HPI & PE

Question 1

Parietal Pain

Answer 1

steady, aching pain, precisely located over involved structure

Generally more severe pain

Question 2

What is the patient’s posture and habitus in parietal pain?

Answer 2

Prefers to lie still

Earth’s rotational movement is too much

Aggravated by any movement

Question 3

Somatic pain location

Answer 3

Originates in the deep tissues of:
Skin
Muscle
Bones

Question 4

Parietal pain location

Answer 4

Originates from inflammation in the parietal peritoneum

Question 5

Somatic pain

Answer 5

Described as MSK discomfort such as dull and aching

Easier to locate

Question 6

Parietal pain example

Answer 6

appendicitis

Question 7

somatic pain example

Answer 7

muscle ache

Question 8

visceral pain

Answer 8

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

Question 9

visceral pain location/habitus/posture

Answer 9

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

Question 10

visceral pain example

Answer 10

epigastric pain from biliary tree or liver

Question 11

referred pain

Answer 11

Pain / discomfort is felt in a location distant from the origin

May be felt superficially or deeply but is usually well localized

Question 12

referred pain exmaple

Answer 12

Cholecystitis – often times felt on scapula

Renal Calculi - the stone is a different place than the pain

Question 13

Cullen’s sign

Answer 13

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

Question 14

Cullen’s sign examples (4)

Answer 14

Acute Pancreatitis
Blunt Abdominal Trauma
Aortic Rupture
Ectopic Pregnancy

Question 15

Grey Turner Sign

Answer 15

Bruising in the upper quadrants or flank area

Question 16

Grey Turner Sign examples

Answer 16

Suggest injury to:
Retroperitoneal Hemorrhage
Liver, Spleen, or Kidneys
Acute Pancreatitis with Hemorrhage
Blunt Abdominal Trauma
Aortic Rupture
Ectopic Hemorrhage

Question 17

Tests for appendicitis

Answer 17

Psoas sign
Obturator sign
McBurney’s point

Question 18

Psoas sign

Answer 18

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

Question 19

Obturator sign

Answer 19

Flex patient’s (R) hip with knee flexed, then rotate leg internally

Question 20

McBurney’s Point

Answer 20

Located 1/3rd distance from Anterior Superior Iliac Spine (ASIS) on a straight line to the umbilicus

Question 21

Test for peritoneal irritation

Answer 21

Rebound tenderness:

(1) : direct - McBurney’s point
(2) : indirect - Rovsing’s maneuver

Question 22

Test for acute cholecystitis

Answer 22

Murphy’s Sign: exhale, place pressure on the gallbladder, have pt. inhale (displaces gallbladder to hand area) and if they stop and scream, positive

Question 23

Test for ascites

Answer 23

shifting dullness

fluid wave