Exam of Abdomen and Rectum_Stasio

Question 1

Visceral or colic pain

Answer 1

source is hollow organs by distension or stretching

comes and goes often palpable near the midline

ex: ACUTE appendiceal pain is often located in the umbilical region

not well localized

Question 2

Parietal pain

Answer 2

caused by inflammation of peritoneum

steady, achy pain that is localized and referred

Question 3

abdominal bruits

Answer 3

soft sound make by disrupted arterial flow thru narrowed artery
aortic (b/w umbilicus and xiphoid)
Renal (lateral to aorta)
Femoral (along inguinal ligament)

Question 4

Rebound pain

Answer 4

tells you about peritoneal tenderness and inflammation

quickly move hand way from point of deep palpation

Question 5

Rovsing’s sign

Answer 5

referred rebound tenderness

press on LLQ and release—>pain in the RLQ (appendix)

Question 6

CVA tenderness

Answer 6

percussion of the kidney at T12

gently hit over area at the angle on each side

pain over a kidney may indicate inflammation or infection

Question 7

Appendicitis hx

Answer 7

pain starts peri-umbilical then shifts to the RLQ
nausea and vomiting 
ANOREXIA 
Fever 
\+rovsing's, psoas, obturator 

*always do DRE and pelvic on female along with pregnancy test to r/o ectopic pregnancy

Question 8

Psoas sign

Answer 8

turn pt on the L side and extend the R leg to check for psoas inflammation

indicates appendicitis

Question 9

Murphy’s Sign

Answer 9

RUQ pain and sudden arrest of inspiration during palpation of the liver and GB

Question 10

diagnostic triad for acute cholecytitis

Answer 10

RUQ pain, fever, leukocytosis (L shift)

elevated bili, AST/ALT

pain can radiate to R shoulder

5 f’s (female, fat, fertile, fair, flatulent)

Question 11

Referred pain

Answer 11

felt at distant sites that are innervated by the same spinal levels

often develops as initial pain becomes more intense
well localized

GB=R shoulder
Spleen=L Shoulder
Pancreas or aorta= back

Question 12

order of PE on the abdomen

Answer 12

Inspection 
Auscultation 
Percussion 
Palpation 
Rectal exam 
Special techniques

Question 13

Ileus

Answer 13

absent bowel sounds after 2 min
often surgically induced

bowel sounds best heard in RLQ (d/t cecum)

Question 14

Tympany

Answer 14

most common note in abdomen

presence of gas in stomach and small bowel

Question 15

liver percussion

Answer 15

should sound dull
start MCL on the chest to hear resonant—>dull—>tympanic

hepatomegaly>10 cm

Question 16

fluid wave

Answer 16

with pt hand midline

tap on one flank and palpate the other. an easily palpable impulse suggests ascites

Question 17

shifting dullness

Answer 17

percuss the pt while supine,and then again on their side

note where tympany (air) shifts to dull (fluid)

dullness shifts down

Question 18

Palpation of aorta

Answer 18

press firmly into upper abdomen with two hands
normal aorta is 2.5-3.0 cm wide

will be dilated in aortic aneurysm