HPI & PE Flashcards
Parietal Pain
steady, aching pain, precisely located over involved structure
Generally more severe pain
What is the patient’s posture and habitus in parietal pain?
Prefers to lie still
Earth’s rotational movement is too much
Aggravated by any movement
Somatic pain location
Originates in the deep tissues of:
Skin
Muscle
Bones
Parietal pain location
Originates from inflammation in the parietal peritoneum
Somatic pain
Described as MSK discomfort such as dull and aching
Easier to locate
Parietal pain example
appendicitis
somatic pain example
muscle ache
visceral pain
Occurs when hollow abdominal organs contract forcefully or are distended or stretched
Solid organs can also become painful when their capsules are stretched. Generally less severe pain
visceral pain location/habitus/posture
May be difficult to localize, discomfort varies – may be gnawing, burning, cramping, or aching
If severe may be associated with sweating, pallor, nausea, vomiting, and restlessness
visceral pain example
epigastric pain from biliary tree or liver
referred pain
Pain / discomfort is felt in a location distant from the origin
May be felt superficially or deeply but is usually well localized
referred pain exmaple
Cholecystitis – often times felt on scapula
Renal Calculi - the stone is a different place than the pain
Cullen’s sign
superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus (bleeds into fatty tissues and causes ecchymosis around the periumbilical area)
Predictive of significant intra-abdominal bleeding
Cullen’s sign examples (4)
Acute Pancreatitis
Blunt Abdominal Trauma
Aortic Rupture
Ectopic Pregnancy
Grey Turner Sign
Bruising in the upper quadrants or flank area
Grey Turner Sign examples
Suggest injury to: Retroperitoneal Hemorrhage Liver, Spleen, or Kidneys Acute Pancreatitis with Hemorrhage Blunt Abdominal Trauma Aortic Rupture Ectopic Hemorrhage
Tests for appendicitis
Psoas sign
Obturator sign
McBurney’s point
Psoas sign
Place your hand just above the patient’s right knee. Ask patient to raise thigh against hand
Alternatively, have patient lie on (L) side. Extend (R) leg at hip.
Flexion of leg = psoas muscle contraction TO IRRITATE APPENDIX
Extension of leg = psoas muscle stretching
Obturator sign
Flex patient’s (R) hip with knee flexed, then rotate leg internally
McBurney’s Point
Located 1/3rd distance from Anterior Superior Iliac Spine (ASIS) on a straight line to the umbilicus
Test for peritoneal irritation
Rebound tenderness:
(1) : direct - McBurney’s point
(2) : indirect - Rovsing’s maneuver
Test for acute cholecystitis
Murphy’s Sign: exhale, place pressure on the gallbladder, have pt. inhale (displaces gallbladder to hand area) and if they stop and scream, positive
Test for ascites
shifting dullness
fluid wave
