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Clinical Medicine > Exam #4: Abdomen > Flashcards

Exam #4: Abdomen Flashcards

1
Q

What is the appropriate sequence of the abdominal examination?

A

1) Inspection
2) Auscultation
3) Percussion
4) Palpation

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2
Q

What is visceral pain?

A

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
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3
Q

What is parietal pain?

A

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.

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4
Q

What is referred pain?

A

Pain felt at more distant sites, innervated at approximately the same level as the disordered structure.

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5
Q

What is Grey Turner’s Sign?

A

Bruising of the flanks caused by:

  • Pancreatitis
  • Abdominal trauma
  • Ruptured AAA
  • Ruptured ectopic pregnancy
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6
Q

What is Cullen’s Sign?

A

Periumbilical ecchymosis caused by:

  • Pancreatitis
  • Ruptured ectopic pregnancy
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7
Q

What is Sister Mary Joseph’s?

A
  • A periumbilical nodule or hard mass

Clinically, Sister Mary Joseph’s reflects metastatic disease caused by intrapelvic or intraabdominal malignancies.

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8
Q

What is Linea Nigra?

A

A line of pigmentation that often develops during pregnancy

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9
Q

What is Caput Medusa?

A

Dilated tortuous, superficial veins radiating upwards from the umbilicus

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10
Q

What is Diastasis Recti?

A

A separation between the left & right side of the rectus abdominus muscle

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11
Q

What is a scaphoid abdomen? What is it a sign of?

A

A sucked in abdomen, which is a sign of malnutrition

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12
Q

What is a distended lower half of the abdomen a sign of?

A

1) Bladder distention
2) Pregnancy
3) Ovarian mass
4) Sigmoid tumor

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13
Q

What is a protuberant abdomen a sign of?

A

1) Ascites
2) Organomegaly
3) Obesity

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14
Q

What are you listening for when you auscultate the abdomen?

A

1) Bowel sounds

2) Bruits of the aortic, renal iliac, and femoral arteries

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15
Q

When you listen to bowel sounds you hear loud prolonged gurgles. What is this a sign of?

A

Borborygmi–normal sounds

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16
Q

When you listen to bowel sounds you hear increased sounds. What is this is a sign of?

A

Gastroenteritis
Early bowel obstruction
Hunger

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17
Q

When you listen to bowel sounds you hear high-pitched tinkling. What is this a sign of?

A

Early obstruction–intestinal fluid & air under pressure

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18
Q

When you listen to bowel sounds you hear decreased sounds. What is this a sign of?

A

Peritonitis

Paralytic ileus

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19
Q

When you listen to bowel sounds you hear no sounds (for > 5 min). What is this an indication of?

A

Bowel obstruction–this is a surgical EMERGENCY.

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20
Q

How will a normal abdomen sound to percussion?

A

The normal abdomen has both tympanitic areas (gas-filled) & dull areas (fluid-filled)

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21
Q

What does a protuberant abdomen that is diffusely tympanitic suggest?

A

Intestinal obstruction

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22
Q

What is the definition of “tympany?” What is it associated with?

A

Musical note of higher pitch than resonance

- air-filled viscera

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23
Q

What is the definition of “hyperresonance?” What is it associated with?

A

Between tympany and resonance

- Base of the lung

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24
Q

What is the definition of “resonance?” What is it associated with?

A

Sustained note of moderate pitch

- Over lung tissue & sometimes abdomen

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25
Q

What is the definition of “dullness?” What is it associated with?

A

Short, high-pitched note with little resonance

- Over solid organs adjacent to air-filled structures

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26
Q

What is a fluid wave indicative of?

A

Ascites

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27
Q

What is shifting dullness? What is shifting dullness a test for?

A
  • 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

28
Q

What is the Lloyd’s punch test?

A

Testing for CVA tenderness

29
Q

What is peritonitis?

A

Inflammation of the peritoneum

30
Q

What is the definition of tenderness?

A

Discomfort elicited by palpation

31
Q

What is guarding?

