Lab- Approach to Abdominal Complaint Flashcards
What are the four steps of the abdominal exam (in order)
inspection, auscultation, percussion, and palpation
what is grey turner’s sign?
bruising on the flanks
what is cullen’s sign and what is it indicative of?
bruising around the umbilicus; indicative of necrotizing pancreatitis with retro or intraperitoneal bleeding
why should you auscultate before percussion and palpation?
maneuvers may alter characteristics of bowel sounds
what could cause hypoactive bowel sounds?
constipation, ileus, medication side effect
what could cause hyperactive bowel sounds?
infectious diarrhea, early stages of intestinal obstruction, bowel prep
what are high pitched tinkling sounds caused by?
intestinal fluid and air under pressure- think intestinal obstruction
what two types of sounds are you listening for when you percuss the abdomen?
tympanic and dull
what is tympanic percussion and where would you expect to hear it?
it is a hollow noise with resonance; most of the abdomen due to the intestines
what is dull percussion and where would you expect to hear it?
flat sound without resonance; over organs like the liver and spleen
how do you percuss the inferior margin of the liver?
start at the RLQ and percuss up the midclavicular line until the tympany shifts to dullness (liver)
how do you percuss the superior margin of the liver?
start at the nipple line and percuss down the midclavicular line until resonance (lung) is replaced by dullness (liver)
what is the normal measurement of the liver?
6-12 cm at the midclavicular line and 4-8 cm at the midsternal line
how do you percuss the spleen?
find the most inferior intercostal space at the anterior axillary line; should be tympanic at rest- have patient inhale while percussing- should remain tympanic
what does dullness of the spleen indicate and what is this sign?
may indicate splenomegaly- Castell’s sign
when might an area of dullness decrease?
when there is free air in the abdomen or with COPD
when might an area of dullness increase?
when there is ascites fluid, pleural effusion, lung consolidation
how do you palpate the liver?
left hand: supporting the 11th/12th rib (posteriorly); right hand: just below the costal margin at the midclavicular line
where palpating the liver using the hooking technique, where should your fingertips be placed?
at the right costal margin
how do you palpate the spleen?
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
how do you palpate the kidney?
right hand: below, at the 11/12th rib; left hand: just below the costal margin at the LUQ
how do you palpate the aorta?
above the umbilicus, midline or slightly left of midline
what is the normal measurement of the aorta?
2-3 cm; anything greater than 3 cm is abnormal
what causes visceral pain and what can be said about its localization?
caused by distention, stretching, or contraction of hollow organs; it does not localize
what causes somatic pain, what aggravates it, and what can be said about its localization?
could be secondary to inflammation in the parietal peritoneum; aggravated by movement or coughing; localized pain
what is rebound tenderness and what does it indicate?
pain upon removal of pressure; indicates peritoneal irritation
what are the specialty tests used for appendicitis?
McBurney’s point, Rovsing Sign, Psoas sign, Obturator test,
what is McBurney’s point?
rebound tenderness or pain at 1/3 the distance from the ASIS to the umbilicus
what is Rovsing’s sign?
pain in the RLQ upon palpation of the LLQ
what is Psoas sign?
patient is in a lateral position with right side up; you extend the patient’s right leg at the hip
what is the obturator test?
patient is supine; you passively flex the right thigh at the hip with the knee bent; rotate leg internally
what is the specialty test used for peritonitis?
heel strike
what is the heel strike test?
patient is supine; you strike the patient’s heel with your palm with enough force to jostle the patient
what does a positive heel strike test indicate?
peritoneal irritation
what is the specialty test used for ascites?
fluid wave test
how do you preform the fluid wave test?
assistant places their hands midline; clinician taps one side of the abdomen and feels for an impulse at the other side
what is the specialty test used for the gallbladder?
Murphy’s sign
what is murphy’s sign?
clinician compresses at the RUQ, during inspiration direct compression under the costal margin; positive finding: pain or sudden stop of inspiration due to discomfort
what is a positive murphy’s sign indicative of?
cholecystitis or cholelithiasis
what is the specialty test used for the kidneys?
