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Emma - Physical Diagnosis > PD - Abdominal exam > Flashcards

PD - Abdominal exam Flashcards

1
Q

abd surface anatomy

A
  • Rectus abdominis muscle
  • Umbilicus
  • Inguinal ligament
  • Costal margins
  • Linea alba
  • Iliac crest
  • Anterior superior iliac spine (ASIS)
  • Symphysis pubis
  • McBurneys Point
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2
Q

LUQ

A 
Liver, left lobe
Spleen
Stomach
Pancreas: body
Left adrenal gland
Left kidney: upper pole 
Splenic flexure 
Transverse colon: portion 
Descending colon: portion
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3
Q

RUQ

A 
Liver
Gallbladder
Pylorus
Duodenum
Pancreas: head
Right adrenal gland
Right kidney: upper pole Hepatic flexure 
Ascending colon: portion Transverse colon: portion
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4
Q

RLQ

A 
Right kidney: lower pole 
Cecum
Appendix
Ascending colon: portion 
Right ovary
Right fallopian tube
Right ureter
Right spermatic cord 
Uterus, Bladder (if enlarged)
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5
Q

LLQ

A 
Left kidney: lower pole 
Sigmoid colon 
Descending colon: portion 
Left ovary
Left fallopian tube
Left ureter
Left spermatic cord
Uterus, Bladder (if enlarged)
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6
Q

Epigastrium

A

Stomach
Pancreas
Liver (portion)
Aorta

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7
Q

Suprapubic area

A

Bladder

Uterus

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8
Q

Imp sx for abd disease

A 
Pain
Nausea and vomiting 
Change in bowel movements 
GI bleeding 
Jaundice or Icterus 
Abdominal distention
Mass
Pruritis (itching)
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9
Q

To characterize abd pain, note…

A 
time
acuteness
location
severity 
character
radiation
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10
Q

Right shoulder pain

A

referred from acute cholecystitis or anything irritating the right hemidiphragm

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11
Q

Testicular pain

A

referred from renal colic or appendicitis

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12
Q

Periodic epigastric pain 1 hour after eating-

A

think gastric peptic ulcer

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13
Q

Pain 2-3 hours after eating

A

think duodenal peptic ulcer

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14
Q

Back pain

A

perforation of duodenal ulcer, pancreatic pain

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15
Q

Nocturnal pain

A

duodenal peptic ulcer

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16
Q

Postprandial pain (after eating)

A

part of the abdominal angina triad, which also includes anorexia and weight loss.

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17
Q

Tenesmus

A

A feeling of needing to void the bowel, but unable to defecate

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18
Q

Causes of vomiting

A

severe irritation of the peritoneum resulting from perforation of an abdominal organ;

abdominal obstruction of the bile duct, ureter, or intestine;

inflammation of intraabdominal structures

extra-abd causes: cardiac ischemia, pregnancy, central nervous system disorders, medications, and drug toxicity

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19
Q

cause of episodic vomiting at height of pain

A

obstruction

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20
Q

causes of persistent vomiting

A

toxin, central nervous system causes, metabolic causes

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21
Q

Green-yellow vomitous cause

A

biliary colic

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22
Q

Feculent smelling vomitus cause

A

intestinal obstruction

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23
Q

causes of nausea w/o vomiting

A

hepatocellular disease, pregnancy, metabolic causes

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24
Q

Not all abd emergencies cause vomiting, exp…

A

intraperitoneal bleeding

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25
Q

bowel movement hx

A 
duration
number of movements per day
onset
whether or not change was associated with a meal
the type of meal one ate,
characterization, 
constipation, 
weight loss, 
caliber of stool, 
other symptoms it may be associated with
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26
Q

acute onset changes in bowel movements may be caused by

A

acute infection or toxin

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27
Q

causes of watery stool

A

small bowel and colon inflammation or protein-losing enteropathies

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28
Q

causes of bloody diarrhea

A

dysentery

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29
Q

causes of alternating diarrhea and constipation

A

colon cancer, diverticulitis, colitis

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30
Q

Floating, light colored, or foul-smelling stool

A

malabsorption syndrome

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31
Q

Stool mixed with blood and mucus

A

ulcerative colitis or Crohn’s colitis

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32
Q

Blood with stool or undigested food

A

inflammation of small bowel or colon

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33
Q

Pencil-thin stool

A

anal or distal rectal carcinoma

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34
Q

clay colored stool

A

obstruction of bile flow or decreased production of bile

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35
Q

Constipation and weight gain

A

hypothyroidism

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36
Q

Constipation and weight loss

A

colon cancer

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37
Q

Silver-colored stool

A

rare cancer of the ampulla of Vater in the duodenum

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38
Q

hematochezia

A

bright red blood per rectum (BRBPR)

causes: colonic tumor, diverticular disease, ulcerative colitis

39
Q

melena

A

black, tarry stool

causes: bleeding of first section of duodenum or upper gastrointestinal tract

40
Q

causes of blood mixed with stool

A

tumors, diverticular disease, ulcerative colitis, or hemorrhoids

41
Q

jaundice

A

yellow discoloration of skin

suspect liver disease or possible biliary obstruction

42
Q

icterus

A

yellow discoloration of sclera of eyes

*usu seen before jaundice

43
Q

causes of jaundice/icterus

A 
hyperbiliurubinemia
Viral hepatitis
Obstructive jaundice
Cholangitis
Liver Failure
44
Q