A

Voluntary contraction of the abdominal musculature

32
Q

What is rebound tenderness?

A

Pain that is worse when the palpating fingers are quickly removed

33
Q

What is rigidity?

A

Involuntary contraction of the abdominal muscles

34
Q

What is the definition of McBurney’s point?

A

1/3 of the distance from ASIS to umbilicus–this is the site of the normal appendix in the non-pregnant adult

35
Q

What is Murphy’s Sign?

A

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

36
Q

What is Dance Sign?

A

Absence of bowel sounds in the RLQ–>intussusception

37
Q

What is Kehr Sign?

A

Abdominal pain radiating into the left shoulder–>

  • Spleen rupture
  • Renal calculi
  • Ectopic pregnancy
38
Q

What is Markle Sign?

A

This is also known as a “heel jar;” hitting the heels causes pain

  • Peritonitis
  • Appendicitis
39
Q

What is Romberg-Howship Sign?

A

Pain to the medial aspect of the thigh to knee–>strangulated obturator hernia

40
Q

What is Rovsing Sign?

A

RLQ pain that is worsened by palpation of the LLQ

  • Peritoneal irritation
  • Appendicitis
41
Q

What is burning pain associated with?

A

peptic ulcer

42
Q

What is cramping pain associated with?

A

Biliary colic

Gastroenteritis

43
Q

What is colicky pain associated with?

A

Appendicitis with impacted feces

Renal stones

44
Q

What is achy pain associated with?

A

Appendiceal irritation

45
Q

What is knifelike pain associated with?

A

Pancreatitis

46
Q

What is ripping or tearing pain associated with?

A

Aortic dissection

47
Q

What is gradual pain associated with?

A

Infection

48
Q

What is sudden pain associated with?

A

Duodenal ulcer
Acute pancreatitis
Obstruction
Perforation

49
Q

Describe the typical presentation of pancreatitis.

A
  • 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
50
Q

What are the most common causes of acute pancreatitis?

A

Gallstones

Alcoholism

51
Q

Describe the typical presentation of cholecystitis.

A
  • 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
52
Q

Describe the typical presentation of diverticulitis.

A
  • LLQ pain, or pain localized to diseased area

- Fever, anorexia & diarrhea associated

53
Q

Describe the typical presentation of PID.

A
  • Lower quadrant pain in sexually active females
  • Nausea, vomiting, cervical discharge, dyspareunia
  • Exam shows adnexal & cervical tenderness
54
Q

Describe the typical presentation of appendicitis.

A
  • 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
55
Q

List the risk factors associated with colon cancer.

A
  • > 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
56
Q

Under what age is it okay to let a child sit on a parents lap for abdominal exam?

A

Kindergarten (school-age)

57
Q

In what age range is it especially important to screen for an umbilical hernia?

A

Under the age of 5

*Closed after this age because at this point, it probably it not going to heal on its own

58
Q

What makes umbilical hernias more prominent?

A

Straining
Coughing
Crying

59
Q

When does the umbilical cord normally fall off?

A

By 2 weeks

60
Q

How do you examine the abdomen of a toddler?

A

Supine

*Lumbar lordosis can make the abdomen appear distended

61
Q

What is the normal size of the liver in an infant?

A

Liver that extends ~1-3 cm below the right costal margin

62
Q

What is hepatomegaly in the infant a sign of?

A

CHF
Infection
Liver Failure

63
Q

How can you calm a baby?

A

Eating (breast feeding)
Sucking on pacifier
Allow patient to stay on parent’s lap

64
Q

What is the first thing you should think if you feel a mass in an infant?

A

Enlarged kidney

65
Q

How should you palpate the abdomen of an infant?

A

With the legs flexed

66
Q

What should you do if a child is ticklish?

A

Use the child’s hand to palpate

67
Q

What is omphalitis?

A

Infection of the umbilical area

- Treat with anti-staphylococcal abx

Clinical Medicine (27 decks)

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