Exam 2 - Abdomen packet Flashcards
How does visceral pain present?
Poorly localized, vague
How does an unprovoked MFTP present?
poorly localized
How does a provoked MFTP present?
localized
How does peritonitis present?
localized pain, pt appears acutely ill
Common stimuli of visceral abdomen pain? (4)
rapid distension of hollow organ sm. Msl, rapid distension of capsules of solid organs, intense contraction of sm. Msls, inflammation
What is the most pain-sensitive in the abdomen?
parietal peritoneum
What is the least pain-sensitive in the abdomen/
parenchymatous organs (kidneys, etc)
Is the underlying muscle tense/painful with visceral pain?
No
Is visceral pain made worse by palpation or movement?
No
What types of pain manifest on the body wall? (3)
Parietal pain, NMS pain, abdominal wall pain (MFTPs)
What causes parietal pain?
noxious stim. Of parietal peritoneum
Is peritonitis made worse by percussion/palpation?
Yes
Is the underlying muscle tense/painful with parietal pain?
Yes
What should you think about if visceral pain changes location and starts becoming parietal pain? (If no evidence of NMS condition or MFTP)
peritonitis
What is Carnett’s sign?
abdominal wall tenderness test. Pain originating from abdominal wall is unchanged or increased by tensing abdominal msls
Is Carnett’s good for detecting evidence of peritonitis?
No
What are the “red flags” you should look for with acute abdominal pain? (5)
severe pain/abrupt onset, “shock”, distended abdomen, palpable mass, ecchymosis
What is Cullen’s ecchymosis?
Around umbilicus
What is Grey-Turner’s ecchymosis?
On flanks
What is considered acute abdominal pain?
less than 7 days
What is “the acute abdomen”?
abrupt abdominal pain and tenderness requiring URGENT Dx. “the Surgical Abdomen”
Common causes of “acute abdomen?”
peritonitis = most common, bowel obstruction
Where should any contact with the abdomen (auscultation, percussion, palpation) start?
the point farthest away from the site of pain
What are the steps in the abdominal exam?
- Proper pt positioning 2. inspection 3. auscultation 4. percussion 5. superficial/gentle palpation
What is ecchymosis on the abdomen associated with?
retroperitoneal hemorrhage from pancreatitis
When are superficial abdominal veins visible/
Portal hypertension - caput medusa
What is inferior vena cava syndrome?
superficial collateral veins distended d/t obstruction of IVC
What are the 5 Fs for abdominal distension?
Fat, Fluid, Feces, Flatus, Fetus
What should you look at during the “inspection” phase of abdominal exam?
umbilicus and abdominal wall
When is diastasis rectus abdominis seen?
pregnancy and/or obesity
Who is umbilical herniation usually seen in?
middle-aged multiparous females, or pts w/ ascites or liver cirrhosis
How much of a role does auscultation have in abdominal exam/
Minor role
What is borborygmus?
old term for gurgling/rumbling that accompanies peristalsis
how often do bowel sounds occur according to “classic” standards?
Every 5-15 seconds
According to “classic” teachings, where should you listen for active bowel sounds?
All four abdominal quadrants for 1 minute
According to “classic” teachings, what are increased, loud, “rushing” bowel sounds associated with?
Diarrhea and EARLY mechanical obstruction of the bowel
According to “classic” teachings, what are decreased bowel sounds and high-pitched “tinkling” associated with/
LATE obstruction of the bowel
According to “classic” teachings, what is a ‘functional’ or ‘adynamic’ ileus associated with?
peritonitis - no organic obstruction
According to “classic” teachings, what is a “mechanical” ileus associated with?
Late intestinal obstruction
When are abdominal bruits of the greatest significance?
cases of renovascular hypertension
Do abdominal bruits assist in Dx of AAA?
No
Which bruits have a higher sensitivity for renal vascular dz?
Anterior
Which bruits have a higher specificity for vascular dz?
“flank” bruits
What is the positive LR of continuous systolic/diastolic bruit for detecting renovascular HTN?
Positive LR 38.9
What do RUQ friction rub that cause pain indicate?
peritonitis of liver
What do LUQ friction rub that cause pain indicate?
peritonitis of spleen
What can light percussion help detect?
Peritonitis
Where do you start superficially palpating the abdomen?
ALWAYS start at point distant from any site of pain
What is “guarding” and what does it imply?
Voluntary contraction of abdominal wall; can imply peritonitis.
What is “rigidity” and why is it important?
Involuntary contraction of abdominal wall; most reliable indicator of parietal peritonitis
What are the 4 best indicators of peritonitis?
- persistent guarding 2. rigidity 3. rebound tenderness 4. positive cough test “Dunphy’s sign”
What is Murphy’s sign?
marked inspiratory arrest during palpation of gall bladder - found in some cases of acute cholecystitis (overt inflammation of gall bladder)
What is the positive LR of Murphy’s sign in detecting cholecystitis?
positive LR 2.0
What is a contraindication to palpation of the spleen?
infectious mononucleosis
