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PDX 1 > Exam 2 - Abdomen packet > Flashcards

Exam 2 - Abdomen packet Flashcards

1
Q

How does visceral pain present?

A

Poorly localized, vague

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2
Q

How does an unprovoked MFTP present?

A

poorly localized

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3
Q

How does a provoked MFTP present?

A

localized

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4
Q

How does peritonitis present?

A

localized pain, pt appears acutely ill

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5
Q

Common stimuli of visceral abdomen pain? (4)

A

rapid distension of hollow organ sm. Msl, rapid distension of capsules of solid organs, intense contraction of sm. Msls, inflammation

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6
Q

What is the most pain-sensitive in the abdomen?

A

parietal peritoneum

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7
Q

What is the least pain-sensitive in the abdomen/

A

parenchymatous organs (kidneys, etc)

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8
Q

Is the underlying muscle tense/painful with visceral pain?

A

No

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9
Q

Is visceral pain made worse by palpation or movement?

A

No

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10
Q

What types of pain manifest on the body wall? (3)

A

Parietal pain, NMS pain, abdominal wall pain (MFTPs)

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11
Q

What causes parietal pain?

A

noxious stim. Of parietal peritoneum

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12
Q

Is peritonitis made worse by percussion/palpation?

A

Yes

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13
Q

Is the underlying muscle tense/painful with parietal pain?

A

Yes

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14
Q

What should you think about if visceral pain changes location and starts becoming parietal pain? (If no evidence of NMS condition or MFTP)

A

peritonitis

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15
Q

What is Carnett’s sign?

A

abdominal wall tenderness test. Pain originating from abdominal wall is unchanged or increased by tensing abdominal msls

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16
Q

Is Carnett’s good for detecting evidence of peritonitis?

A

No

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17
Q

What are the “red flags” you should look for with acute abdominal pain? (5)

A

severe pain/abrupt onset, “shock”, distended abdomen, palpable mass, ecchymosis

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18
Q

What is Cullen’s ecchymosis?

A

Around umbilicus

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19
Q

What is Grey-Turner’s ecchymosis?

A

On flanks

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20
Q

What is considered acute abdominal pain?

A

less than 7 days

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21
Q

What is “the acute abdomen”?

A

abrupt abdominal pain and tenderness requiring URGENT Dx. “the Surgical Abdomen”

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22
Q

Common causes of “acute abdomen?”

A

peritonitis = most common, bowel obstruction

23
Q

Where should any contact with the abdomen (auscultation, percussion, palpation) start?

A

the point farthest away from the site of pain

24
Q

What are the steps in the abdominal exam?

A
  1. Proper pt positioning 2. inspection 3. auscultation 4. percussion 5. superficial/gentle palpation
25
Q

What is ecchymosis on the abdomen associated with?

A

retroperitoneal hemorrhage from pancreatitis

26
Q

When are superficial abdominal veins visible/

A

Portal hypertension - caput medusa

27
Q

What is inferior vena cava syndrome?

A

superficial collateral veins distended d/t obstruction of IVC

28
Q

What are the 5 Fs for abdominal distension?

A

Fat, Fluid, Feces, Flatus, Fetus

29
Q

What should you look at during the “inspection” phase of abdominal exam?

A

umbilicus and abdominal wall

30
Q

When is diastasis rectus abdominis seen?

A

pregnancy and/or obesity

31
Q

Who is umbilical herniation usually seen in?

A

middle-aged multiparous females, or pts w/ ascites or liver cirrhosis

32
Q

How much of a role does auscultation have in abdominal exam/

A

Minor role

33
Q

What is borborygmus?

A

old term for gurgling/rumbling that accompanies peristalsis

34
Q

how often do bowel sounds occur according to “classic” standards?

A

Every 5-15 seconds

35
Q

According to “classic” teachings, where should you listen for active bowel sounds?

A

All four abdominal quadrants for 1 minute

36
Q

According to “classic” teachings, what are increased, loud, “rushing” bowel sounds associated with?

A

Diarrhea and EARLY mechanical obstruction of the bowel

37
Q

According to “classic” teachings, what are decreased bowel sounds and high-pitched “tinkling” associated with/

A

LATE obstruction of the bowel

38
Q

According to “classic” teachings, what is a ‘functional’ or ‘adynamic’ ileus associated with?

A

peritonitis - no organic obstruction

39
Q

According to “classic” teachings, what is a “mechanical” ileus associated with?

A

Late intestinal obstruction

40
Q

When are abdominal bruits of the greatest significance?

A

cases of renovascular hypertension

41
Q

Do abdominal bruits assist in Dx of AAA?

A

No

42
Q

Which bruits have a higher sensitivity for renal vascular dz?

A

Anterior

43
Q

Which bruits have a higher specificity for vascular dz?

A

“flank” bruits

44
Q

What is the positive LR of continuous systolic/diastolic bruit for detecting renovascular HTN?

A

Positive LR 38.9

45
Q

What do RUQ friction rub that cause pain indicate?

A

peritonitis of liver

46
Q

What do LUQ friction rub that cause pain indicate?

A

peritonitis of spleen

47
Q

What can light percussion help detect?

A

Peritonitis

48
Q

Where do you start superficially palpating the abdomen?

A

ALWAYS start at point distant from any site of pain

49
Q

What is “guarding” and what does it imply?

A

Voluntary contraction of abdominal wall; can imply peritonitis.

50
Q

What is “rigidity” and why is it important?

A

Involuntary contraction of abdominal wall; most reliable indicator of parietal peritonitis

51
Q

What are the 4 best indicators of peritonitis?

A
  1. persistent guarding 2. rigidity 3. rebound tenderness 4. positive cough test “Dunphy’s sign”
52
Q

What is Murphy’s sign?

A

marked inspiratory arrest during palpation of gall bladder - found in some cases of acute cholecystitis (overt inflammation of gall bladder)

53
Q

What is the positive LR of Murphy’s sign in detecting cholecystitis?

A

positive LR 2.0

54
Q

What is a contraindication to palpation of the spleen?

A

infectious mononucleosis

PDX 1 (7 decks)

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