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PCM II Midterm > Approach to Abdominal Exam 1 > Flashcards

Approach to Abdominal Exam 1 Flashcards

1
Q

What are 3 types of abdominal pain?

A

visceral pain
parietal pain
referred pain

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2
Q

What is the difference between visceral and parietal pain?

A

visceral is stretching of organs (more generalized) while parietal is more sharp & localized pain

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3
Q

What causes visceral pain and where is it felt?

A

stimulation of visceral pain fibers secondary to distension/stretch of organs

felt in midline @ level of structure involved

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4
Q

What causes parietal pain and where is it felt?

A

stimulation of somatic pain fibers secondary to inflammation in parietal peritoneum

constant & more severe pain

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5
Q

Referred pain

A

originates w/ abdomen but felt @ distant sites that are innervated @ same spinal levels as disordered structure (often felt in back)

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6
Q

Examples of referred pain

A

duodenal & pancreatic pain referred to back

biliary tree (gall bladder) referred to R shoulder

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7
Q

What is most important in CC/HPI for ab pain?

A

LOCATION

Aggravating/alleviating factors

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8
Q

What discriminators are important in ROS every time?

A

fever, chills, CP, SOA, cough

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9
Q

What should be asked in a focused ROS for ab pain?

A

GI (nausea, vomit, diarrhea)
GU (dysuria, polyuria, etc)
GYN (vaginal bleeding, pregnancy)

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10
Q

PMH specific for ab complaint

A 
hepatitis
liver problems
cancer
chronic pain
constipation
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11
Q

PSH specific for ab complaint

A

abdominal (cholecystectomy or appendectomy)

gynecologic

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12
Q

Important meds/allergies for ab complaint

A

blood thinners (GI bleed?)
NSAIDS
narcotics
steroids

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13
Q

Why would you not want to give narcotics to pt w/ ab pain?

A

narcotics will mask the pain

narcotics slow down bowel (can lead to constipation)

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14
Q

PE for ab complaint

A

inspection
auscultation
percussion
palpation

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15
Q

What must you do in PE for ab complaint?

A

must DRAPE pt

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16
Q

Important landmarks for inspection

A

Xiphoid process
Costal margins
Umbilic
ASIS

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17
Q

What is important about inspection during ab PE?

A

approach inspection via quadrants (cross @ umbilicus)

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18
Q

RUQ

A

liver, gallbladder

stomach, SB & LB

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19
Q

RLQ

A

appendix, ovary

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20
Q

LLQ

A

colon, ovary

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21
Q

LUQ

A

stomach

spleen

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22
Q

Epigastric area

A

pancreas

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23
Q

What do you look for on inspection?

A

surface: skin color, surgical scars, rash, ecchymoses

contour of abdomen: bulges, obese, flat, round

24
Q

Why is auscultation important in ab exam?

A

provides info about bowel motility

25
Q

How do you auscultate during ab exam?

A

place diaphragm on abdomen to listen for sounds

use bell to listen for bruits

26
Q

What are abnormal bowel sounds & what pathology are they associated with?

A

absent (none for >2 min, intestinal obstruction, intestinal perforation, mesenteric ischemia)

decreased (none for 1 min, post surgical or peritonitis)

increased (diarrhea, obstruction)

27
Q

What do high pitched bowel sounds indicate?

A

early intestinal obstruction

28
Q

What are bruits on abdomen associated with?

A

vascular obstruction

29
Q

What do friction rub sounds indicate?

A

inflammation of peritoneal surface of organ (over liver & spleen)

30
Q

What do venous hums indicate?

A

increased collateral circulation btwn portal & systemic venous systems

31
Q

Why do you percuss abdomen in PE?

A

assess for fluid & solid-filled masses, amt gas in abdomen, sizing of liver & spleen

32
Q

Why would tympany predominate in abdomen?

A

due to gas in GI tract, scattered areas of dullness is normal from fluid & feces

33
Q

What is important about palpation in ab PE?

A

need to gently palpate & then deeply palpate in all 4 quadrants

always start away from tender area

34
Q

Assessment of liver

A

mostly covered by rib cage on R side

assess shape & size by percussion & palpation

35
Q

Assessment of spleen

A

normally not palpable unless enlarged

use percussion & palpation to assess for splenomegaly

36
Q

Describe liver palpation

A

L hand behind pt supporting 11 & 12 ribs

push L hand upward

R hand on pt R abdomen

press in & cephalad w/ R hand

ask pt to take deep breath

feel liver edge as comes down to meet R hand

37
Q

Describe spleen palpation

A

w/ L hand, reach over pt & grab posterior aspect of LUQ

w/ R hand below L costal margin, press posteriorly

ask pt to take deep breath in

try to feel edge as comes down to meet L hand

38
Q

How do you test for ascites?

A

Shifting dullness test

abnormal is dullness shifts to dependent side & tympany to top side

39
Q

McBurney’s point tenderness

A

positive is tenderness

highest sensitivity & specificity to diagnose appendicitis

40
Q

Rovsing’s sign

A

for appendicitis

positive is pain felt in RLQ

41
Q

Psoas sign

A

for appendicitis

positive test if increased ab pain

42
Q

Obturator sign

A

for appendicitis

positive test is R hypograstic pain

43
Q

Murphy’s sign

A

for biliary colic

positive test is sharp increase in tenderness w/ sudden stop in inspiratory effort

44
Q

Llyod’s sign

A

sign for kidney inflammation/distension

positive test is pain in area of CVA w/ deep precussion

implies kidney pathology

45
Q

What are signs of peritoneal inflammation?

A

guarding
rigidity
rebound tenderness

46
Q

What are the 2 types of guarding?

A

voluntary-pt pushes hand away when push on abdomen

involuntary-when muscles push hands away when abdomen is palpated

47
Q

If pt has RUQ, what HPI questions may you want to ask?

A

alcohol
diet
fever

48
Q

What is working DDX for RUQ pt?

A

gall bladder

49
Q

What do the diagnostic results show in case #1?

A

gall stones on ultrasound

50
Q

What is the assessment for case #1?

A

cholelithiasis

51
Q

What is abnormal on labs of case #2 and what does it indicate?

A

increased lipase

acute pancreatitis

52
Q

What must you always consider with RLQ pain?

A

appendicitis

53
Q

What would kidney stone show on ultrasound?

A

fluid backup in kidney due to obstruction

54
Q

What labs must you always order?

A

urine analysis, CBC, lipases

55
Q

How would someone w/ acute appendicitis present?

A

gastroenterocitis

pain localized to RLQ (parietal periteoneum around appendix is inflammed)

56
Q

How would someone w/ acute cholecystitis present?

A

R shoulder pain
RUQ pain

more likely if obese & female & family history

PCM II Midterm (15 decks)

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