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GI 1 > Phys Di - Abdominal Exam > Flashcards

Phys Di - Abdominal Exam Flashcards

1
Q

What to keep in mind when females c/o abdominal pain

A
  • can arise from gynecological problem
  • PID
  • ectopic pregnancy
  • torsion of ovary
  • ovarian cyst
  • so always consider pelvic exam
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2
Q

wavelike/”colicky” pain

A
  • pain that comes on in a wave, hits a hard peak, then goes down
  • typically a sign of the body trying to push something out
  • i.e: constipation, ureteral calculi, obstruction of bowel, gallstone
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3
Q

what to consider with continuous or constant abdominal pain

A
  • infection
  • abcess
  • cyst
  • diverticulitits
  • IBD
  • mesenteric adenitits
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4
Q

What to consider w/ stabbing, searing, boring abdominal pain

A
  • pancreatitis
  • PUD
  • cholangitis
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5
Q

ripping pain is characteristic of?

A

-rupturing AAA

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6
Q

out of proportion pain to physical findings is characteristic of what?

A
  • mesenteric ischemia

- IBS

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7
Q

HPI for for abdominal exam

A

big 8 always works

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8
Q

additional things to consider in GI HPI

A
  • relation to menstrual cycle
  • relation to BM
  • stool characteristic details
  • ALWAYS find out about blood
  • remember blood can be black
  • constipation is VERY subjective
  • pts often won’t offer info on fetal incontinence so ask
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9
Q

melena

A

black, tarry stool; indicates GI bleed is NOT from colon depending on transit time

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10
Q

hematochezia

A

bloody stool, passing of blood from rectum w/ or w/o stool

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11
Q

steatorrhea

A

oily, greasy stool, sign of malabsorption

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12
Q

suprapubic

A

area of abdomen just above pubis

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13
Q

hematuria

A

bloody urine

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14
Q

tenesmus

A

rectal “dry heave”

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15
Q

proctalgia fugax

A

rectal spasm

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16
Q

oliguria

A

small amout of urine

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17
Q

chyluria

A

milky urine

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18
Q

urolithiasis

A

stones in urinary tract

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19
Q

borborygmi

A

audible rumbling sound of digestion

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20
Q

post-prandial

A

after meals

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21
Q

BRBPR

A

bright red blood per rectum

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22
Q

NABS

A

normal active bowel sounds

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23
Q

PUD

A

peptic ulcer dz

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24
Q

family hx for GI

A
  • **colon CA
  • any abdominal CA
  • IBD
  • IBS
  • GERD, gastric ulcer
  • celiac dz
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25
Q

social hx for GI

A
  • smoking
  • ETOH
  • eating habits
  • stress level
  • caffeine
  • fiber
  • sexual contact
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26
Q

GI ROS

A
  • abdominal pain
  • n/v/d
  • hematemesis
  • indigestion
  • belching/flatulence
  • appetite change
  • food intolerance
  • jaundice
  • hx of hepatitis
  • constipation
  • BM change or frequency
  • steatorrhea
  • melena
  • hematochezia
  • hemorrhoids
  • hx of laxative use
  • hx of colon polys/colonoscopy
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27
Q

what is something you ALWAYS ask about in GI work up?

A

colon CA

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28
Q

when should one start getting colonoscopys?

A

50 unless fam hx then 40

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29
Q

what is the order of PE for GI?

A
  • inspection
  • auscultation
  • percussion
  • palpation
  • special tests
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30
Q

general summary of what to look at during inspection

A
  • contour (round, flat, protuberant)
  • symmetry
  • masses
  • surface features (striae, lesions, masses, visable pulsations/peristalsis)
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31
Q

general summary of what to look at during auscultation

A
  • verify bowel sounds in 4 quadrants
  • describe bowel sounds as normoactive, high-pitched, tinkling, rumbling, hyper or hypo active or absent
  • listen for bruits
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32
Q

what do you focus on during percussion of the abdomen?

