Approach to Abdominal Complaint 1 & 2 Flashcards
Visceral Pain
- Caused by ____
- Secondary to_______
localized or not localized?
Visceral Pain
- Caused by stimulation of the visceral pain fibers
- Secondary todistention, stretching or contracting of hollow organs, stretching the capsule of solid organs or organischemia
NOT localized
Parietal (somatic) Pain
- Caused by ____
- Secondary to_______
localized or not localized?
- Caused by stimulation of the somatic pain fibers
- Secondary to inflammation in the parietal peritoneum
Localized
Referred pain in back?
due to
Duodenal and pancreatic pain
Referred pain in right shoulder?
due to
Biliary tree
When taking a history, always ask about these meds specifically:
- GI Prescriptions (H2 blockers, proton pump inhibitors, dicyclomine)
- OTC meds (Tylenol, Aspirin/ibuprofen, antacids, laxatives)
- Herbs
- **blood thinners
- NSAIDS
- Narcotics
- Steroids**
Abdominal Physical Exam - 4 steps
- Inspection
- Auscultation
- Percussion
- Palpation
**Must be done in this order
**Must drape your patient
Pearl: Do it the same way every time!
Auscultation – Bowel Sounds
normal?
absent?
decreased?
increased?
high pitched?
•Normal bowel sounds: 5-34 clicks/gurgles per minute
- Absent bowel sounds-none for>2minutes
- Long-lasting intestinal obstruction, intestinal perforation, mesenteric ischemia
- Decreased bowel sounds-none for 1minute
- Post-surgical ileus, peritonitis
- Increased bowel sounds
- Diarrhea, early bowel obstruction
•High pitched bowel sounds-• sounds like tinkling Suggests early intestinal obstruction
Auscultation- abnormal sounds: Bruits?
vascular sounds resembling heart murmur
result from turbulent flow
–vascular obstruction–
Auscultation - abnormal sounds - Friction Rub?
grating sounds with respiratory variation
–inflammation of peritoneal surface of an organ
Auscultation - abnormal sounds - Venous hum?
soft humming noise
–increased collateral circulation between portal and systemic venous systems
Percussion allows you to assess for__?
fluid ad solid-filled masses, the amount of gas in the abdomen, and sizing of the liver and spleen
Special tests for ascites (2):
Fluid wave test (normal = no impulse felt on other flank)
Shifting dullness test (normal = borders stay the same)
Appendicitis SpecialTests (4)
McBurney’s point tenderness (best)
Rovsing’s sign
Psoas sign
Obturator’s sign
What does Murphey’s sign indicate?
Biliary colic
Special test for kidney inflammation/distention?
Lloyd’s punch
Peritoneal Signs of inflammation (“acute abdomen”)
- Guarding
- Rigidity
- Rebound Tenderness
CONSTIPATION ASSOCIATED SYMPTOMS
- Abdominal bloating
- Low back pain
- Tenesmus
- Pain on defecation
- Rectal bleeding*
- Severe abdominal pain*
- Inability to pass flatus*
- Vomiting*
Constipation common causes
Delaying Defecation
Diet, Exercise
Medications
Endocrine Dysfunction
Uncommon cause: obstruction > mass effect or tumor
COMMON CAUSES OF GASTROENTERITIS
Viral (Norovirus, Rotavirus, Adenovirus)
Bacterial (Salmonella, Shigella, Campylobacter)
Parasitic (Giardia, Cryptosporidium)
What is an important question to ask regarding patient abdominal complaint - change in bowel habits?
Stool characteristics: what is your normal?
