Exam of the Abdomen Flashcards
dysphagia
difficulty in swallowing
visceral pain
colic pain in hollow organs -distension or stretching -comes and goes not well localized (innervation autonomic)
parietal pain
inflammation of peritoneum
-steady aching pain well localized
referred pain
right shoulder - gallbladder
left shoulder - spleen
back - pancreas/aorta
right shoulder pain
gallbladder
left shoulder pain
spleen
flank pain
kidney
back pain
pancreas or aorta
physical exam of abdomen includes?
inspection auscultation percussion palpation rectal examination special techniques
adequate exposure of abdomen?
xiphoid to pubis
necessary for inspection
best place to listen to cecum?
right lower quadrant
normal bowel sounds
high pitched tinkle every 3-5 seconds
sound of bowel sounds is peristalsis
when to do auscultation
BEFORE palpation
barborygmi
increased hyperactive bowel sounds
low pitched rumbling
hyperperistalsis
abdominal bruits
soft sound made by disrupted arterial flow through narrow artery
aortic
renal
femoral
aortic bruits?
between umbilicus and xiphoid
renal artery bruit?
lateral to aorta
femoral artery bruit?
along inguinal ligament
best position for palpation?
supine
tympanic sound
gas in stomach and small bowel
percussion of liver
resonant to dull to tympanic **
right mid-clavicular line
normal liver size
less than 10cm
ascites
fluid
fluid wave
tap on flank and palpate other side
-impulse indicates ascites
have assistants hands midline - stops wave through adipose tissue
shifting dullness
percuss patient on back and then side
note where changes of sound from tympany to dull and shift of sound when patient is turned on side
segments of palpation?
light deep liver spleen kidney rebound
light palpation
one hand
-finger tips with gentle motion
all four quadrants
deep palpation
one hand on top of the other
top push/bottom palpate
rebound tenderness
shows peritoneal tenderness
-slowly, gently, deeply palpate and quickly remove
rovsings sign
referred rebound tenderness
ex/
- press on LLQ and release
- positive if pain in RLQ
often with appendicitis
liver palpation
right hand under 11th and 12th rib (RUQ)
have patient breathe deeply as examiner presses inward and upward
-better palpation of liver on inhalation (diaphragm pushes it down
hooking technique
stand near patients head
hook fingers around lower right ribs
have patient breathe while pulling inward and upward
spleen palpation
left hand under 11th 12th ribs
right hand in LUQ under costal margin
spleen normally not palpated
palpation of aorta
press firmly and deep in the upper abdomen with two hands
aortic aneurysm
pathologic dilation of aorta
palpation of kidney
sandwich method
normally not palpated
percussion of kidneys
aka CVA tenderness
fist gently hit over area
pain may indicate an inflammatory infectious process of kidney
CVA tenderness
lloyds sign
level of T12
aka lloyds sign
percussion of kidneys
rectal examination
every abdominal examination should conclude with a DRE
modified lithotomy
patient on back
sims patient
patient on left side
standing position
standing, bent over exam table
rectal exam
inspect
-spread buttocks
palpation
- insert lubed finger and rotate 180 degrees
- in male feel prostate
fecal occult blood testing
positive test requires a thorough evaluation for CRC
either colonoscopy or sigmoidoscopy with air contrast barium enema
prolapsed internal hemorrhoid
comes out of anus
anal warts
HPV - condyloma acuminata**
syphylis - condylomata lata**
appendicitis
obstruction of appendicular lumen
pain peri-umbilical then shifts to right lower quadrant
-nausea and vomiting, anorexia, fever
obturator sign
right leg in figure 4
-press on right knee while holding down left iliac crest
always do rectal and pelvic on female**
psoas sign
extend leg
check for psoas muscle inflammation
acute cholecystitis
obstruction of cystic duct by gall stone
RUQ pain, N/V, anorexia, obesity, fever
pain comes and goes
pain radiates to shoulder
5 f’s - female, fat, fertile, fair, flatulent’
elevate direct bilirubin
murphys sign
RUQ pain and arrest of inspiration during palpation
acute cholecystitis
diagnostic triad
RUQ pain, fever, leukocytosis
nine regions of abdomen
epigastric, umbilical, suprapubic
R/L hypochondrium
R/L lumbar
R/L inguinal
