Lecture 4 - Abdominal Exam

Question 1

What structures are in the right upper quadrant?

Answer 1

Liver, gallbladder
Pylorus, duodenum
Head of pancreas
Ascending/transverse colon
Right kidney/adrenal

Question 2

What structures are in the right lower quadrant?

Answer 2

Right kidney and ureter
Cecum/appendix/ascending colon
Ovary, fallopian tube
Spermatic cord
uterus/bladder (if enlarged)

Question 3

What structures are in the left upper quadrant?

Answer 3

Liver (left lobe)
Spleen
Stomach
Body of pancreas
Descending/transverse colon
Left kidney/adrenal

Question 4

What structures are in the left lower quadrant?

Answer 4

Left kidney and ureter
Sigmoid/descending colon
Ovary/fallopian tube
Spermatic cord
Uterus/bladder (if enlarged)

Question 5

What may be the source of pain at the right upper quadrant?

Answer 5

Biliary tree and liver

Question 6

What might be the source of pain at the epigastric region?

Answer 6

stomach, duodenum, pancreas

Question 7

What might be the source of pain at the periumbilical region?

Answer 7

small intestine, appendix, proximal colon

Question 8

What might be the source of pain at the suprapubic region?

Answer 8

Rectum

Question 9

What might be the source of pain at the hypogastric region?

Answer 9

Colon, bladder, uterus

Question 10

On inspection of the abdomen, what does blanching red marks and striae (purple marks) indicate?

Answer 10

Spider angiomata

Question 11

What are the 2 ways to describe the contour of the abdomen upon inspection?

Answer 11

concave (scaphoid) or convex (protuberant)

Question 12

What is it called when upon inspection of the abdomen you observe dilated veins radiating from the umbilicus?

Answer 12

Caput medusa, indicating cirrhosis

Question 13

What is the order of examination for an abdominal exam?

Answer 13

Inspect -> auscultate -> percussion -> palpation

Question 14

How should the patient be situated for an abdominal exam?

Answer 14

Lying flat, abdomen exposed

Arms at side and legs straight (bending knees may relax abdomen)

Question 15

What do you suspect if you hear increase bowel sounds upon auscultation?

Answer 15

Obstruction

Question 16

What do you suspect if you hear decreased bowel sounds upon auscultation?

Answer 16

Peritonitis

Question 17

What is the area in the left lower anterior chest wall between the lung resonance and above the costal margin?

Answer 17

Traube’s space

Question 18

What sound do you expect to hear when you percuss the spleen after a deep breath if the spleen is normal?

Answer 18

The sound before the breath should be tympanitic, and the sound after the breath should remain tympanitic

Question 19

If percussion of the abdomen gives a dull note, what do you suspect? What 2 additional techniques help to confirm your suspicion?

Answer 19

Suspect ascites, a buldging abdomen with protuberant flanks

-can do shifting dullness and assessment for a fluid wave to help confirm

Question 20

In a shifting dullness test for a patient without ascites, what do you expect?

Answer 20

Percuss and mark the borders of tympany and dullness. Ask patient to turn to the side. Percuss and mark the borders again.
Without ascites, no movement of the border.