A

difference in sounds

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33
Q

general summary of what to look at during palpation

A
  • light: feel for any superficial masses, if soft, rigid, guarding and aortic pulsation
  • deep: feel for stool, deep tenderness, organs, masses, McBurney’s, Rovsings, rebound last
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34
Q

locations of the abdomen (other than the normal RUQ, LUQ etc)

A
  • costal margins
  • suprapubic
  • inguinal
  • ASIS
  • peri-umbilical
  • flank
  • epigastric
  • generalized
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35
Q

skin/eye inspection during GI PE

A
  • jaundice
  • scleral icterus
  • pallor
  • skin turgor
  • nail clubbing
  • spider nevi
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36
Q

abdomen inspection

A
  • contour, distention
  • symmetry
  • masses
  • scars
  • have patient lift head, crunch
  • purple striae (Cushing’s)
  • dilated vein
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37
Q

Why do you have the patient lift head/”crunch” during the abdomen inspection?

A

to assess if the pain is deep or within the muscular abdominal wall

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38
Q

skin turgor

A
  • “pinch test”

- check it if evaluating a pt who is severely dehydrated (n/v/d)

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39
Q

striae

A
  • purple colored stretch marks
  • sign of Cushing’s if >1cm
  • caused by high cortisol levels
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40
Q

gray turner sign

A
  • retroperitoneal hemorrhage
  • can be sign of acute pancreatitis
  • on side**
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41
Q

cullen sign

A
  • sign of retroperitoneal hemorrhage
  • blood diffuses from retroperitoeum to the subQ tissue of abdomen
  • around umbilicus**
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42
Q

diastiasis recti

A
  • “reverse 6-pack”
  • men may say they have hernia
  • common in younger women after pregnancy
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43
Q

auscultation of all 4 quadrants

A

-auscultate for bowel sounds using diaphragm

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44
Q

borborygmi

A

normal sounds of peristalsis / “stomach growling”

45
Q

absence of bowel sounds on ausultation

A
  • intra-abdominal catastrophe, ileus, complete obstruction

- cannot determine they are actually absent unless you listen for full 5 min

46
Q

high pitched tinkling sounds on auscultation

A

partial bowel obstruction or stricture of bowel

47
Q

liver scratch test

A
  • use bell
  • pretty worthless in clinical setting
  • used to determine liver size by auscultation of scratching sound over abdomen
48
Q

what is the technique of the liver scratch test

A
  • place bell just below xyphoid
  • scratch up from RLQ at mid-clavicular line
  • sudden increase of sound is where inf. liver edge begins
  • document if inf liver edge is below costal margin (enlarged)
  • an enlarged liver will extend beyond the right costal margin
  • in nl test: sound changes AT right costal margin
49
Q

what do you percuss for in the RUQ?

A
  • liver size
  • dullness heard when percussing over solid organ
  • really only able to percuss if liver is enlarged, palpating is better
50
Q

What do you percuss in the LUQ aka Traube space

A
  • the gastric bubble
  • if NOT tympanic, possible enlarged spleen or mass?
  • should NOT be dull
51
Q

What do you percuss for in the suprapubic area?

A
  • enlarged or distended bladder

- would be dull

52
Q

what is a normal finding on percussion of abdomen?

A

nl to have different areas of flat tones and tympanic throughout

53
Q

palpation on PE of abdomen

A
  • for tenderness
  • for masses
  • for organomegaly
  • light vs deep
  • for rebound tenderness (LAST)
  • keep fingernails trimmed
  • bimanual technique
54
Q

what to do if pt is extremely ticklish

A

put their hand on yours

55
Q

what is the normal finding on palpation?

A

-soft to touch, non-tender (meaning no pain elicited w/ palpation)

56
Q

how would you document nl findings upon palpation?

A

“abdomen is soft and non tender to palpation w/ no guarding, rebounding, masses or organomegaly noted”

57
Q

If tenderness is present upon palpation of the abdomen, what do you need to pay attention to?

A
  • where? which quadrant? localized or diffuse?

- how bad? mild, moderate, severe?

