Exam #4: Abdomen Flashcards
What is the appropriate sequence of the abdominal examination?
1) Inspection
2) Auscultation
3) Percussion
4) Palpation
What is visceral pain?
Visceral pain is the pain that occurs when hollow abdominal organs are forcefully contracted, distended, or stretched; it also occurs with stretching of the capsules of solid organs. Patients describe the pain as:
- gnawing
- burning
- achy
- cramping
What is parietal pain?
Inflammation or the parietal peritoneum that results in steady achy pain that is more severe than visceral pain. This pain is exacerbated by movement; patients prefer to lie still.
What is referred pain?
Pain felt at more distant sites, innervated at approximately the same level as the disordered structure.
What is Grey Turner’s Sign?
Bruising of the flanks caused by:
- Pancreatitis
- Abdominal trauma
- Ruptured AAA
- Ruptured ectopic pregnancy
What is Cullen’s Sign?
Periumbilical ecchymosis caused by:
- Pancreatitis
- Ruptured ectopic pregnancy
What is Sister Mary Joseph’s?
- A periumbilical nodule or hard mass
Clinically, Sister Mary Joseph’s reflects metastatic disease caused by intrapelvic or intraabdominal malignancies.
What is Linea Nigra?
A line of pigmentation that often develops during pregnancy
What is Caput Medusa?
Dilated tortuous, superficial veins radiating upwards from the umbilicus
What is Diastasis Recti?
A separation between the left & right side of the rectus abdominus muscle
What is a scaphoid abdomen? What is it a sign of?
A sucked in abdomen, which is a sign of malnutrition
What is a distended lower half of the abdomen a sign of?
1) Bladder distention
2) Pregnancy
3) Ovarian mass
4) Sigmoid tumor
What is a protuberant abdomen a sign of?
1) Ascites
2) Organomegaly
3) Obesity
What are you listening for when you auscultate the abdomen?
1) Bowel sounds
2) Bruits of the aortic, renal iliac, and femoral arteries
When you listen to bowel sounds you hear loud prolonged gurgles. What is this a sign of?
Borborygmi–normal sounds
When you listen to bowel sounds you hear increased sounds. What is this is a sign of?
Gastroenteritis
Early bowel obstruction
Hunger
When you listen to bowel sounds you hear high-pitched tinkling. What is this a sign of?
Early obstruction–intestinal fluid & air under pressure
When you listen to bowel sounds you hear decreased sounds. What is this a sign of?
Peritonitis
Paralytic ileus
When you listen to bowel sounds you hear no sounds (for > 5 min). What is this an indication of?
Bowel obstruction–this is a surgical EMERGENCY.
How will a normal abdomen sound to percussion?
The normal abdomen has both tympanitic areas (gas-filled) & dull areas (fluid-filled)
What does a protuberant abdomen that is diffusely tympanitic suggest?
Intestinal obstruction
What is the definition of “tympany?” What is it associated with?
Musical note of higher pitch than resonance
- air-filled viscera
What is the definition of “hyperresonance?” What is it associated with?
Between tympany and resonance
- Base of the lung
What is the definition of “resonance?” What is it associated with?
Sustained note of moderate pitch
- Over lung tissue & sometimes abdomen
What is the definition of “dullness?” What is it associated with?
Short, high-pitched note with little resonance
- Over solid organs adjacent to air-filled structures
What is a fluid wave indicative of?
Ascites
What is shifting dullness? What is shifting dullness a test for?
- When percussing the abdomen with ascites, there is a shit from tympany–>dullness when the patient is erect as you proceed outward
- Repeating the percussion with the patient on side, there is a shift in the location of dullness due to gravity
*This is a test for ascites
What is the Lloyd’s punch test?
Testing for CVA tenderness
What is peritonitis?
Inflammation of the peritoneum
What is the definition of tenderness?
Discomfort elicited by palpation
What is guarding?
Voluntary contraction of the abdominal musculature
What is rebound tenderness?
Pain that is worse when the palpating fingers are quickly removed
What is rigidity?
Involuntary contraction of the abdominal muscles
What is the definition of McBurney’s point?
