Approach to Abdominal Complaint 1 & 2

Question 1

Visceral Pain

• Caused by ____
• Secondary to_______

localized or not localized?

Answer 1

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

Question 2

Parietal (somatic) Pain

• Caused by ____
• Secondary to_______

localized or not localized?

Answer 2

• Caused by stimulation of the somatic pain fibers
• Secondary to inflammation in the parietal peritoneum

Localized

Question 3

Referred pain in back?

Answer 3

due to

Duodenal and pancreatic pain

Question 4

Referred pain in right shoulder?

Answer 4

due to

Biliary tree

Question 5

When taking a history, always ask about these meds specifically:

Answer 5

• GI Prescriptions (H2 blockers, proton pump inhibitors, dicyclomine)
• OTC meds (Tylenol, Aspirin/ibuprofen, antacids, laxatives)
• Herbs
• **blood thinners
• NSAIDS
• Narcotics
• Steroids**

Question 6

Abdominal Physical Exam - 4 steps

Answer 6

1. Inspection
2. Auscultation
3. Percussion
4. Palpation

**Must be done in this order
**Must drape your patient
Pearl: Do it the same way every time!

Question 7

Auscultation – Bowel Sounds

normal?
absent?
decreased?
increased?
high pitched?

Answer 7

•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

Question 8

Auscultation- abnormal sounds: Bruits?

Answer 8

vascular sounds resembling heart murmur
result from turbulent flow

–vascular obstruction–

Question 9

Auscultation - abnormal sounds - Friction Rub?

Answer 9

grating sounds with respiratory variation

–inflammation of peritoneal surface of an organ

Question 10

Auscultation - abnormal sounds - Venous hum?

Answer 10

soft humming noise

–increased collateral circulation between portal and systemic venous systems

Question 11

Percussion allows you to assess for__?

Answer 11

fluid ad solid-filled masses, the amount of gas in the abdomen, and sizing of the liver and spleen

Question 12

Special tests for ascites (2):

Answer 12

Fluid wave test (normal = no impulse felt on other flank)
Shifting dullness test (normal = borders stay the same)

Question 13

Appendicitis SpecialTests (4)

Answer 13

McBurney’s point tenderness (best)

Rovsing’s sign

Psoas sign

Obturator’s sign

Question 14

What does Murphey’s sign indicate?

Answer 14

Biliary colic

Question 15

Special test for kidney inflammation/distention?

Answer 15

Lloyd’s punch

Question 16

Peritoneal Signs of inflammation (“acute abdomen”)

Answer 16

1. Guarding
2. Rigidity
3. Rebound Tenderness

Question 17

CONSTIPATION ASSOCIATED SYMPTOMS

Answer 17

• Abdominal bloating
• Low back pain
• Tenesmus
• Pain on defecation
• Rectal bleeding*
• Severe abdominal pain*
• Inability to pass flatus*
• Vomiting*

Question 18

Constipation common causes

Answer 18

Delaying Defecation
Diet, Exercise
Medications
Endocrine Dysfunction

Uncommon cause: obstruction > mass effect or tumor

Question 19

COMMON CAUSES OF GASTROENTERITIS

Answer 19

Viral (Norovirus, Rotavirus, Adenovirus)
Bacterial (Salmonella, Shigella, Campylobacter)
Parasitic (Giardia, Cryptosporidium)

Question 20

What is an important question to ask regarding patient abdominal complaint - change in bowel habits?

Answer 20

Stool characteristics: what is your normal?