58
Q

abnl findings on palpation of abdomen

A
  • guarding
  • rebounding/rebound tenderness
  • rigidity
59
Q

guarding

A

involuntary contraction of anterior abdominal muscles, usually a sign of peritoneal irritation or inflammation

60
Q

rebounding/rebounding tenderness

A

also a sign of peritoneal irritation or inflammation

61
Q

rigidity

A

sign of severe issue, involuntary muscle contraction

62
Q

what could be a cause of suprapubic tenderness?

A
  • cystitis

- also, pelvic structures could normally be tender on palpation of RLQ and LLQ

63
Q

how should you accurately assess for hernias?

A

-examine w/ pt standing +/- valsalva

64
Q

what to document if abdominal wall hernia is found

A
  • size
  • if it easily reduced
  • overlying skin changes (indication of strangulation or incarceration )
65
Q

When do you palpate/percuss the kidneys?

A

after auscultating the posterior chest and before laying the pt down

66
Q

what could tenderness to first percussion of the CVA suggest?

A
  • renal inflammation
  • pyelonephritis
  • stones
  • so be gentle, kidney inflammation causes bad pain
67
Q

technique for palpation of masses

A
  • use 2 hands
  • have pt lift head
  • if floating, use ballottement technique
68
Q

when palpating for masses, what all do you need to determine?

A
  • size
  • shape
  • tenderness
  • location
  • consistency
  • mobility
  • is it midline and pulsatile?
69
Q

what could be confused for a mass in the LLQ?

A

poop

70
Q

murphy’s sign

A
  • deeply palpate RUQ
  • ask pt to take deep breath
  • if breath is abruptly stopped d/t pain, consider GB dz (positive murphy’s)
71
Q

liver edge

  • where measured
  • how to describe
A
  • measured in right mid-clavicular line
  • described by # of finger breadths it extends below costal margin
  • nl finding could be: liver edge not palpable or no hepatomegaly
72
Q

what is the preferred method of examination of the liver?

A

liver hooking technique

73
Q

what to palpate at LUQ?

A

spleen

74
Q

when is it possible to palpate the spleen?

A

never, unless there is a pathologic enlargement

75
Q

how to palpate for spleen

A
  • deeply palpate at LUQ at costal margin
  • have pt take deep breath (enlarged spleen may come forward)
  • can also apply posterior pressure to flank
  • nl: no spleen palpated
76
Q

how do document nl spleen palpation

A
  • no splenomegaly present

- no splenomegaly noted on palpation of the LUQ

77
Q

structures at RLQ

A
  • appendix
  • ileocecal valve
  • distal ileum
78
Q

tenderness at McBurney’s point indicates what?

A

appendicitis

79
Q

in what other conditions might the RLQ be tender?

A
  • IBD

- IBS

80
Q

where is McBurney’s point?

A

1/3 of the way between the ASIS and umbilicus

81
Q

what often causes LLQ tenderness?

A
  • diverticulitis

- colitis

82
Q

Rovsing’s sign

A

if deep palpation of LLQ produces referred pain in RLQ

83
Q

what is rovsing’s sign a sign of?

A

acute appendicitis

84
Q

what are the special tests for appendicitis?

A
  • psoas sign: flex hip against resistance and look for pain in RLQ
  • obturator sign: internally rotate right rip
  • heel jar test: “jar” heel w/ hand
85
Q

what are the special tests for ascites?

A
  • shifting dullness: fluid moves as you move the patient to side
  • fluid wave
86
Q

What would a note look for for PE of abdomen

A

The abdomen is soft and non-distended with normal contour, withtout visible scars, masses,, acites, or striae present. Normoactive bowel sounds in all 4 quadrants w/ no bruits (aortic, renal iliac, femoral) noted. The abdomen is non tender to palpation w/ no guarding, rebounding, masses, hepatosplenomegaly or CVA tenderness noted. The aortic pulse has normal width. No pelvic or suprapubic tenderness present

87
Q

what to consider with rectal exam

A
  • protect pts privacy, use drape
  • chaparone
  • lay pt on side
  • use lube
  • have guiac or hemoccult card ready before you begin
88
Q

how to position patient for rectal exam

A

left lateral decubitis

89
Q

what to inspect for during rectal exam

A
  • skin abnormalities (perianal candidiasis, condyloma)
  • external hemorrhoids, thrombosed?
  • fissure
  • prolapse
  • neoplastic lesions
  • polyps
  • fistula (Crohn’s)
  • abscess
90
Q

