in inspiratory effort
Special Test for Kidney Inflammation/Distention
-Lloyd’s Sign
-Lloyd’s Sign: pain to deep percussion in costovertebral angle
Pos–> pain in area of CVA with deep percussion
Signs of Peritoneal Inflammation
- Guarding: voluntary and involuntary
- Rigidity: involuntary reflex, abdominal muscles stiff
- Rebound Tenderness: push down deep into abdomen and let go quickly positive–> more tenderness with letting go than pushing in
