Lecture 4 - Abdominal Exam Flashcards
What structures are in the right upper quadrant?
Liver, gallbladder Pylorus, duodenum Head of pancreas Ascending/transverse colon Right kidney/adrenal
What structures are in the right lower quadrant?
Right kidney and ureter Cecum/appendix/ascending colon Ovary, fallopian tube Spermatic cord uterus/bladder (if enlarged)
What structures are in the left upper quadrant?
Liver (left lobe) Spleen Stomach Body of pancreas Descending/transverse colon Left kidney/adrenal
What structures are in the left lower quadrant?
Left kidney and ureter Sigmoid/descending colon Ovary/fallopian tube Spermatic cord Uterus/bladder (if enlarged)
What may be the source of pain at the right upper quadrant?
Biliary tree and liver
What might be the source of pain at the epigastric region?
stomach, duodenum, pancreas
What might be the source of pain at the periumbilical region?
small intestine, appendix, proximal colon
What might be the source of pain at the suprapubic region?
Rectum
What might be the source of pain at the hypogastric region?
Colon, bladder, uterus
On inspection of the abdomen, what does blanching red marks and striae (purple marks) indicate?
Spider angiomata
What are the 2 ways to describe the contour of the abdomen upon inspection?
concave (scaphoid) or convex (protuberant)
What is it called when upon inspection of the abdomen you observe dilated veins radiating from the umbilicus?
Caput medusa, indicating cirrhosis
What is the order of examination for an abdominal exam?
Inspect -> auscultate -> percussion -> palpation
How should the patient be situated for an abdominal exam?
Lying flat, abdomen exposed
Arms at side and legs straight (bending knees may relax abdomen)
What do you suspect if you hear increase bowel sounds upon auscultation?
Obstruction
What do you suspect if you hear decreased bowel sounds upon auscultation?
Peritonitis
What is the area in the left lower anterior chest wall between the lung resonance and above the costal margin?
Traube’s space
What sound do you expect to hear when you percuss the spleen after a deep breath if the spleen is normal?
The sound before the breath should be tympanitic, and the sound after the breath should remain tympanitic
If percussion of the abdomen gives a dull note, what do you suspect? What 2 additional techniques help to confirm your suspicion?
Suspect ascites, a buldging abdomen with protuberant flanks
-can do shifting dullness and assessment for a fluid wave to help confirm
In a shifting dullness test for a patient without ascites, what do you expect?
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.