See jaundice/icterus, ask pt about…

A

duration and onset, associated sx, use of recreational drugs, travel, transfusions or tatooing, urine and stool characterization, work, and any friends with similar sx

45
Q

viral hepatitis

A

jaundice, nausea, vomiting, loss of appetite, and aversion to smoke

46
Q

obstructive jaundice

A

slowly developing jaundice with clay-colored stool and cola-colored urine

47
Q

cholangitis

A

jaundice with fever and chills;

may be caused by stasis of bile in duct due to gallstone or cancer of the head of pancreas

48
Q

Liver Failure

A 
jaundice
abdominal distension
ascites
caput medusae
spider telangiectasia
49
Q

Abd distention

A

due to increased gas in the GI tract or to ascites (free intraperitoneal fluid)

increased gas –> via malabsorption, irritable colon, air swallowing

ascites –> via cirrhosis, CHF, portal HTN, neoplasia…

50
Q

Possible cause of intermittent distention relieved by flatus or belching

A

gas related to eating

51
Q

Possible cause of ascites and loss of appetite

A

cirrhosis, malignancy, CHF

52
Q

Possible cause of ascites and SOB

A

CHF or decreased pulmonary capacity w/ ascites from other cause

53
Q

Abd mass may be a …

A

neoplasm, hernia, organomegaly, stool, pregnancy or something else

Note swelling/pulsatile nature/duration/location/pain

54
Q

common causes of groin or scrotum mass

A

inguinal hernia
hydrocele
varicocele

55
Q

common causes of pulsatile mass in abd

A

abdominal aortic aneurism (AAA)

56
Q

Common GI causes of generalized itching

A

diffuse skin disorder or chronic renal or hepatic disease

57
Q

Common GI causes of intense itching

A

lymphoma, Hodgkin’s, or GI malignancies

58
Q

Common GI causes of anal pruritis

A

fistulae, fissure, psoriasis, parasite, poor hygeine

59
Q

No abdominal examination is complete without performing a …

A

genitourinary examination and a rectal examination!

Evaluate for color and consistency of the stool, presence of gross or occult blood, and presence of presence of masses.

60
Q

for the abd exam, ______ is performed prior to _______________, in contrast to the Pulmonary and Cardiac examination

A

auscultation is performed prior to percussion or palpation, bc the latter can stimulate GI sounds, rendering ausculation inaccurate

61
Q

order for the abd examination

A
  • Inspection
  • Auscultation
  • Percussion
  • Palpation
  • Special Tests
62
Q

inspection of abd

A

◦ Contour: obese, flat, or scaphoid (sucked inward)
◦ Presence of absence of visible pulsations or pulsatile mass
◦ Presence or absence of surgical scars
◦ Presence or absence of visible masses

63
Q

during abd exam, examine skin for

A 
jaundice
Caput medusae (abnormal, dilated periumbilical veins)
Spider telangiectasias (small patches of prominent, thin veins)
64
Q

during abd exam, examine extremities for

A

peripheral edema

65
Q

abd auscultation

technique, normal bowel sound timing?

A

use diaphragm of stethoscope over mid abd to listen for bowel sounds

normal bowel sounds –> every 5-10 sec

absence of bowel sounds –> no sounds within 2 mins (must auscultate this amnt of time)

66
Q

borborygmi

A

low-pitched rumbling sounds created via hyperperistalsis

67
Q

possible cause of absence of bowel sounds

A

paralytic ileus perhaps due to diffuse peritoneal irritation

68
Q

possible cause of high-pitched, rushing bowel sounds

A

acute intestinal obstruction

69
Q

Auscultation may be used to detect bruits. Which area would you auscultate?

A

auscultate over the general area of the renal arteries (bruits=result from stenosis of a renal a. or abd aorta)

70
Q

percussion used to…

A

determine size of organs
evaluate for xs gas, fluid, solid mass
assess for peritonitis

71
Q

when percussing all quadrants, ________ predominates, w/ areas of ______

A

when percussing all quadrants, tympany predominates, w/ areas of dullness

72
Q

Sequence of percussion

A
  1. general (all quadrants)
  2. liver
  3. spleen
  4. percuss for shifting dullness (detects ascites)
73
Q

percussion of liver

A

1st: start at upper border of liver in midclavicular line at level of nipple, percuss in inferior direction
chest –> resonance
liver –> dullness (upper edge)

2md: move to abd @ ~umbilicus, percuss twd head –> hyper resonance
liver –> dullness (lower edge)

