Exam of Abdomen (stasio-8) Flashcards
Common sx of Abdominal disease
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
types of abdominal pain (3)
1) visceral or colic pain
2) parietal pain
3) referred pain
Visceral/colic pain
from hollow organ that is distended/stretched
comes and goes
not well localized
parietal pain
from inflammation of peritoneum
steady, achy pain
well localized
referred pain
from a source that is distant to present pain
GB–>R shoulder
Spleen–>L soulder
Pancreas/Aorta–>Back
renal pain refers where?
flank
ureteral pain refers?
around the flank and down to UG
epigastric pain from?
stomach
duodenum
pancreas
if RUQ pain–biliary tree, liver
periumbilical pain
small intestine
appendix
proximal colon
hypogastric pain
colon
bladder
uterus
(from colon, pain is more diffuse)
suprapubic/sacral pain
rectum
inspection
from xiphoid to pubis
skin-scars, stria, superficial vv
umbilicus-hernia, “Caput medusa”-due to varicocele
contour-flat, protuberant, scaphoid (sunken)
pulsations/persitalsis
auscultation
BEFORE PALPATION
to all 4 quadrants
RLQ is best to listen b/c of cecum
listen for 2 minutes before documenting absent
normal bowel sounds
high pitched “tinkle” every 3-5 seconds
borborygmi
increased, hyperactive BS
low pitched rumbling
hyperperistalsis
abdominal bruits
due to disrupted arterial flow in narrowed artery check: aortic (b/w umb and xiph) renal (lat to aorta) femoral (along ing lig)
common locations of abdominal bruits
aorta
renal aa
iliac aa
femoral aa
percussion
evaluates for gaseous distention, fluid, solid masses, size/location of liver and spleen
do all 4 quadrants
best w/ pt supine
tympany
most common
from gas in stomach and small bowel
direction of percussion
along R MCL top to bottom
resonant–>dull–>tympanic
hepatomegaly
> 10 cm
ascites
test using:
fluid wave
shifting dullness
fluid wave
place pt hand midline
tap on one flank and palpate other flank
feel for fluid wave
shifting dullness
percuss pt on back and on side
note where sound changes from tympanic to dull in both positions
palpation types (6)
light deep liver spleen kidney rebound tenderness
light palpation
detects tenderness and areas of muscular spasms or rigidity
fingertips
deep palpation
evaluates organ size, abnormal masses, aorta, deep pain
one hand on other
rebound tenderness
evaluate peritoneal tenderness and inflammation
slowly and deeply palpate, then quickly remove hand
(+) if painful
Rovsing’s sign
referred rebound tenderness
press on LLQ, release, (+) if pain moves to RLQ
liver palpation
one hand under ribs 11 and 12
other hand in RUQ
pt breathes as dr pushes inward
Hooking technique
for liver palpation
dr near pt’s head
hook fingers under lower margin of liver
pt breathes as dr pulls inward
spleen palpation
one hand under ribs 11 and 12
other hand in LUQ
pt breathes in and dr presses inward
NORMALLY NOT PALPATED
aortic palpation
press deeply into upper abdomen with both hands
normal: 2.5-3 cm wide
aortic aneurysm
pathologic dilation of aorta
associated with bruit
assessed with U/S or CT scan
kidney palpation
one hand above and one below costal margins
deep palpation can reach lower pole of each kidney
NORMALLY NOT PALPATED
kidney percussion
called CVA tenderness
with fist, hit over costovertebral angle on each side of spine
pain? ifm or infxn
Lloyd’s sign
CVA tenderness
with fist, hit over costovertebral angle on both sides to elicit pain, if any, due to ifm or infxn
rectal exam (DRE)
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**
fecal occult blood testing
tests for blood in stool or rectum (+) FOBT needs to be evaluated for CRC Methods: colonoscopy sigmoidoscopy/air contrast barium enema
appendicitis etiology
obs of append. lumen from fecal or foreign matter, tumors or lymphomas
appendicitis hx
periumbilical pain–>RLQ
nausea/vomiting
anorexia due to lsos of appetite
fever
psoas sign
patient on L side
extend R leg to check for ifm
obturator sign
R leg in figure 4
press on R knee while stabilizing L iliac crest
female pt with possible appy dx
ALWAYS do rectal and pelvic exams
give beta-hCG test
test for appendicitis
CT most sensitive
UA will help RO UG condition
CBC shows mod leukocytosis with L shift
U/S shows large, thick appendix
acute cholecystitis etiology
obs of cystic duct by gallstone, sometimes neoplasm
acute cholecystitis hx
RUQ postprandial pain pain--> R shoulder nausea/vomiting anorexia obesity fever
The 5 “F”s of acute cholecystitis
female fertile fat fair flatulent
murphy’s sign
RUQ pain
sudden arrest of inspiration during liver and GB palpation
Diagnostic triad of Acute Cholecystitis
RUQ pain
fever
leukocytosis
Tests for acute cholecystitis
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
