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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
What is ecchymosis on the abdomen associated with?
retroperitoneal hemorrhage from pancreatitis
26
When are superficial abdominal veins visible/
Portal hypertension - caput medusa
27
What is inferior vena cava syndrome?
superficial collateral veins distended d/t obstruction of IVC
28
What are the 5 Fs for abdominal distension?
Fat, Fluid, Feces, Flatus, Fetus
29
What should you look at during the "inspection" phase of abdominal exam?
umbilicus and abdominal wall
30
When is diastasis rectus abdominis seen?
pregnancy and/or obesity
31
Who is umbilical herniation usually seen in?
middle-aged multiparous females, or pts w/ ascites or liver cirrhosis
32
How much of a role does auscultation have in abdominal exam/
Minor role
33
What is borborygmus?
old term for gurgling/rumbling that accompanies peristalsis
34
how often do bowel sounds occur according to "classic" standards?
Every 5-15 seconds
35
According to "classic" teachings, where should you listen for active bowel sounds?
All four abdominal quadrants for 1 minute
36
According to "classic" teachings, what are increased, loud, "rushing" bowel sounds associated with?
Diarrhea and EARLY mechanical obstruction of the bowel
37
According to "classic" teachings, what are decreased bowel sounds and high-pitched "tinkling" associated with/
LATE obstruction of the bowel
38
According to "classic" teachings, what is a 'functional' or 'adynamic' ileus associated with?
peritonitis - no organic obstruction
39
According to "classic" teachings, what is a "mechanical" ileus associated with?
Late intestinal obstruction
40
When are abdominal bruits of the greatest significance?
cases of renovascular hypertension
41
Do abdominal bruits assist in Dx of AAA?
No
42
Which bruits have a higher sensitivity for renal vascular dz?
Anterior
43
Which bruits have a higher specificity for vascular dz?
"flank" bruits
44
What is the positive LR of continuous systolic/diastolic bruit for detecting renovascular HTN?
Positive LR 38.9
45
What do RUQ friction rub that cause pain indicate?
peritonitis of liver
46
What do LUQ friction rub that cause pain indicate?
peritonitis of spleen
47
What can light percussion help detect?
Peritonitis
48
Where do you start superficially palpating the abdomen?
ALWAYS start at point distant from any site of pain
49
What is "guarding" and what does it imply?
Voluntary contraction of abdominal wall; can imply peritonitis.
50
What is "rigidity" and why is it important?
Involuntary contraction of abdominal wall; most reliable indicator of parietal peritonitis
51
What are the 4 best indicators of peritonitis?
1. persistent guarding 2. rigidity 3. rebound tenderness 4. positive cough test "Dunphy's sign"
52
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)
53
What is the positive LR of Murphy's sign in detecting cholecystitis?
positive LR 2.0
54
What is a contraindication to palpation of the spleen?
infectious mononucleosis

PDX 1 (7 decks)

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