Approach to Abdominal Exam 2 Flashcards
What is the sound on percussion of the abdomen?
tympanic (for air)
What is a Murphy sign?
gall bladder disease
What is McBurney’s point?
a location
tenderness over point for apendicitis
What is a Rovsing sign?
press over LLQ & ask where it hurts
if pt has apendicitis, will feel pain in RLQ
What is the order of examination for the abdomen?
Inspection
Auscultation
Percussion
Palpation
Where do you expose the abdomen from during exam?
from xiphoid process to ASIS
What are normal findings on abdomen exam?
flat non-distended normoactive bowel sounds tympanic throughout soft no masses non-tender no hepatomegaly/splenomegaly
What are abnormal findings on abdomen exam?
distended round obese scaphoid tenderness to palpation rebound guarding rigid
What are some common GI issues in primary care?
Constipation
Gastoenteritis
Irritable Bowel Syndrome
What is constipation?
a SYMPTOM, not a disease
What is the Rome criteria?
tool to categorize constipation
need to have 2 symptoms over 3 months:
fewer than 3 bowel movements/week
straining
lumpy or hard stools
sensation of incomplete defecation
manual maneuvering required to defecate
What is considered abnormal about bowel movements?
if less than 1 bowel movement each week
What is the Bristol
stool scale?
describes look & feel of feces & passage of fecal material
What is considered normal on the Bristol stool scale?
types 3 to 4 are considered normal (formed & easy to pass)
What is considered constipation on Bristol stool scale?
type 1 & 2
What symptoms are associated with constipation?
abdominal bloating low back pain tenesmus (contracted anal sphincter) pain on defecation rectal bleeding abdominal pain inability to pass flatus vomiting
What are the most urgent symptoms assoc w/ constipation?
rectal bleeding
abdominal pain
inability to pass flatus
vomiting
What do you want to ask about in history for cc of constipation?
normal pattern of defecation
frequency
hardness of stools?
whether pt strains to defecate
time spent on toilet
what have tried to help
duration of problem
relation to any changes in diet, water intake or exercise
What do you include in PE for constipation complaint?
abdomen exam
pelvic exam for females (fissure between rectum & vagina)
anorectal exam
What does a distension or mass indicate on abdomen exam?
colonic stools or tumors (in LLQ)
What do you look for on anorectal exam?
perianaal excoriation skin tags/hemorrhoids anal fissure prolapse during straining masses tone of internal sphincter gross blood fecal impaction
What are some lifestyle modifications for constipation?
increase fiber in diet increase water in diet use bathroom when have urge increase exercise uninterrupted time
What is the purpose of the squatty potty?
proper positioning of body for a bowel movement
What is diarrhea?
a component of gastroenteritis
What is gastroenteritis?
stomach flu
primary manifestation is diarrhea but can also have nasea, vomiting, ab pain
What tends to cause gastroenteritis?
infectious agents (usually viral)
food-borne
drug associated
What are the 2 major viral gastroenteritis?
Norovirus & rotavirus
Norovirus
starts w/ sudden onset of uncontrolled vomiting for 12-48 hrs
usually more vomiting
think outbreak on cruise-ship or casino
Rotavirus
very contagious
can be immunized against
What are 3 bacterial gastroenteritis?
salmonella
C difficile
E coli
What is the major parasitic gastroenteritis?
Giardia (causes diarrhea, bloating, ab cramping)
often get in infected water
What drugs are associated w/ diarrhea?
antibiotics laxatives Colchicin Quinidine Sorbitol PPIs
What is IBS?
functional GI disorder
altered bowel habits
abdominal pain
ab bloating/distension
What questions should you ask a pt who presents w/ diarrhea?
nausea vomiting ab cramping ab bloating fever
What questions do you ask about stools w/ diarrhea complaint?
frequency, amot, color, consistency
What does a white/bulk stool indicate?
small bowel pathology (malabsorption)
What are large stools associated with?
enteric infection
What are small stools associated with?
colonic infection
What does stool from cholera infection look like?
copious rice water diarrhea
What are important historical clues for diarrhea?
travel
recent change in meds
recent hiking/camping
What are some osteopathic treatments for pts presenting w/ constipation?
Mesenteric release (lympathic treatment)
What is an osteopathic treatment for diarrhea?
ganglion inhibition (want to inhibit bowel movement)