Lloyd punch
what is a positive lloyd punch indicative of?
pyelonephritis, perinephric abscess, nephrolithiasis, hydronephrosis
what is a viscerosomatic reflex?
localized visceral stimuli producing patterns of reflex response in segmentally related somatic structure
what does a viscerosomatic reflex involve?
compromise of the autonomic nervous system
what are the sympathetics of the head/neck?
T1-T5
what are the sympathetics of the heart?
t1-t6
sympathetics of the lungs?
t1-t7
sympathetics of the upper GI (includes lower esophagus)?
t5-t10
sympathetics for the small intestine/ascending colon?
T9-t11
sympathetics for the ascending and transverse colon?
t10-L2
sympathetics for the descending and sigmoid colon/rectum?
t12-L2
sympathetics for the adrenal glands?
t5-t10
sympathetics for the GU tract including the bladder?
t10-L2
sympathetics for the ureter (upper)?
t10-t11
sympathetics for the ureter (lower)?
t12-L2
sympathetics for the upper extremities?
t2-t7
sympathetics for the lower extremities?
t11-L2
parasympathetics for the upper GI, small intestine, ascending colon, transverse colon, kidneys, upper ureter?
Vagus n (OA and AA)
parasympathetics for the descending and sigmoid colon/rectum, bladder, and lower ureter?
s2-s4 (sacrum)
what is sympathetic inhibition?
treatment geared toward reducing inappropriate sympathetic tone
what are some techniques for sympathetic inhibition?
rib raising (supine), rib raising (seated), and paravertebral muscles
what is sympathetic inhibition: paravertebral muscles good for?
thoracic and lumbar spine hypertonic paravertebral muscles associated with abdominal complaint or post-surgical patients
how do you treats overactive parasympathetics?
suboccipital release or sacral rocking
during sacral rocking, when the patient inhales deeply, what does the physician allow the sacrum to do?
to extend during inhalation
during sacral rocking, when the patient exhales, what does the physician allow the sacrum to do?
to flex during exhalation
what are chapman reflex points?
a group of palpable points that are reflections of visceral dysfunction or disease
what are chapman reflex points diagnosis based off of?
location, palpation, and patient’s feedback to pain
where are the anterior chapman points for the esophagus?
between rib 2 and 3 parasternally
where are the anterior chapman points for stomach?
left-between rib 5-6 and 6-7 at the costochondral junction
where are the anterior chapman points for liver?
right- between rib 5-6 and 6-7 at the costochondral junction
where are the anterior chapman points for gallbladder?
right, between rib 6-7 at the costochondral junction
where are the anterior chapman points for pancreas?
right- between ribs 7-8 at the costochondral junction
where are the anterior chapman points for the small intestines?
between ribs 8-11 bilaterally at the costochondral junction
where are the posterior chapman points for the esophagus?
lateral to T2 spinous process
where are the posterior chapman points for the stomach?
left- lateral to T5 and T6 spinous process
where are the posterior chapman points for the liver?
right- lateral to T5 and T6 spinous process
where are the posterior chapman points for the gallbladder?
right-lateral to T6
where are the posterior chapman points for the pancreas?
right- lateral to spinous process of T7
where are the posterior chapman points for the small intestines?
lateral to spinous processes of T8, 9, and 10
where are the anterior chapman points for the appendix?
tip of the 12th rib
where are the anterior chapman points for the intestinal peristalsis?
lateral to AIIS bilaterally
where are the anterior chapman points for the colon?
anterior IT band
where are the anterior chapman points for the cecum?
at the right greater trochanter
where are the anterior chapman points for the hepatic flexure?
just above the right knee
where are the posterior chapman points for the appendix?
transverse process of t12
where are the posterior chapman points for the rectum?
posterior-lateral sacrum 1/2 way between sacral sulcus and ILA
where are the posterior chapman points for the large intestines?
transverse processes of L2, 3, and 4
where are the anterior chapman points for the kidneys?
about 1 inch lateral and 1 inch superior to the umbilicus
where are the anterior chapman points for the ureters?
there are none
where are the anterior chapman points for the bladder?
the umbilicus
where are the anterior chapman points for the urethra?
superior surface of pubic bone relative positions
where are the posterior chapman points for the kidneys?
lateral to the spinous process of L1
where are the posterior chapman points for the bladder?
transverse process of L2
where are the posterior chapman points for the urethra?
transverse process of L3
