Exam 3: ABD Flashcards
What are the screening recommendations for colorectal cancer?
What are the screening recommendations for an abdominal aortic aneurysm?
Because symptoms are uncommon and screening can reduce AAA-related mortality by about 50% over 13 to 15 years, the USPSTF makes a grade B recommendation for one-time ultrasound screening of men aged 65 to 75 years who have smoked more than 100 cigarettes in a lifetime (pg 521- PV system chapter)
When auscultating the abdomen, what would be normal findings?
Normal- consist of clicks and gurgles, occurring at an estimated frequency of 5 to 34 per minute. Occasionally you may hear the prolonged gurgles of hyperperistalsis from “stomach growling” called borborygmi.
Auscultate the abdomen before performing percussion or palpation, maneuvers which may alter the characteristics of the bowel sounds.
When auscultating the abdomen, when may altered bowel sounds be heard?
Altered bowel sounds are common in diarrhea, intestinal obstruction, paralytic ileus, and peritonitis.
Bowel sounds may be:
Increased, as in diarrhea or early intestinal obstruction
Decreased, then absent, as in adynamic ileus and peritonitis. Before deciding that bowel sounds are absent, sit down and listen where shown for 2 min or even longer.
High-pitched tinkling sounds suggest intestinal fluid and air under tension in a dilated bowel. Rushes of high-pitched sounds coinciding with an abdominal cramp signal intestinal obstruction.
When auscultating the abdomen, What would bruits indicate?
Bruits- suggest vascular occlusive disease. Vascular sounds resembling heart murmurs over the aorta or other arteries in the abdomen.
When auscultating the abdomen, what would a Venous hum sound like and indicate?
When auscultating the abdomen, what would a friction rib sound like and indicate?
What is the visceral pain?
Hollow abdominal organs (the intestine or biliary tree) contract forcefully or are distended or stretched. Solid organs (liver) can also become painful when their capsules are stretched. May be difficult to localize. It is typically palpable near the midline at levels that vary according to the structure involved. Ischemia also stimulates visceral pain fibers. Varies in quality and may be gnawing, burning, cramping, or aching. When it becomes severe, sweating, pallor, nausea, vomiting, and restlessness may follow.
- Visceral pain in the RUQ suggests liver distention against its capsule from the various causes of hepatitis, including alcoholic hepatitis.*
- Visceral periumbilical pain suggests early acute appendicitis from distention of an inflamed appendix. It gradually changes to parietal pain in the RLQ from inflammation of the adjacent parietal peritoneum. For pain disproportionate to physical findings, suspect intestinal mesenteric ischemia.*
What is parietal pain?
Parietal- from inflammation of the parietal peritoneum (peritonitis). Steady, aching pain, more severe than visceral pain and more precisely localized over the involved structure. Aggravated by movement or coughing. Pts prefer to lie still.
In contrast to peritonitis, patients with colicky pain from a renal stone move around frequently trying to find a comfortable position.
What is referred pain?
Referred- felt in more distant sites which are innervated at approximately the same spinal levels as the disordered structures. Often develops as the initial pain becomes more intense and seems to radiate or travel from the initial site. It may be palpated superficially or deeply but is usually localized.
- Pain of duodenal or pancreatic origin may be referred to the back, pain from the biliary tree, to the right scapular region or the right posterior thorax.*
- Pain from pleurisy or inferior wall MI may be referred to the epigastric area.*
What is the hooking technique, how is it done, and when would it be helpful to use it?
The “hooking technique” is used to palpate the liver and may be helpful, especially when the patient is obese. Stand to the right of the patient’s chest. Place both hands, side by side, on the right abdomen below the border of liver dullness. Press in with your fingers and up toward the costal margin. Ask the patient to take a deep breath. The liver edge shown in is palpable with the fingerpads of both hands.
What is this assessment, how is it done, and what are you assessing for? What are abnormal findings?
Percussion - Vertical span of liver dullness
Starting at a level well below the umbilicus in the RLQ (in an area of tympany, not dullness), percuss upward toward the liver. Identify the lower border of dullness in the midclavicular line.
Next, identify the upper border of liver dullness. Starting at the nipple line, percuss downward in the midclavicular line until lung resonance shifts to liver dullness.
Abnormal findings:
- The span of liver dullness is increased when the liver is enlarged.
- The span of liver dullness is decreased when the liver is small, or when there is free air below the diaphragm, as from a perforated bowel or hollow viscus. Liver span may decrease with resolution of hepatitis or heart failure or, less commonly, with progression of fulminant hepatitis.
- Dullness from a right pleural effusion or consolidated lung, if adjacent to liver dullness, may falsely increase estimated liver size.
- Gas in the colon may produce tympany in the RUQ, obscure liver dullness, and falsely decrease estimated liver size.
What is the normal span of the liver at the midsternal line and right midclavicular line? When is the liver palpable about 3 cm below the right costal margin in the midclavicular line?
On inspiration, the liver is palpable about 3 cm below the right costal margin in the midclavicular line.
What does tenderness over the liver suggest?
Tenderness over liver suggests inflammation, found in hepatitis, or CHF
What is the scratch test, what is it used to detect, and what are some abnormalities found?
The scratch test- to determine the lower border of the liver. Place the diaphragm of your stethoscope just above the right costal margin at the MCL. With your fingernail, lightly scratch the skin of the abdomen along the MCL, moving from below the umbilicus toward the costal margin. When your scratching finger reaches the liver’s edge you will hear a change in the scratching sound as it passes through the liver to your stethoscope. (*The accuracy of the scratch test has not been well studied).
- Hepatomegaly in young children is unusual. It can be caused by cystic fibrosis, protein malabsorption, parasites, fatty liver, and tumors.*
- If hepatomegaly is accompanied by splenomegaly, portal hypertension, storage diseases, chronic infections, and malignancy should be considered.*
What is Obturator sign and what does it indicate?
Flex the patient’s right thigh at the hip, with the knee bent, and rotate the leg internally at the hip. This maneuver stretches the internal obturator muscle.
Right hypogastric pain is a positive obturator sign, from irritation of the obturator muscle by an inflamed appendix. This sign has very low sensitivity.
What is the McBurney point?
Classically, “McBurney point” lies 2 inches from the anterior superior spinous process of ilium on a line drawn from that process to the umbilicus
What are signs of peritonitis ?
Signs of peritonitis include a positive cough test, guarding, rigidity, rebound tenderness, and percussion tenderness.
When positive, these signs roughly double the likelihood of peritonitis; rigidity makes peritonitis almost four times more likely. Causes include appendicitis, cholecystitis, and a perforation of the bowel wall.
What are the various presentations of bloody stool? What are the possible etiologies?
