Chapter 11 The Abdomen Flashcards
Gastritis/GERD
Often occurs with epigastric pain
Cholecystitis
Pain in RUQ
IBS (irritable bowel syndrome)
Bloating
Aerophagia
Belching from swallowing air
GERD
primarily sx of heartburn, reflux, regurgitation; aggravated by alcohol, chocolate, onions, coffee, citrus fruits. Some “alarm sx” include dysphagia and odyophagia, vomiting, weight loss, anemia
Renal stone
cramping pain radiating to RLQ or LLQ
Caput Medusa
Appearance of distended and engorged umbilical veins which are seen radiating from the umbilicus across the abdomen to join systemic veins. Typically associated with cirrhosis and advanced stages of liver disease.
Incisional Hernias
Protrusion through an operative scar.
Umbilical Hernias
Protrusion through a defective umbilical ring
Direct Inguinal Hernia
directly penetrates the inguinal triangle and creates a bulge superior and medial to the inguinal ligament
Indirect Inguinal Hernia
passes through the inguinal canal and creates a bulge over the inguinal ligament as it passes through the inguinal ring. In men it often herniates into the scrotum
Diffuse Abdominal distension
6Fs: Fat (obesity), Fluid (ascites or obstructed viscera filled with fluid), Flatus (air), Feces (constipation), Fetus (pregnancy), Fatal cancer
Distension of lower abdomen
usually caused by pregnancy, full bladder, ovarian tumor, or uterine fibroids (common benign growths)
Visible peristalsis
usually abnormal, unless the patient is emaciated. Otherwise, it is a sign of intestinal obstruction.
Borborygmi
loud easily audible sound transmitted across the abdomen so it is not necessary to listen at multiple places, commonly called “growling.
Early intestinal obstruction
High pitched , tinkling (raindrops in a barrel) sounds
Dull areas of percussion
large liver or spleen, distended bladder, pregnant uterus, ovarian tumor
Decreased gut sounds (~1min)
can be markedly decreased after abdominal surgery; abdominal infection or injury
Absent gut sounds (~5 min)
Can be caused from perforation, infection, infarction, or ischemia
Aortic bruits
Heard in epigastrium; may be a sign of AAA.
Renal artery bruits
R& L upper quadrants; may be a sign of renal artery stenosis (tx cause of hypertension)
Illiac/femoral bruits
R & L lower quadrants; may be a sign of peripheral atherosclerosis
Friction rubs
scratchy sounds that may indicate possible splenic infarction or hepatic infarction, tumor, or abscess.
Tympany
hollow sounds; normally present over most of the abdomen in the supine position, caused from bowel gas
Enlarged liver
Midclavicular percussion >12 cm (normal 6-12 cm)
Small liver
Mid-sternal percussion <4cm (normal 4-8 cm); can cirrhosis, end stage liver disease
Rebound tenderness
peritoneal inflammation
Tenderness of liver
suggests inflammation as in hepatitis
Splenomegaly
if percussion dullness is present
Ascites
protuberant abdomen with bulging flanks; from diseases such as cirrhosis and cancer
Areas of dullness (ascites)
located on lateral side of abdomen
Areas of tympany (ascites)
anterior portion of abdomen
Positive splenic percussion sign
change in percussion note from tympany to dullness on inspiration that suggests splenomegaly.
Kidney enlargement
hydronephrosis, cyts, and tumors
Test for shifting dullness (ascites)
Have the patient roll to one side. In ascites there should be a shift due to free fluid moving with gravity.
Voluntary guarding
patient consciously flinches when you touch them
Involuntary guarding
muscles spasm when you touch them but the patient cannot control the reaction which is a sign of inflammation or tenderness
Techniques to asses voluntary guarding
Have the patient breathe out deeply, Have the patient mouth breathe with the jaw dropped open
Rigidity
a constant board-like spasm which is a sign of perforation, peritonitis, or bowel infarction
Reducible hernia palpation
when the contents of the hernia can be easily displaced
Irreducible or incarceratedm hernia palpation
when the contents cannot be displaced and are stuck
Strangulated hernia palpation
an incarcerated hernia that has cut off its blood supply, resulting in tissue necrosis and gangrene.
Acute Appendicitis: PE signs
RLQ pain (or pain that migrates from periumbilical region) that leades to positive rebound tenderness, Rovsing’s sign, Psoa’s sign, Obturator sign
McBurney’s Point
In appendicitis, tenderness over right side of abdomen that is one third the distance from the anterior superior iliac spine to the umbilicus
Rovsing’s Sign
Similiar to rebound tenderness but putting pressure on opposite side of LLQ. In the case of appendicitis, the pain is felt in the right lower quadrant despite pressure being placed elsewhere.
Psoa’s sign
Pain is elicited on hip extension of right thigh (pt lying on left side). If appendix is inflamed and in contact with the psoas muscle, which when stretched will cause pain
Obturator sign
Pain on internal rotation of flexed thigh. Inflamed appendix is in contact with the obturator internus muscle, which is stretched in this maneuver.
Cholecystitis: PE findings
localized or diffuse RUQ pain that may radiate right to scapula, positive murphy’s sign
Positive Murphy’s Sign
When deep palpation toward the liver at the right costal margin causes severe pain, and possible a palpable mass from an enlarge gallbladder may be noted
Pancreatitis: PE findings
severe abdominal pain in LUQ and may radiate to left upper back
Grey turner’s sign
Ecchymoses on the abdomen noted most often in left flank that occurs with acute hemorrhagic pancreatitis
Diverticulitis: PE findings
Sx can feel like appendicitis; LLQ pain with a palpable mass, pain is severe and comes on suddenly
to assess in periumbilical area
any mlasses of distended loops of bowl, hepatomegaly, splenomegalo, enlarged kidneys, enlarged gallbladder, pulsatile mass in midline indicating an aortic aneurysm, femoral pulses and inguinal nodes
Hepatitis
Cirrhosis of the liver (decrease in size)
