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ECOS II Midterm > Lab- Approach to Abdominal Complaint > Flashcards

Lab- Approach to Abdominal Complaint Flashcards

1
Q

What are the four steps of the abdominal exam (in order)

A

inspection, auscultation, percussion, and palpation

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2
Q

what is grey turner’s sign?

A

bruising on the flanks

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3
Q

what is cullen’s sign and what is it indicative of?

A

bruising around the umbilicus; indicative of necrotizing pancreatitis with retro or intraperitoneal bleeding

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4
Q

why should you auscultate before percussion and palpation?

A

maneuvers may alter characteristics of bowel sounds

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5
Q

what could cause hypoactive bowel sounds?

A

constipation, ileus, medication side effect

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6
Q

what could cause hyperactive bowel sounds?

A

infectious diarrhea, early stages of intestinal obstruction, bowel prep

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7
Q

what are high pitched tinkling sounds caused by?

A

intestinal fluid and air under pressure- think intestinal obstruction

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8
Q

what two types of sounds are you listening for when you percuss the abdomen?

A

tympanic and dull

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9
Q

what is tympanic percussion and where would you expect to hear it?

A

it is a hollow noise with resonance; most of the abdomen due to the intestines

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10
Q

what is dull percussion and where would you expect to hear it?

A

flat sound without resonance; over organs like the liver and spleen

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11
Q

how do you percuss the inferior margin of the liver?

A

start at the RLQ and percuss up the midclavicular line until the tympany shifts to dullness (liver)

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12
Q

how do you percuss the superior margin of the liver?

A

start at the nipple line and percuss down the midclavicular line until resonance (lung) is replaced by dullness (liver)

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13
Q

what is the normal measurement of the liver?

A

6-12 cm at the midclavicular line and 4-8 cm at the midsternal line

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14
Q

how do you percuss the spleen?

A

find the most inferior intercostal space at the anterior axillary line; should be tympanic at rest- have patient inhale while percussing- should remain tympanic

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15
Q

what does dullness of the spleen indicate and what is this sign?

A

may indicate splenomegaly- Castell’s sign

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16
Q

when might an area of dullness decrease?

A

when there is free air in the abdomen or with COPD

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17
Q

when might an area of dullness increase?

A

when there is ascites fluid, pleural effusion, lung consolidation

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18
Q

how do you palpate the liver?

A

left hand: supporting the 11th/12th rib (posteriorly); right hand: just below the costal margin at the midclavicular line

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19
Q

where palpating the liver using the hooking technique, where should your fingertips be placed?

A

at the right costal margin

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20
Q

how do you palpate the spleen?

A

right hand: below left costal margin (posteriorly); left hand: just below the costal margin at the midclavicular line to anterior axillary line; SHOULD NOT BE ABLE TO FEEL SPLEEN

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21
Q

how do you palpate the kidney?

A

right hand: below, at the 11/12th rib; left hand: just below the costal margin at the LUQ

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22
Q

how do you palpate the aorta?

A

above the umbilicus, midline or slightly left of midline

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23
Q

what is the normal measurement of the aorta?

A

2-3 cm; anything greater than 3 cm is abnormal

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24
Q

what causes visceral pain and what can be said about its localization?

A

caused by distention, stretching, or contraction of hollow organs; it does not localize

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25
Q

what causes somatic pain, what aggravates it, and what can be said about its localization?

A

could be secondary to inflammation in the parietal peritoneum; aggravated by movement or coughing; localized pain

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26
Q

what is rebound tenderness and what does it indicate?

A

pain upon removal of pressure; indicates peritoneal irritation

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27
Q

what are the specialty tests used for appendicitis?

A

McBurney’s point, Rovsing Sign, Psoas sign, Obturator test,

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28
Q

what is McBurney’s point?

A

rebound tenderness or pain at 1/3 the distance from the ASIS to the umbilicus

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29
Q

what is Rovsing’s sign?

A

pain in the RLQ upon palpation of the LLQ

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30
Q

what is Psoas sign?

A

patient is in a lateral position with right side up; you extend the patient’s right leg at the hip

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31
Q

what is the obturator test?

A

patient is supine; you passively flex the right thigh at the hip with the knee bent; rotate leg internally

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32
Q

what is the specialty test used for peritonitis?

A

heel strike

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33
Q

what is the heel strike test?

A

patient is supine; you strike the patient’s heel with your palm with enough force to jostle the patient

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34
Q

what does a positive heel strike test indicate?

A

peritoneal irritation

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35
Q

what is the specialty test used for ascites?

A

fluid wave test

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36
Q

how do you preform the fluid wave test?

A

assistant places their hands midline; clinician taps one side of the abdomen and feels for an impulse at the other side

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37
Q

what is the specialty test used for the gallbladder?

A

Murphy’s sign

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38
Q

what is murphy’s sign?

A

clinician compresses at the RUQ, during inspiration direct compression under the costal margin; positive finding: pain or sudden stop of inspiration due to discomfort

39
Q

what is a positive murphy’s sign indicative of?

A

cholecystitis or cholelithiasis

40
Q

what is the specialty test used for the kidneys?

A

Lloyd punch

41
Q

what is a positive lloyd punch indicative of?