1/3 of the distance from ASIS to umbilicus–this is the site of the normal appendix in the non-pregnant adult
What is Murphy’s Sign?
Brief inspiratory arrest secondary to patient discomfort when the examiner presses his or her fingers inward in the RUQ
*This is a sign of acute cholecystitis
What is Dance Sign?
Absence of bowel sounds in the RLQ–>intussusception
What is Kehr Sign?
Abdominal pain radiating into the left shoulder–>
- Spleen rupture
- Renal calculi
- Ectopic pregnancy
What is Markle Sign?
This is also known as a “heel jar;” hitting the heels causes pain
- Peritonitis
- Appendicitis
What is Romberg-Howship Sign?
Pain to the medial aspect of the thigh to knee–>strangulated obturator hernia
What is Rovsing Sign?
RLQ pain that is worsened by palpation of the LLQ
- Peritoneal irritation
- Appendicitis
What is burning pain associated with?
peptic ulcer
What is cramping pain associated with?
Biliary colic
Gastroenteritis
What is colicky pain associated with?
Appendicitis with impacted feces
Renal stones
What is achy pain associated with?
Appendiceal irritation
What is knifelike pain associated with?
Pancreatitis
What is ripping or tearing pain associated with?
Aortic dissection
What is gradual pain associated with?
Infection
What is sudden pain associated with?
Duodenal ulcer
Acute pancreatitis
Obstruction
Perforation
Describe the typical presentation of pancreatitis.
- Sudden LUQ, epigastric, or umbilical pain that may refer to the left shoulder
- Vomiting, fever, & shock associated
- PE shows Grey Turner and/or Cullen’s signs
What are the most common causes of acute pancreatitis?
Gallstones
Alcoholism
Describe the typical presentation of cholecystitis.
- Severe unrelenting RUQ or epigastric pain that refers to the right subscapular area
- Anorexia, vomiting, fever, & possible jaundice associated
- Exam shows RUQ tenderness & positive Murphy’s sign
Describe the typical presentation of diverticulitis.
- LLQ pain, or pain localized to diseased area
- Fever, anorexia & diarrhea associated
Describe the typical presentation of PID.
- Lower quadrant pain in sexually active females
- Nausea, vomiting, cervical discharge, dyspareunia
- Exam shows adnexal & cervical tenderness
Describe the typical presentation of appendicitis.
- Periumbilical or epigastric pain that localizes to the RLQ
- “Colicky”
- Fever, nausea, vomiting, and anorexia assocaited
- Exam shows guarding & positive: Obturator, iliopsoas, Rovsing, Markle, & McBunney’s signs
List the risk factors associated with colon cancer.
- > 50
- Family hx
- Personal hx of colon ca, intestinal polyps, chronic inflammatory disease, FAP, & HNPCC
- Hx of obarian or endometrial cancer
- Ashkenazi Jew
- Low fiber, veggie, & fruit diet with high fat
- Obesity
- Smoking
- Lack of exercise
- Alcoholism
Under what age is it okay to let a child sit on a parents lap for abdominal exam?
Kindergarten (school-age)
In what age range is it especially important to screen for an umbilical hernia?
Under the age of 5
*Closed after this age because at this point, it probably it not going to heal on its own
What makes umbilical hernias more prominent?
Straining
Coughing
Crying
When does the umbilical cord normally fall off?
By 2 weeks
How do you examine the abdomen of a toddler?
Supine
*Lumbar lordosis can make the abdomen appear distended
What is the normal size of the liver in an infant?
Liver that extends ~1-3 cm below the right costal margin
What is hepatomegaly in the infant a sign of?
CHF
Infection
Liver Failure
How can you calm a baby?
Eating (breast feeding)
Sucking on pacifier
Allow patient to stay on parent’s lap
What is the first thing you should think if you feel a mass in an infant?
Enlarged kidney
How should you palpate the abdomen of an infant?
With the legs flexed
What should you do if a child is ticklish?
Use the child’s hand to palpate
What is omphalitis?
Infection of the umbilical area
- Treat with anti-staphylococcal abx
