PC Abdomen Flashcards
What are the 7 steps to the abdominal exam
- Wash Hands
- Greet Patient
- Chaperone
- Focused History
- Vital Signs
- Examine Abdomen
- Wash Hands
What does the Focused History include? (5 points) PCHPM
- Pt ID
- Chief Complaint
- HPI
- PMHX
- Meds/Allergies
What do the Vital Signs Include? (5 points)
- Blood Pressure
- Pulse (R, R, S)
- Respiration
- Sp02
- Oral Temperature
What does the General Survey Include? (2 points)
- Physical appearance / alterations in gait
- Mental / emotional status
What does inspecting the Abdomen include? (6 points) SEADSP
- Swelling
- Erythema
- Atrophy
- Deformity (shape, symmetry, masses, contour)
- Skin changes (rashes, lesions, striae, scars)
- Peristalsis / Pulsations
What does auscultating the Abdomen include? (3 points) EAV
- Explain procedure to patient
- Auscultate four quadrants (Counterclockwise)
- Verbalize bowel sounds present
What does percussing the Abdomen include? (3 points) EPM
- Explain procedure to patient
- Percuss four quadrants (Counterclockwise)
- Make note of different sounds heard
What does palpating the Abdomen include? (3 points) EPP
- Explain procedure to patient
- Palpate from area of least pain to area of most pain
- Palpate four quadrants
What does SAMPIFR stand for?
Social history / Sexual history
Allergies
Medications
Past medical history
Immunizations
Family history
Review of systems
What does CHLORIDE AAA stand for?
Character
History
Location
Onset (gradual/sudden)
Radiate
Intensity (rating from 1-10)
Duration
Events
Aggravating factors
Alleviating factors
Associated signs and symptoms
List symptoms of Appendicitis
Classically periumbilical pain which ultimately migrates to the RLQ with assoc. N&V, loss of appetite, +/- fever, +/- constipation, +/- distension.
Three stages of discomfort:
1 Hours of “gastroenteritis” like symptoms
2 Direct somatic irritation
3 Perforation -> Sick peritonitic patient
List symptoms of Gastroenteritis
Diarrhea: at least 3 liquid or semi-liquid stools every 24 hours or stool that is more abundant and frequent than usual
Abdominal cramps
Nausea
Vomiting
List symptoms of UTI
Painful/burning urination (dysuria) with increased frequency and urgency +/- sensation of incomplete emptying, hematuria, and abd pain
List symptoms of Ectopic Pregnancy
Classic triad is abdominal pain, missed menses, & vaginal bleeding but up to 25% lack the full triad and 10% may have no symptoms. Individual symptoms should prompt considerations.
Vital signs may be falsely reassuring due to reflex bradycardia. Exam findings of note include: abdominal tenderness (QL4), orthostasis (QL4), adnexal tenderness/mass, and uterine enlargement.
Describe Visceral (Organ) pain
Poorly localized pain due to insult of the nerve fibers innervating the walls and capsules of internal organs. Can result from inflammation, ischemia, or stretching of these nerve fibers. May be described as colicky (crampy), dull, achy, or deep.
Describe Parietal pain
Results from irritation of fibers which line the parietal peritoneum (the inner lining of the abdominal wall). This occurs due to progression of underlying disease process and produces peritoneal signs (rebound tenderness, rigidity, and guarding).
Describe Referred (somatic) pain
Is pain which is perceived at an area of the body distinct from its source. I.E. gall bladder pain will often cause RUQ pain (visceral) and also right sided scapular pain (referred). This results from multiple primary sensory neurons converging on a single spinal tract (spinothalamic in this case)
List symptoms of GERD
Epigastric or substernal pain, burning, or gnawing +/- waterbrash, belching, gaseousness, and abdominal distension. Exam typically unremarkable.
QList symptoms of Kidney stones
These patients will often present with intense, lancinating, colicy pain which radiates to the groinThey will often be restless and may have hematuria (blood in the urine). Associated: N&V, sweating, tachycardia.
