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PCM II Exam 1 > Exam of Abdomen (stasio-8) > Flashcards

Exam of Abdomen (stasio-8) Flashcards

1
Q

Common sx of Abdominal disease

A 
pain
nausea/vomiting
change in bowel habits (constipation/diarrhea)
rectal bleeding
jaundice
abdominal distention
abdominal mass
indigestion
anorexia
dysphagia
hematemesis
melena-black, "tarry" stool
change in stool size
weight loss
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2
Q

types of abdominal pain (3)

A

1) visceral or colic pain
2) parietal pain
3) referred pain

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3
Q

Visceral/colic pain

A

from hollow organ that is distended/stretched
comes and goes
not well localized

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4
Q

parietal pain

A

from inflammation of peritoneum
steady, achy pain
well localized

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5
Q

referred pain

A

from a source that is distant to present pain
GB–>R shoulder
Spleen–>L soulder
Pancreas/Aorta–>Back

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6
Q

renal pain refers where?

A

flank

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7
Q

ureteral pain refers?

A

around the flank and down to UG

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8
Q

epigastric pain from?

A

stomach
duodenum
pancreas
if RUQ pain–biliary tree, liver

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9
Q

periumbilical pain

A

small intestine
appendix
proximal colon

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10
Q

hypogastric pain

A

colon
bladder
uterus
(from colon, pain is more diffuse)

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11
Q

suprapubic/sacral pain

A

rectum

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12
Q

inspection

A

from xiphoid to pubis
skin-scars, stria, superficial vv
umbilicus-hernia, “Caput medusa”-due to varicocele
contour-flat, protuberant, scaphoid (sunken)
pulsations/persitalsis

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13
Q

auscultation

A

BEFORE PALPATION
to all 4 quadrants
RLQ is best to listen b/c of cecum
listen for 2 minutes before documenting absent

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14
Q

normal bowel sounds

A

high pitched “tinkle” every 3-5 seconds

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15
Q

borborygmi

A

increased, hyperactive BS
low pitched rumbling
hyperperistalsis

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16
Q

abdominal bruits

A 
due to disrupted arterial flow in narrowed artery
check:
aortic (b/w umb and xiph)
renal (lat to aorta)
femoral (along ing lig)
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17
Q

common locations of abdominal bruits

A

aorta
renal aa
iliac aa
femoral aa

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18
Q

percussion

A

evaluates for gaseous distention, fluid, solid masses, size/location of liver and spleen
do all 4 quadrants
best w/ pt supine

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19
Q

tympany

A

most common

from gas in stomach and small bowel

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20
Q

direction of percussion

A

along R MCL top to bottom

resonant–>dull–>tympanic

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21
Q

hepatomegaly

A

> 10 cm

22
Q

ascites

A

test using:
fluid wave
shifting dullness

23
Q

fluid wave

A

place pt hand midline
tap on one flank and palpate other flank
feel for fluid wave

24
Q

shifting dullness

A

percuss pt on back and on side

note where sound changes from tympanic to dull in both positions

25
Q

palpation types (6)

A 
light
deep
liver
spleen
kidney
rebound tenderness
26
Q

light palpation

A

detects tenderness and areas of muscular spasms or rigidity

fingertips

27
Q

deep palpation

A

evaluates organ size, abnormal masses, aorta, deep pain

one hand on other

28
Q

rebound tenderness

A

evaluate peritoneal tenderness and inflammation
slowly and deeply palpate, then quickly remove hand
(+) if painful

29
Q

Rovsing’s sign

A

referred rebound tenderness

press on LLQ, release, (+) if pain moves to RLQ

30
Q

liver palpation

A

one hand under ribs 11 and 12
other hand in RUQ
pt breathes as dr pushes inward

31
Q

Hooking technique

A

for liver palpation
dr near pt’s head
hook fingers under lower margin of liver
pt breathes as dr pulls inward

32
Q

spleen palpation

A

one hand under ribs 11 and 12
other hand in LUQ
pt breathes in and dr presses inward
NORMALLY NOT PALPATED

33
Q

aortic palpation

A

press deeply into upper abdomen with both hands

normal: 2.5-3 cm wide

34
Q

aortic aneurysm

A

pathologic dilation of aorta
associated with bruit
assessed with U/S or CT scan

35
Q

kidney palpation

A

one hand above and one below costal margins
deep palpation can reach lower pole of each kidney
NORMALLY NOT PALPATED

36
Q

kidney percussion

A

called CVA tenderness
with fist, hit over costovertebral angle on each side of spine
pain? ifm or infxn

37
Q

Lloyd’s sign

A

CVA tenderness

with fist, hit over costovertebral angle on both sides to elicit pain, if any, due to ifm or infxn

38
Q

rectal exam (DRE)

A

position pt:
on back, on L side, standing and bent over
inspection:
spread buttocks, sacrococcygeal and perianal areas, anus and rectum
warts, tumors, hemorrhoids, fistulas, ulcers, ifm, rashes, skin tags
palpate prostate gland**

39
Q

fecal occult blood testing

A 
tests for blood in stool or rectum
(+) FOBT needs to be evaluated for CRC
Methods:
colonoscopy
sigmoidoscopy/air contrast barium enema
40
Q

appendicitis etiology

A

obs of append. lumen from fecal or foreign matter, tumors or lymphomas

41
Q

appendicitis hx

A

periumbilical pain–>RLQ
nausea/vomiting
anorexia due to lsos of appetite
fever

42
Q

psoas sign

A

patient on L side

extend R leg to check for ifm

43
Q

obturator sign

A

R leg in figure 4

press on R knee while stabilizing L iliac crest

44
Q

female pt with possible appy dx

A

ALWAYS do rectal and pelvic exams

give beta-hCG test

45
Q

test for appendicitis

A

CT most sensitive
UA will help RO UG condition
CBC shows mod leukocytosis with L shift
U/S shows large, thick appendix

46
Q

acute cholecystitis etiology

A

obs of cystic duct by gallstone, sometimes neoplasm

47
Q

acute cholecystitis hx

A 
RUQ postprandial pain
pain--> R shoulder
nausea/vomiting
anorexia
obesity
fever
48
Q

The 5 “F”s of acute cholecystitis

A 
female
fertile
fat
fair
flatulent
49
Q

murphy’s sign

A

RUQ pain

sudden arrest of inspiration during liver and GB palpation

50
Q

Diagnostic triad of Acute Cholecystitis

A

RUQ pain
fever
leukocytosis

51
Q

Tests for acute cholecystitis

A 
CBC-leukocytsos w/ L shift
Elevated bili
elevated AST?ALT
U/S detects stones, thick GB wall, dilated bile duct
can also do HIDA and CT

PCM II Exam 1 (7 decks)

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