Phys Dx: Abdominal Exam Flashcards
When performing ROS for abdominal issues, what other systems should you include?
1 above, 1 below
cardiopulm
GU
GYN
a GI patient writhing in pain can indicate…
stone
a GI patient who is lying motionless to avoid pain may indicate…
peritonitis
protuberant abdomen and umbilicus
bulging flank
areas of tympany and dullness
This may indicate…
ascites, fluid in peritoneal cavity
bulging at the umbilicus often when coughing…
this indicates
umbilical hernia
most common post-op
bulging near previous incision site
incisional hernia
Midline ridge, obvious with neck flexion
separation of rectus abdominus muscles
Diastasis recti
an increase of peristaltic waves may indicate…
intestinal obstruction
abdominal ecchymosis is indicative of…
intraperitoneal/retroperitoneal hemorrhage
vertical striae on the abdomen can indicate…
cushings
prominent abdominal veins suggests…
portal hypertension and cirrhosis
Splenomegaly
esophageal varices
ascites
hepatic encephalopathy
These are all signs of…
cirrhosis of the liver
normal frequency for bowel sounds…
5-34/min
normal bowel sound character…
clicks and gurgles
borborygmi (stomach growling)
Altered/abnormal bowel sound character
high pitched tinkling
hyper/hypoactive
high pitched, tinkling bowel sounds can indicate…
early intestinal obstruction
hyperactive bowel sounds can indicate
early peritonitis
diarrhea/gastroenteritis
absent bowel sounds are concerning for…
ileus (ilium obstruction)
hyperactive bowel sounds progressing to hypoactive is concerning for…
peritonitis
4 common areas for bruits in abdominal exam…
aorta
renal arteries
iliac arteries
femoral arteries
a distended abdomen that is tympanic to percussion throughout is suggestive of
intestinal obstruction or paralytic ileus
protuberant abdomen w/ bulging flanks and dullness is suggestive of…
ascites
cirrhosis
hepatitis
alcoholic liver disease
abscess
hepatic tumor/cysts
hereditary condition
biliary disease
heart failure.
These are common causes of…
hepatomegaly
when the speen enlarges, where does it expand?
anterior, downward, medial
at what volume does dullness appear in the bladder?
400-600mL
TTP of the bladder may indicate
cystitis
is the bladder usually palpable?
no
distension of the bladder, ability to be palpated, indicates
urethral stricture, prostatic hyperplasia, neurogenic bladder
light palpation is assessing for
tenderness, guarding, rigidity
voluntary contraction of the abdominal wall to with palpation…
guarding
involuntary reflex contraction of abdominal wall muscles persistent over several examinations…
rigidity
purpose of deep palpation is to…
delineate pain
identify masses and organs
palpation of liver and spleen in respiratory cycle
A physiologic mass to deep abdominal palpation is…
pregnant uterus
an inflammatory mass on deep abdominal palpation is…
diverticulitis
a vascular mass on deep abdominal palpation is
AAA
an obstructive mass on deep abdominal palpation is
distended bladder or dilated loop of bowel
RUQ pain
radiates to right scapula
(+) murphy’s sign
acute cholecystitis
epigastric pain
radiates to back
boring pain, drill-like pain
acute pancreatitis
pain begins at umbilicus
migration to RLQ
(+) psoas, obturator, rovsing sign
acute appendicitis
LLQ pain
acute diverticulitis
(+) costovertebral angle tenderness
wraps from mid back to lateral abdomen
acute pylonephritis
acute, severe colicky flank pain
radiates to groin
nephrolithiasis
explosive, excruciating abdominal pain is concerning for…
biliary or renal colic
ruptured aneurysm or viscus
coronary occlusion
abnormal liver presentation
firmness
blunt edge
surface irregularity
congestive diseases (portal HTN, HF, splenic vein thrombosis
hematologic malignancies
Infx
These can cause…
splenomegaly
kidney enlargement is suggestive of…
hydronephrosis
cysts/tumors
polycystic kidney disease
an aorta of < _____ is normal
3cm
focal dilation of the aorta > 3 cm
men
over 65
hx of tobacco use
this is concerning for…
AAA
(+) Rebound tenderness, Guarding, Rigidity
may indicate…
peritoneal irritation
(+) Rovsing, psoas, obturator
may indicate
peritoneal irritation with suspected appendicitis
(+) Shifting dullness and fluid wave
may indicate…
ascites
(+) murphy sign
may indicate…
cholecystitis
(+) CVA tenderness
may indicate
kidney inflammation/pylonephritis
