Exam of Abdomen (stasio-8)

Question 1

Common sx of Abdominal disease

Answer 1

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

Question 2

types of abdominal pain (3)

Answer 2

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

Question 3

Visceral/colic pain

Answer 3

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

Question 4

parietal pain

Answer 4

from inflammation of peritoneum
steady, achy pain
well localized

Question 5

referred pain

Answer 5

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

Question 6

renal pain refers where?

Answer 6

flank

Question 7

ureteral pain refers?

Answer 7

around the flank and down to UG

Question 8

epigastric pain from?

Answer 8

stomach
duodenum
pancreas
if RUQ pain–biliary tree, liver

Question 9

periumbilical pain

Answer 9

small intestine
appendix
proximal colon

Question 10

hypogastric pain

Answer 10

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

Question 11

suprapubic/sacral pain

Answer 11

rectum

Question 12

inspection

Answer 12

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

Question 13

auscultation

Answer 13

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

Question 14

normal bowel sounds

Answer 14

high pitched “tinkle” every 3-5 seconds

Question 15

borborygmi

Answer 15

increased, hyperactive BS
low pitched rumbling
hyperperistalsis

Question 16

abdominal bruits

Answer 16

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

Question 17

common locations of abdominal bruits

Answer 17

aorta
renal aa
iliac aa
femoral aa

Question 18

percussion

Answer 18

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

Question 19

tympany

Answer 19

most common

from gas in stomach and small bowel

Question 20

direction of percussion

Answer 20

along R MCL top to bottom

resonant–>dull–>tympanic

Question 21

hepatomegaly

Answer 21

> 10 cm

Question 22

ascites

Answer 22

test using:
fluid wave
shifting dullness

Question 23

fluid wave

Answer 23

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

Question 24

shifting dullness

Answer 24

percuss pt on back and on side

note where sound changes from tympanic to dull in both positions

Question 25

palpation types (6)

Answer 25

``` light deep liver spleen kidney rebound tenderness ```

Question 26

light palpation

Answer 26

detects tenderness and areas of muscular spasms or rigidity | fingertips

Question 27

deep palpation

Answer 27

evaluates organ size, abnormal masses, aorta, deep pain | one hand on other

Question 28

rebound tenderness

Answer 28

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

Question 29

Rovsing's sign

Answer 29

referred rebound tenderness | press on LLQ, release, (+) if pain moves to RLQ

Question 30

liver palpation

Answer 30

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

Question 31

Hooking technique

Answer 31

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

Question 32

spleen palpation

Answer 32

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

Question 33

aortic palpation

Answer 33

press deeply into upper abdomen with both hands | normal: 2.5-3 cm wide

Question 34

aortic aneurysm

Answer 34

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

Question 35

kidney palpation

Answer 35

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

Question 36

kidney percussion

Answer 36

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

Question 37

Lloyd's sign

Answer 37

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

Question 38

rectal exam (DRE)

Answer 38

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**

Question 39

fecal occult blood testing

Answer 39

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

Question 40

appendicitis etiology

Answer 40

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

Question 41

appendicitis hx

Answer 41

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

Question 42

psoas sign

Answer 42

patient on L side | extend R leg to check for ifm

Question 43

obturator sign

Answer 43

R leg in figure 4 | press on R knee while stabilizing L iliac crest

Question 44

female pt with possible appy dx

Answer 44

ALWAYS do rectal and pelvic exams | give beta-hCG test

Question 45

test for appendicitis

Answer 45

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

Question 46

acute cholecystitis etiology

Answer 46

obs of cystic duct by gallstone, sometimes neoplasm

Question 47

acute cholecystitis hx

Answer 47

``` RUQ postprandial pain pain--> R shoulder nausea/vomiting anorexia obesity fever ```

Question 48

The 5 "F"s of acute cholecystitis

Answer 48

``` female fertile fat fair flatulent ```

Question 49

murphy's sign

Answer 49

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

Question 50

Diagnostic triad of Acute Cholecystitis

Answer 50

RUQ pain fever leukocytosis

Question 51

Tests for acute cholecystitis

Answer 51

``` 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 ```