Exam of Abdomen Flashcards
dysphagia
difficulty swallowing
hematemesis
throwing up blood
melena
dark stool
visceral pain
colic pain- source of usually hollow organ caused by distension or stretching. comes and goes, crescendo pattern. not well localized (ANS)
ex. cholic = gas in babies
parietal pain
caused by inflammation of peritoneum. steady aching pain that is usually well localized
referred pain
pain from a distant sight right shoulder = gallbladder left shoulder = spleen back = pancreas or aorta lateral side = kidney pain loin to groin = ureteral pain
examination of abdomen
1- inspection 2- auscultation 3- percussion 4- palpation rectal examination (no abdominal exam is complete without this!) special techniques
most important thing to exposing abdomen
must go from xiphoid to pubis symphysis
caput medusa
varicosities around the umbilicus
three anastamoses
rectal varicies (hemorroids) esophageal varicies umbilical varicies
abdominal striae
stretch marks
auscultation
all 4 quadrants
- RLQ is best place to hear: transition of cecum
- bowel sounds tell us that peristalsis is occurring (every 3-5 seconds)
- no bowel sounds = ileus
ileus
no bowel sounds, most commonly due to post-abdominal surgery
borborygmi
Increased, hyperactive bowel sounds,
Low pitched rumbling
Hyperperistalsis
“stomach growling”
abdominal bruits
A soft sound made by disrupted arterial flow through a narrowed artery.
– turbulent arterial flow causing a soft “hissing sound”
- Aortic – between the umbilicus and xiphoid (bifurcation occurs at the umbilicus of iliac)
- Renal artery – just lateral to the aorta
- Femoral artery – along the inguinal ligament
percussion
should get tympanic sound: presence of gas in stomach and small bowels --> can do this at MCL resonant = lungs dull = liver tympany = stomach/small bowels
liver is normally < 10 cm
fluid wave
–> way to test for ascites
tap on one side, a wave will move across to the other side
Place patient’s or assistant’s hand in midline. Tap on one flank and palpate with the other
hand. An easily palpable impulse
suggests ascites.
shifting dulness
–> way to test for ascites
if patient is laying on back, dullness will be percussed at the fluid level, the fluid will shift from supine position to when patient is laying on their side
- tympany will be palpated where the organs lie
palpation of abdomen
- Light palpation (work towards point of tenderness, using one hand)
- Deep palpation (use one hand on top of other, top hand is the pushing hand, bottom hand is palpating hand)
- Liver palpation (right hand in the RUQ, place one hand under right 11th/12th rib, instruct patient to breath deeply, can feel liver on inhalation)
- Spleen palpation (place left hand under the 11th/12th ribs, place right hand in the LUQ under the costal margin- not normally palpable)
- Kidney palpation (sandwich method above and below the costal margins- not normally palpable)
- Rebound palpation
rebound tenderness
- start away from point of tenderness
- indicated peritoneal tenderness, irritation and inflammation: “peritonitis”
- if it is painful on the rebound “+ rebound tenderness”
Rovsing’s sign
- referred rebound tenderness
- press on the LLQ and release, positive if pain in the RLQ
- indicates appendicitis
aorta palpation
- press firmly in upper abdomen
palpate for aortic aneurysm - dilation of the aorta, can be asscoiated with a bruit - need to listen first!
CVA tenderness
percussion of kidneys - costovertebral angle tenderness indicate Lloyd’s sign
positions of DRE
patient on back: modified lithotomy
**lying on left side : Sim’s position (female)
**standing: bend over the exam table (male- easier access to prostate gland)
DRE: inspection, palpation
rectal examination: inspection
spread buttocks
look at sacroccygeal (common place for absess) and perianal areas
look at anus and rectum
DRE
- palpation: put finger on external sphincter, have them relax muscles under the finger, roll finger into rectum, put finger into the knuckle slowly.
- Once inside, rotate finger 180 degrees both ways to look for masses
- in male, can feel prostates: size of walnut
- use stool collected for fecal occult blood testing (positive test turns blue when reacting to iron)
anal warts
condyloma acuminate = caused by HPV
condylomata lata = caused by syphilis
appendicitis:
due to obstruction of appendicular lumen. fecal or foreign matter, tumors or lymphomas
hx: pain starts peri-umbilical then shifts to the right lower quadrant
- nausea, vomiting, anorexia, fever
Rovsing’s sign, (reffered rebound tenderness, press on LLQ, pain referred to RLQ)
psoas sign,
obturator sign
must always do a pelvic exam on a woman with abdominal pain - must do pregnancy test
what is most sensitive test for appendicitis?
CT scan
Acute Cholecystitis
Etiology:
Obstruction of the cystic duct usually by a gallstone, sometimes a neoplasm.
History: RUQ postprandial pain. Biliary colic pain. Pain radiating to the right shoulder. Nausea and vomiting. Anexoria Obesity Fever The 5 “f’s” – female, fat, fertile, fair, flatulent.
Murphy’s Sign: RUQ pain and sudden arrest of inspiration during palpation of the liver and gallbladder
Diagnostic Triad : RUQ pain, fever and leukocytosis
physical exam of acute cholecystitis
Physical Examination
RUQ pain and RUQ rebound tenderness.
Decreased or absent bowel sounds.
Abdominal distention.
Murphy’s sign – RUQ pain and sudden arrest of inspiration during palpation of the liver and gallbladder.
Diagnostic Triad – RUQ pain, fever and leukocytosis.
Diagnostic Work up of Acute Cholecystitis
CBC: leukocytosis with left shift
can have midly elevated serum bilirubin
AST/ALT can be elevated
ultrasound will detect stones
Murphy’s sign
done as part of liver palpation
- the examiner places their finger tips just below the liver edge and as the patient inhales, the examiner presses inward on the liver.
- pain during inspiration causing the patient to stop inhaling is suggestive of an acutely inflamed gallbladder