74
Q

normal span of liver

A

10cm or less

75
Q

percussion of spleen

A

same as liver, but percuss more laterally at anterior axillary line

more easily felt with the patient in the left lateral decubitus position

not palpable in healthy individual

76
Q

percussion for shifting dullness

A

helps detect ascites

pt supine, begin percussing laterally abd in midline, superior to umbilicus

determine where tympany changes to dullness
(area of tympany should be above area of dullness)

turn pt away from side you percussed (while maintaining your hand @ tympany-dullness interface)

ascites –> tympany/dullness interface shifts w/ pt, if fluid w/I peritoneal cavity is free to move

77
Q

sequence of palpation of abd

A 
light palpation
deep palpation
palpation of liver
palpation of spleen
palpation of kidney (often not possible)
examine for peritoneal signs
78
Q

light palpation

A

detects guarding, tenderness and areas of muscular spasm or rigidity

use flat part of hand or pads of fingers with fingers together

list from area to area instead of sliding

79
Q

deep palpation

A

determines organ size/presence of abnormal masses

have pt breathe thru their mouth,
place flat portion of R hand on abd, place L hand over it

L hand exerts pressure, R hand appreciates any movement or mass

pressure should be gentle but steady

80
Q

if pt has pain in abd, palpate that part of abd first or last?

A

palpate painful area of abd LAST

81
Q

rigidity

A

involuntary muscle spasm, indicative of peritoneal irritation

may be diffuse or localized

82
Q

guarding

A

abd wall muscle tension/contraction

may be diffuse or localized

may be voluntary (pt can control guarding and relax abd wall muscles w/ encouragement)

or involuntary (uncontrollable abd wall muscle spasm aka rigidity)

83
Q

2 techniques to palpate liver

A
  1. Stand at pts R side
    place L hand posteriorly between 12th rib and iliac crest.
    - Place R hand on RUQ, parallel, and lateral to rectus m., below area of liver dullness.
    - Ask pt to take deep breath, press inward and upward w/ R hand while L hand pulls upward.
    - liver edge should be felt w/ R hand fingertips
    normal edge: firm, regular, smooth
  2. Pt laying supine.
    - stand at their head and place both hands below R costal margin and the area of dullness.
    - press inward and upward in a hook motion during patient inspiration –> edge of the liver should be felt.
84
Q

palpation of spleen

A

pt laying supine, stand at R side. Place L hand in lower L rib cage, pull rib cage upward.

  • also put R hand flat below L costal margin
  • press inward and upward toward anterior axillary line during pt’s deep inspiration
  • normally not palpable but may feel tip of an enlarged spleen
  • more easily palpated in L lateral decubitus position
85
Q

palpation of kidneys

A

often not palpable

to attempt, stand at pt’s right

  • place L hand on pt’s R flank between costal margin and iliac crest
  • place R hand below costal margin w/ tips pointing toward your left
  • deep palpation
  • lower pole of kidney should be smooth and round

move to L and repeat for pt’s L kidney

86
Q

examination for peritoneal signs

A

rebound tenderness

perform deep palpation then abruptly remove your examining hand, causing abd contents to spring back

+ rebound tenderness –> peritoneal irritation

*not recommended if clinical suspicion is high bc painful

87
Q

+ peritoneal signs (w/o testing for rebound tenderness)

A

bump the edge of the table to see if pain develops as the peritoneal contents are moved ever so slightly

pump the gurney up

ask the patient to cough

ask the patient if they had any pain during the car ride over as the car passed over bumps in the road

88
Q

McBurney’s Point

A

2/3 of the distance between the umbilicus and the right anterior superior iliac spine

tenderness –> concerning for appendicitis

89
Q

fluid waves

A

Tests for ascites

pt lying supine, ask an assistant (or the patient) to put his/her hand on the midline of the abd.

tap on one side of the patients abdomen to propagate a fluid wave. Feel for the wave on the other side of the abd.

Presence of a fluid wave indicates ascites.

90
Q

Rovsing’s Sign

A

tests for appendicitis

push on pt’s LLQ

if pain present on OTHER side (RLQ, or at McBurney’s point) –> rosving’s sign present

91
Q

obturator sign

A

tests for inflammation, appendicitis, peritoneal irritation

pt laying supine, flex pt’s leg at hip w/ knee bent

rotate leg internally

if inflammation next to obturator m., pain results

may be a sign of appendicitis, OR abscess of another origin irritating the obturator m.

92
Q

psoas sign

A

tests for intra-and inflammation, appendicitis, psoas abscess

pt lying on unaffected side, passively extend affected side

presence of abd pain –> + test

93
Q

murphy’s sign

A

acute cholecystitis (inflammed gallbladder)

pt laying supine, palpate liver head on pt’s deep inspiration - feel for gallbladder (RUQ)

pt stops inspiration bc/ of pain –> Murphy’s sign

Emma - Physical Diagnosis (12 decks)

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