A

pyelonephritis, perinephric abscess, nephrolithiasis, hydronephrosis

42
Q

what is a viscerosomatic reflex?

A

localized visceral stimuli producing patterns of reflex response in segmentally related somatic structure

43
Q

what does a viscerosomatic reflex involve?

A

compromise of the autonomic nervous system

44
Q

what are the sympathetics of the head/neck?

A

T1-T5

45
Q

what are the sympathetics of the heart?

A

t1-t6

46
Q

sympathetics of the lungs?

A

t1-t7

47
Q

sympathetics of the upper GI (includes lower esophagus)?

A

t5-t10

48
Q

sympathetics for the small intestine/ascending colon?

A

T9-t11

49
Q

sympathetics for the ascending and transverse colon?

A

t10-L2

50
Q

sympathetics for the descending and sigmoid colon/rectum?

A

t12-L2

51
Q

sympathetics for the adrenal glands?

A

t5-t10

52
Q

sympathetics for the GU tract including the bladder?

A

t10-L2

53
Q

sympathetics for the ureter (upper)?

A

t10-t11

54
Q

sympathetics for the ureter (lower)?

A

t12-L2

55
Q

sympathetics for the upper extremities?

A

t2-t7

56
Q

sympathetics for the lower extremities?

A

t11-L2

57
Q

parasympathetics for the upper GI, small intestine, ascending colon, transverse colon, kidneys, upper ureter?

A

Vagus n (OA and AA)

58
Q

parasympathetics for the descending and sigmoid colon/rectum, bladder, and lower ureter?

A

s2-s4 (sacrum)

59
Q

what is sympathetic inhibition?

A

treatment geared toward reducing inappropriate sympathetic tone

60
Q

what are some techniques for sympathetic inhibition?

A

rib raising (supine), rib raising (seated), and paravertebral muscles

61
Q

what is sympathetic inhibition: paravertebral muscles good for?

A

thoracic and lumbar spine hypertonic paravertebral muscles associated with abdominal complaint or post-surgical patients

62
Q

how do you treats overactive parasympathetics?

A

suboccipital release or sacral rocking

63
Q

during sacral rocking, when the patient inhales deeply, what does the physician allow the sacrum to do?

A

to extend during inhalation

64
Q

during sacral rocking, when the patient exhales, what does the physician allow the sacrum to do?

A

to flex during exhalation

65
Q

what are chapman reflex points?

A

a group of palpable points that are reflections of visceral dysfunction or disease

66
Q

what are chapman reflex points diagnosis based off of?

A

location, palpation, and patient’s feedback to pain

67
Q

where are the anterior chapman points for the esophagus?

A

between rib 2 and 3 parasternally

68
Q

where are the anterior chapman points for stomach?

A

left-between rib 5-6 and 6-7 at the costochondral junction

69
Q

where are the anterior chapman points for liver?

A

right- between rib 5-6 and 6-7 at the costochondral junction

70
Q

where are the anterior chapman points for gallbladder?

A

right, between rib 6-7 at the costochondral junction

71
Q

where are the anterior chapman points for pancreas?

A

right- between ribs 7-8 at the costochondral junction

72
Q

where are the anterior chapman points for the small intestines?

A

between ribs 8-11 bilaterally at the costochondral junction

73
Q

where are the posterior chapman points for the esophagus?

A

lateral to T2 spinous process

74
Q

where are the posterior chapman points for the stomach?

A

left- lateral to T5 and T6 spinous process

75
Q

where are the posterior chapman points for the liver?

A

right- lateral to T5 and T6 spinous process

76
Q

where are the posterior chapman points for the gallbladder?

A

right-lateral to T6

77
Q

where are the posterior chapman points for the pancreas?

A

right- lateral to spinous process of T7

78
Q

where are the posterior chapman points for the small intestines?

A

lateral to spinous processes of T8, 9, and 10

79
Q

where are the anterior chapman points for the appendix?

A

tip of the 12th rib

80
Q

where are the anterior chapman points for the intestinal peristalsis?

A

lateral to AIIS bilaterally

81
Q

where are the anterior chapman points for the colon?

A

anterior IT band

82
Q

where are the anterior chapman points for the cecum?

A

at the right greater trochanter

83
Q

where are the anterior chapman points for the hepatic flexure?

A

just above the right knee

84
Q

where are the posterior chapman points for the appendix?

A

transverse process of t12

85
Q

where are the posterior chapman points for the rectum?

A

posterior-lateral sacrum 1/2 way between sacral sulcus and ILA

86
Q

where are the posterior chapman points for the large intestines?

A

transverse processes of L2, 3, and 4

87
Q

where are the anterior chapman points for the kidneys?

A

about 1 inch lateral and 1 inch superior to the umbilicus

88
Q

where are the anterior chapman points for the ureters?

A

there are none

89
Q

where are the anterior chapman points for the bladder?

A

the umbilicus

90
Q

where are the anterior chapman points for the urethra?

A

superior surface of pubic bone relative positions

91
Q

where are the posterior chapman points for the kidneys?

A

lateral to the spinous process of L1

92
Q

where are the posterior chapman points for the bladder?

A

transverse process of L2

93
Q

where are the posterior chapman points for the urethra?

A

transverse process of L3

ECOS II Midterm (19 decks)

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