Lecture 2: The Abdominal Exam Flashcards
When asking about meds during PE for abdominal pain which are particularly important to note?
- Blood thinners
- Meds that need levels checked
- Meds related to the chief complaint
What are important complaint specific aspects of PMH for an abdominal exam?
ESLD, Hepatitis, GERD/PUD, Cancer
What are the 4 landmarks for Inspection of Abdomen?
1) Xiphoid process of sternum
2) Costal Margins
3) Umbilicus
4) ASIS
What is considered normal bowel sounds?
5-34 clicks/gurgles per minute
What is considered absent bowel sounds and possible causes?
- None for >2 minutes
- Long-lasting intestinal obstruction, intestinal perforation, mesenteric ischemia
What is considered increased bowel sounds and possible causes?
- None for 1 minute
- Post-surgical ileus, peritonitis
What are causes of increased bowel sounds?
Diarrhea, early bowel obstruction
What do high pitched bowel sounds sound like and suggest what?
- Sound like tinkling (raindrops on metal)
- Suggest early intestinal obstruction
What may cause the sound of a Bruit in the abdomen?
Vascular obstruction
What gives sound of Friction Rub in abdomen and where do we listen for this?
- Inflammation of the peritoneal surface of an organ
- Listen over liver and spleen
What causes a Venous Hum in the abdomen and where do you listen for this sound?
- Increased collateral circulation between portal and systemic venous systems
- Listen over epigastric and umbilical regions
Where do we hear resonance?
Hollow abdominal organs (lungs)
When would you hear hyper-resonance?
Air-filled hollow organs (pneumothorax)
Is visceral pain easy to localize and where is it usually felt/palpated best?
- Pain is difficult to localize
- Usually felt/palpated in the midline at level of structure involved
Is parietal pain easy to localize and what makes it worse?
- Easier to localize
- Steady, aching pain usually more severe than visceral pain
- Aggravated by movement or coughing, patients want to lie still
Example of RUQ visceral pain?
Liver distention against its capsule w/ alcoholic hepatitis
Example of Periumbilical visceral pain?
Acute appendicitis
Example of RUQ/epigastric parietal tenderness?
Acute cholecystitis
Example of Epigastric parietal tenderness?
Acute pancreatitis
Example of RLQ parietal tenderness?
Later finding in acute appendicitis
Example of LLQ parietal tenderness?
Acute diverticulitis
Where is duodenal and pancreatic pain typically referred to?
Reffered to the back
Where is Biliary tree pain often referred to?
The right shoulder
Is the spleen normally palpable and which direction does it typically enlarge?
- Normally not palpable, unless enlarged
- When spleen enlarges, it expands anteriorly, downward, and medially
What are pathologies felt in the RUQ?
- Acute cholecystitis
- Budd-Chiari
- Basal pneumonia
What are pathologies felt in the Epigastric region?
- Acute peptice ulcer
- Acute pancreatitis
- Biliary colic
- MI
What are pathologies felt in the LUQ?
- Splenic infarction
- Basal pneumonia
What are pathologies felt in the umbilical region?
- Acute pancreatitis
- Small bowel obstruction
- Mesenteric ischemia
What are pathologies felt in the Hypogastric/Suprapubic region?
- Acute urinary retention
- Ruptured ectopic
- Ruptured ovarian cyst
- Acute cystitis
What would cause the vertical span of the liver to decrease?
- Shrunken liver = cirrhosis
- Free air under diaphragm/perforated hollow viscus
What would an irregular edge/nodules tell you when palpating the liver?
Hepatocellular carcinoma
What would an firmness/hardess tell you when palpating the liver?
Cirrhosis, hematochromatosis, amyloidosis, lymphoma
What is the shifting dullness test for ascites; normal and positive test finding?
- Percuss the borders of tympany and dullness w/ patient supine
- Then have pt lay on side and percuss borders again
- Normal = borders stay the same
- Ascities/positive test = dullness shifts to dependent side and tympany to top side
What is the fluid wave test for ascites; normal and positive findings?
- Ask the patient to rest his/her hands on chest
- Have an assistant place the ulnar aspect of hands midline, then tap one flank sharply w/ finger tips
- Normal = no impulse felt on the other hand
- Ascites/positive = impulse transmitted to the other flank
What is the test for a ventral hernia?
- When lying supine, ask pt to raise both head and shoulder off the table
- Postive test = bulge of hernia will usually appear
