Abdominal Physical exam review Flashcards
Generalized abdominal pain common causes
● AAA
● Acute pancreatitis
● Bowel perforation
● Bilateral pleurisy
Central/Umbilical abdominal pain
● Early appendicitis
● Ruptured AAA
● Acute pancreatitis
● Small bowel obstruction
● Mesenteric thrombus
● Umbilical hernia
Epigastric abdominal pain causes
● Esophagitis
● Peptic/Duodenal ulcer
● Acute pancreatitis
● AAA
Right upper quadrant abdominal pain causes
● Gallbladder disease
● Duodenal ulcer
● Acute pancreatitis
● Liver
● Renal
● Pneumonia/pleurisy
Left upper quadrant abdominal pain causes
● Gastric ulcer
● Acute pancreatitis
● Sleenic
● Renal
● Constipation (splenic flexure)
● Pneumonia/pleurisy
Suprapubic abdominal pain causes
● UTI
● Urinary retention
● Pelvic Inflammatory Disease
● Ectopic Pregnancy
● Constipation/Diverticulitis
Lower right abdominal pain causes
● Appendicitis
● Meckel’s Diverticulum
● Crohn’s Disease
● PID
● Salpingitis
● Ovarian cyst
● Ectopic Pregnancy
Lower left abdominal pain causes
● Diverticulitis
● Constipation
● IBS
● Ulcerative colitis
● Rectal cancer
● PID
● Ovarian cyst
● Ectopic pregnancy
There are essentially three different types of
abdominal pain:
○ Referred Pain
○ Parietal Pain
○ Visceral Pain
Referred Pain
Pain felt in more distant sites that have similar
innervation
Referred pain is usually well localized and often
develops as the initial pain becomes more severe
Parietal Pain
○ Originates from inflammation of the parietal
peritoneum and is localized to that inflamed spot
○ Steady, aching, and severe, which is typically
aggravated by movement or coughing
Visceral Pain
○ When hollow organs
contract forcefully or are distended
○ When solid organs like the liver distend and
stretch their capsule
○ Difficult to localize
○ Can be gnawing, burning, cramping, or
aching
When also found with other signs
(buffalo hump, moon face,
hypertension, etc.), can be
suggestive of Cushing’s Syndrome
“Purple Striae”, also known as
stretch marks
_____ can strengthen the case of suspected
intestinal obstruction
increased peristaltic waves
increased aortic pulsations can be
seen with _____
aortic aneurysms
Cullens sign Can be a sign of
■ Acute pancreatitis
■ Hemorrhage from trauma
■ Bleeding from a ruptured ectopic pregnancy
This can be a sign of retroperitoneal
hemorrhage
Grey Turner’s Sign
Retroperitoneal Organs – “SAD PUCKER”
■ Suprarenal (adrenal glands)
■ Aorta (+ inferior and superior vena cava)
■ Duodenum (2nd and 3rd segments)
■ Pancreas
■ Ureters
■ Colon (ascending and descending)
■ Kidneys
■ Esophagus
■ Rectum
The _____ of bowel sounds changes with intestinal function
Frequency
A normal liver may be palpable about ____
cm below the right costal margin at the
midclavicular line
3
The normal diameter of an abdominal aorta is less than ____ cms.
3
A protuberant abdomen that is _____
throughout suggests bowel obstruction
tympanic
_____ in the flanks bilaterally may suggest
ascites and warrant further workup
Dullness
If the percussion note at this site
changes from tympany to dullness
upon inspiration, this suggests possible
splenic _____
enlargement
A positive Murphy’s Sign is highly
suggestive of an _____
Acute Cholecystitis
This constitutes a positive Rovsing’s Sign
Pain in the RIGHT lower quadrant during
the LLQ palpation
Pain in the RIGHT lower quadrant during
the LLQ palpation
Cutaneous Hyperesthesia