What to palpate for in rectal exam

A
  • masses/polyps
  • prostate if applicable
  • collect stool if hemoccult is needed
  • internal hemorrhoids
  • sphincter tone
91
Q

technique of rectal exam

A
  • use lube
  • apply gentle pressure w/ pad of finger onto anal opening
  • insert finger to examine entire canal
  • should be painless if pt is relaxed
  • ask pt to bare down or squeeze if need to check sphincter tone
92
Q

what causes visceral abdominal pain

A
  • noxious stimuli to visceral organs

- ischemia, stretch, distention, inflammtion

93
Q

how is visceral abdominal paint described?

A
  • many words used
  • belly ache, stomach ache, cramping, gnawing, burning, etc.
  • does NOT get worse by moving around
  • brain has difficult localizing the pain
  • happens early in dz (appendicitis)
94
Q

what is the cause of parietal (somatic) pain

A

-carried by somatic nerves and enters the spinal cord unilaterally
afferent receptors on the parietal surface

95
Q

description of parietal/somatic pain

A
  • sharply localized
  • peritoneal pain/peritonitis
  • easier to localize b/c it is unilaterally innervated
96
Q

What is the differential if pain is in the RUQ

A
  • biliary dz
  • hepatitis
  • renal colic
  • diverticulitis
97
Q

Differential if pain is in the epigastric region

A
  • MI
  • PUD
  • panreatitis
  • biliary dz
98
Q

differential if pain is in LUQ

A
  • splenic injury
  • renal colic
  • diverticulitis
99
Q

differential if pain is in RLQ

A
  • appendicitis
  • ovarian dz
  • PID
  • ruptured ectopic preg
100
Q

differential if pain is in the LLQ

A
  • ovarian dz
  • PID
  • ruptured ectopic preg
101
Q

differential if pain is in the umbilicus

A
  • IBD
  • bowel obstruction/ischemia
  • appendicitis
  • AAA
  • IBS
  • DKA
  • gastroenteritis
102
Q

review charts

A
  • slide 70: localization of pain
  • 71: notable causes
  • 72: “NOT” clues
  • 73: pain referral patterns
103
Q

duodenal ulcer pain

A
  • poorly localized to midline early b/c visceral
  • commonly awakens pt at night
  • made better by eating** and worse by fasting
  • “burning or gnawing”
  • worsed by ETOH and ASA
  • rarely refers to back
104
Q

acute cholecystitis

A
  • RUQ
  • almost always post-prandial**
  • often refers to scapula or right shoulder (phrenic)
105
Q

acute pancreatitis

A
  • poorly localized, usually above umbilicus/epigastrium
  • made worse by eating
  • commonly radiates straight through to mid back
  • associated w/ ETOH and n/v
106
Q

acute pancreatitis can be cause by gallstones obstructing what duct?

A

common bile duct

107
Q

acute appendicitis

A
  • can be in epigastrum or centrally if early
  • localized to RLQ (unless retrocecal)
  • ck for peritoneal signs like rebound tenderness
  • younger pts
  • ck for fever
  • rectal exam reveals tenderness to peritoneal pouches
108
Q

diverticulitis

A

usually felt as diffuse (visceral) lower abd pain

  • if perforation, pain becomes acutely severe w/ N/V
  • more localized pain if inflammation is transcolonic
  • MC in LLQ but possible in RLQ
  • can feel some relieve after defecation
  • stool changes: narrow, mucoid, small vol.
109
Q

renal colic

A
  • often begins in CVA
  • ipsilateral and SEVERE
  • commonly associated w/ stone
  • wavelike pain = colic
  • commonly radiates to testicle/vaginal area as stone moves
  • transureteral inflammation can feel like need to have BM
  • not effected by meals, vomiting common
  • pts are agitated, pacing or rocking

GI 1 (16 decks)

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