Abdominal Physical Exam

Question 1

How many Abdominal Quadrants and Regions

Answer 1

4 Quadrants: RUQ
LUQ
RLQ
LLQ

9 Regions: Epigastric,
L and R hypochondriac
L and R lumbar flank
L and R inguinal region
Umbilical
Hypogastric or suprapubic

Question 2

ROS

Answer 2

Upper GI-
Trouble swallowing
Heartburn
change in appetite
N/V, regurgitation
vomiting of blood
indigestion

Stomach- epigastric
abdominal pain 
food intolerance
excessive belching or passing gas 
jaundice
liver or gallbladder problems 
hepatitis

Lower GI-
Changes in bowel habits
rectal bleeding 
black tarry stools
hemorrhoids 
constipation
diarrhea

Question 3

Abdominal Complaints

Answer 3

Acute vs chronic abdominal pain
indigestion
N/V- hematemesis
anorexia, early satiety
Dysphagia or Odynophagia
change in bowel function
diarrhea, constipation
bloody stools 
jaundice

Question 4

True or False?

Many patients will confuse suprapubic or flank pain as abdominal complaint

Answer 4

True

Question 5

Urinary or Renal disorders

Answer 5

Suprapubic pain
Dysuria ,Urgency, Frequency
Hesitancy, split stream
polyuria, nocturia
Incontinence 
Hematuria
Kidney or flank pain
Ureteral Colic

Question 6

Other abdominal complaints
Heartburn

Excessive Gas or Flatus

Anorexia-

regurgitation

vomiting

Answer 6

• burning at epigastric region radiating into throat; associated with REGURGITATION
• needing to belch; bloated

Abdominal fullness or early satiety

lack of appetite; unintentional weight loss
over a short or extended period of time

reflux of food and stomach acid back into the mouth w/ a brine-like taste

How: Retching- spasmodic movement of the chest and diaphragm
amount
type: food, green or yellow-bile, mucus, blood, coffee ground emesis ( hematemesis).

Question 7

Abdominal pain - Qualify

Visceral pain

              solid organs

Answer 7

• when hollow organs such as stomach, colon forcefully contract or become distended
• liver or spleen- pain when they swell against their capsule
• Gnawing, cramping, or arching
• Difficulty to localize
  ie: Hepatitis

Question 8

Parietal pain

Answer 8

-there is inflammation from the hollow or solid organs that affect the parietal peritoneum

• easily localized pain
  ie: Appendicitis

Question 9

Referred pain

Answer 9

• originates at different sites but shares innervation from the same spinal level
  ie: pancreatitis pain at shoulder

Question 10

Locations of pain

RUQ or Epigastric pain

Epigastric pain

Periumbilical pain

Hypogastric pain

Suprapubic or sacral

Answer 10

biliary tree and liver

stomach, Duodenum, or pancreas

from small intestine, appendix, proximal colon

the colon, bladder, or uterus
colonic pain diffuse

rectum

Question 11

HPI- 7 attributes

Answer 11

1- location- point w one finger the area of pain
2- Quality- description on own words, 
3-Quantity- rate severity on a scale from 1 to 10
4- setting
5- Timing- (onset) when it began
                  how frequent
                  how long it last
6- Radiation 
7- Factors that aggravates or relieves 
8- symptoms associated with pain

Question 12

Changes in bowel movement

Answer 12

frequency
quality- diarrhea vs constipation
pain with BM

Question 13

Blood or black stool

Answer 13

Hematochezia

Question 14

Tarry stool

Answer 14

Melena

Question 15

Jaundice stool

Answer 15

Icteric Sclerae

Question 16

Associated things that lead to pain

Answer 16

Hepatitis, cirrhosis, GB problems or Pancreatitis
previous Sx
Foreign travel or occupational hazards
Use of tobacco, alcohol, illegal drugs, medication hx
hereditary disorders affecting 
fz and urgency of urination
pain during urination
incontinence
 flank pain

Question 17

hematuria

Answer 17

blood in the urine

Question 18

Abdominal exam ord

1. Inspection

Answer 18

skin- scars, striae ( stretch marks) vein pattern, hair distribution, rashes or lesions

umbilicus- contour, location and signs of any visible defects

abdomen- symmetry and contour: flat, rounded, protuberant, gravid, or scaphoid.

signs of peristalsis and pulsations

Question 19

2- Auscultation

Answer 19

• most be done before palpation or percussion
• Listen for BS w the diaphragm over the 4 Q
• listen for Bruits with Bell over Aorta, iliac, femoral for Bruits

Question 20

Borborygmi

Answer 20

long gurgles,

typical BS Q 20 min; unless the pt just ate

Question 21

3. Palpation
   Quadrants

              Organs

Answer 21

palpate (probing) light and deep over 4 Quadra

Liver- at level of the 11th and 12 the rib superiorly; ask pt to take a deep breath to force the liver downward
-(+) indicative of gallbladder or liver disease

Spleen- never be palpable, unless there is splenomegaly, hemorrhage, cracked spleen

kidney- (L then R ) to capture at the peak of inspiration

Question 22

4. Percussion

                      Liver span
   
                      Spleen

Answer 22

-over all 4 quadrants-listen :
Tympanic- hollow
dullness- mass

percuss at mid-clavicular line- 6-12 cm
( LONGER SPAN= Enlarged liver)
mid-sternal line- 4-8 cm
(SHORTER SPAN- small, hard cirrhotic liver)

left lower ant chest wall btw lung resonance above the costal margin
dullness= enlarged spleen
Tympanic= splenomegaly